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4.4.4.1.

Coverage provided to children in families at or below 200% FPL: describe the methods of monitoring substitution.

The joint Medicaid/KCHIP application process determines whether the applicant has been or is covered under group health benefit plan, and if coverage was terminated in the past six months, why. A person will be ineligible for the KCHIP Medicaid expansion or separate insurance program for targeted low income children if they have group health insurance coverage. If a person has had group health insurance coverage in the prior six month time period, with exceptions noted below, this person is ineligible for the KCHIP separate insurance program, but would be eligible for the Medicaid expansion program. The state will annually evaluate the responses to the question about health insurance coverage other than Medicaid.

The application process will also determine whether the applicant currently has group or individual comprehensive health coverage and will deem the child ineligible if he/she has such coverage. Under the separate insurance program, an application may be approved in cases where coverage ended less than six months prior to determination of eligibility for KCHIP, if the coverage was terminated for reasons beyond the parent’s control, such as:

1. Loss of employment, 2. Death of a parent, 3. Divorce, where children’s coverage had been provided by a non-parental adult, 4. Change of employment, 5. Change of address so that no employer-sponsored coverage is available, 6. Discontinuation of health benefits to all employees of the applicants employer, 7. Expiration of the coverage periods established by the Consolidates Omnibus Budget Reconciliation Act (COBRA) of 1985 (P.L. 99-272), as amended from time to time, 8. Self-employment, and 9. Termination of health benefits due to a long term disability.

This information will be by declaration under penalty of perjury, with selective verification with the family’s employers if necessary.

During the initial enrollment process and annual recertification process, income will be cross-referenced with other programs which require income verification.

4.4.4.2.

Coverage provided to children in families over 200% and up to 250% FPL: describe how substitution is monitored and identify specific strategies to limit substitution if levels become unacceptable.

4.4.4.3.

Coverage provided to children in families above 250% FPL: describe how substitution is monitored and identify specific strategies in place to prevent substitution.