2611 Medicaid

The Medicaid program is divided into two segments, the "categorically needy" and the "medically needy."

Categorically Needy - Those persons who are eligible for a cash benefit under the SSI program or who meet Family Medical guidelines comprise a good portion of the categorically needy. Children and pregnant women who, although ineligible for cash assistance, have incomes that fall below certain poverty level guidelines also are classified within this group. The categorically needy receive medical assistance either because their income falls within defined income guidelines or as a result of SSI eligibility. Within the categorically needy segment are also those persons who are "deemed" to be receiving an SSI cash benefit. This would include persons who qualify for 1619*b) status under the SSI program benefits because they are working but who retain disability. Coverage of the categorically needy is largely mandated by federal law with some limited options within each individual group. The categorically needy consists of both mandatory populations and optional populations. When determining eligibility, mandatory categories take precedent over optional categories of coverage. Mandatory Groups - As a condition of receiving federal funds, certain groups must be covered under the Medicaid plan. These groups include: Persons meeting Caretaker Medical criteria whose countable income does not exceed 38% of the Federal Poverty Level. SSI recipients, including those deemed to be receiving SSI. Pregnant women and children under the age of 1 whose countable income does not exceed 171% of the federal poverty level. Children ages 1 through 5 whose countable income does not exceed 149% of the federal poverty level. Children ages 6 through 18 whose countable income does not exceed 133% of the federal poverty level. Children receiving federally funded foster care or adoption support payments. Persons eligible for restricted coverage under the Qualified Medicare Beneficiary program (QMB), any of the Low Income Medicare Beneficiary (LMB) programs, or Qualified Working Disabled (QWD) program. Special protected groups such as the Pickle Amendment, Disabled Adult Children, etc. Non-citizens meeting all eligibility criteria for any Medicaid program except for the citizenship/alienage provisions, under SOBRA. Young Adults ages 18-26 who have aged out of Foster Care (were in Foster Care the month of their 18th birthday). Presumptive Eligibility for children, Caretaker Medical, Pregnant Women, Breast and Cervical Cancer, Foster Care - aged out. Persons meeting TransMed and Extended Medical criteria. Optional Groups - Kansas has elected to cover the following optional groups under the Medicaid plan: Persons receiving services under the State's home-and-community based services (HCBS) waiver or Program of All - Inclusive Care for the Elderly (PACE) and certain NF residents. Children who do not meet the age criteria of the poverty level programs reflected above and who are financially eligible for Family Medical. (This primarily includes children who receive only state-funded foster care or adoption support payments.) Children under the age of 21 in long term institutional settings or between the ages of 19 and 22 and in the HCBS/SED waiver. Persons with disabilities between the ages of 16 and 64 with earned income under the Working Healthy program. Persons diagnosed with and receiving treatment for breast & cervical cancer.

Medically Needy - The medically needy segment is comprised of those persons, who while meeting the non-financial criteria of one of the categorically needy programs such as age or disability, do not qualify because of excess income or resources or, in the case of pregnant women and children, have income which exceeds the poverty level guidelines of either Poverty Level Programs or CHIP. Most persons in the medically needy group are obligated for a share of their medical costs through the "spenddown" process. Coverage of this group is optional under federal law. If a state chooses this option, it must cover pregnant women (including coverage of the 12-month postpartum period) and children. Kansas provides coverage for the following groups: Pregnant women Children up to age 18 or age 18 and not acting on their own behalf Persons 65 years of age and older Persons who are disabled or blind under SSA standards.