Health Insurance for Low-Income
The Kansas Department of Health and Environment (KDHE) and Division of Health Care Finance (DHCF) offer medical assistance to help cover healthcare costs. In January 2013, the state of Kansas rolled out the KanCare program to provide Medicaid services to over 360,000 individuals across the state. Kansas contracts with three health plans, or managed care organizations (MCOs), to manage healthcare for nearly all Medicaid recipients. The KanCare health plans are Amerigroup of Kansas, Inc. (Amerigroup), Sunflower State Health Plan (Sunflower), and UnitedHealthcare Community Plan of Kansas (United).
At the point of approval for KanCare, an individual must choose an MCO. Once a year during your open enrollment, you may choose to switch to a different MCO. Your yearly open enrollment is during the month you first enrolled in the program. All Home and Community Based Services (HCBS) are a part of KanCare. The MCOs are required to manage all types of care for you. This is accomplished by providing the right care, in the right amount, in the right setting, at the right time. The focus of the MCO is to make sure you receive the preventive services and screenings you need as well as ongoing help with managing chronic conditions.
Kansas Medicaid Plan Options
KanCare under the Medicaid plan
Kansas’ largest Medicaid program covers people with limited income. It may include pregnant women, children, persons with disabilities and senior citizens. We provide Medicaid through various special programs. The income standards vary depending on the age of the child.
KanCare under the CHIP plan
Kansas’ Children’s Health Insurance Program covers children up to age 19 who don’t qualify for Medicaid. The income standards vary depending on the age of the child. If a child doesn’t qualify for Medicaid (which has lower income levels), they are screened for CHIP. The CHIP program is based on 225% of the Federal Poverty Level.
Medical Coverage for Parents or Caregivers of Children
This program is available to families with children. There must be children in the home under the age of 19. This program may cover the children and their parents who live together. Or, if the children are living with other relatives or legal guardians, this program may cover the children and the other relatives or legal guardians.
Medical Coverage for Pregnant Woman
This program provides medical coverage for pregnant women. To be eligible, you must be a Kansas resident with the intent to stay in Kansas.
Supplemental Security Income (SSI) is a cash program from Social Security that helps meet the basic needs for food, clothing, and shelter. It is for people with little or no income. It is for seniors age 65 and older. It is also for persons with disabilities. People who receive SSI benefits normally qualify for medical assistance. Children who are disabled also may receive SSI.
Medicare Costing Savings programs
The purpose of Medicare Costing Savings programs is to assist individuals in paying their Medicare premiums and by making payments to medical providers for coinsurance and deductibles for Medicare services; or Medicare Part B premiums only. The Qualified Medicare Beneficiary (QMB) program pays for Medicare Part B premiums, coinsurance, and deductibles for eligible persons enrolled in Medicare Part A. The Specified Low Medicare Beneficiary (SLMB) program provides payment of Medicare Part B premiums only for individuals who would be eligible for the QMB program except for excess income.
Qualified Working Disabled (QWD)
This program is for individuals that lose Medicare Part A due to work. If a single person’s income is below $1,805, this program may pay the premium. The Working Healthy program offers medical assistance to employed persons with disabilities. It is for persons ages 16-64. Its income and asset limits are higher than other programs. Some individuals must pay a premium. Premiums start at $55 per month.
Medically Needy Spenddown
The Medically Needy program offers coverage to individuals that have income over the maximum allowable income standard. The Spenddown amount is their share of their family’s medical bills. The Spenddown amount is similar to an insurance deductible. Once the Spenddown amount (deductible) is met, Medicaid will pay any medical bills over that amount. A Spenddown can be set for individuals such as pregnant women, children under age 19, seniors age 65 or older, or persons determined disabled by Social Security.
This plan is for individuals with disabilities. Most individuals have a pending application with Social Security for disability. Patients may receive MediKan for 12 months. MediKan has limited services. Services do include prescription drugs and medical. People must receive General Assistance to receive MediKan.
This plan is for individuals that do not meet citizenship rules. It covers life-threatening emergency care costs and baby deliveries only. The program may also cover families with children, seniors, and persons with disabilities. Individuals must meet income and asset rules to qualify.
Breast and Cervical Cancer
This plan covers treatment for individuals with breast or cervical cancer. The Early Detection Works program must diagnose the condition. The Early Detection Works program provides a free breast and cervical cancer screening to some women ages 40-65.
Inpatient Tuberculosis Care
This plan only covers tuberculosis treatment in a hospital setting.
Nursing Facility Coverage
Nursing Facility coverage is for individuals in a nursing home or similar facility. Single persons must have assets below $2,000. The value of the home is not counted, provided the person intends to return home. There generally is not an income limit for nursing home care. We use the person’s monthly income to fund their share of the nursing home costs. There are special rules for married persons in a nursing facility called Division of Assets or Spousal Impoverishment.
Home and Community Based Services (HCBS)
HCBS offers services in the community rather than in a nursing home. HCBS is much like nursing home healthcare coverage. Patients must have a medical need for the special care. There must be an open space in the HCBS program. The asset limit is $2,000 for single patients. People on HCBS must also share in the cost of care. Persons with income more than $727 a month help pay for their care.
Program of All-Inclusive Care for the Elderly (PACE)
This is a program for people ages 55 and older. To qualify, individuals must live in Sedgwick, Douglas, Jackson, Jefferson, Osage, Pottawatomie, Shawnee, and Wabaunsee Counties. PACE provides long-term care through a managed care network. It only covers medical expenses from providers in the managed care network. For people living in the community, the HCBS rules apply. For people who move to a nursing facility, the nursing facility rules apply.
Frail Elderly (FE) Program
The Home and Community Based Services Frail Elderly (FE) program provide an option for seniors that receive Medicaid and qualify functionally to receive community-based services as an alternative to nursing facility care. The program promotes independence within the community and helps to offer residency in the most integrated environment.
Services are provided to children diagnosed with Autism, Asperger’s Syndrome, or Pervasive Developmental Disorder (not otherwise specified) until their sixth birthday. Autism services are limited to three years, however, an additional year may be submitted for approval.
Intellectual/Developmentally Disabled (I/DD) Program
The Home and Community Based Services Intellectual/Developmentally Disabled (I/DD) program provide services to individuals age 5 and older that meet the definition of intellectual disability, having a developmental disability or are eligible for care in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID).
Physically Disabled (PD) Program
The Physical Disabilities Program provides services to individuals from the age of 16 to 65 that meet the criteria for nursing facility placement due to their physical disability, are determined disabled by social security standards, and are Medicaid eligible.
Serious Emotional Disturbance (SED) Waiver
The term “serious emotional disturbance” (SED) is defined as a diagnosed mental health condition that substantially disrupts a child's ability to function socially, academically, and/or emotionally. The SED waiver provides services to children from age 4 to 18 that experience serious emotional disturbance and are at risk of inpatient psychiatric treatment. SED waiver services provide children with special intensive support so they may remain in their homes and communities. Both parents and children are actively involved in planning for all services. The SED waiver is a federal Medicaid waiver program. Local Community Mental Health Centers provide services covered by the program. Children that meet the eligibility requirements will receive a medical card and are eligible for Medicaid physical and behavioral health services.
Technology Assisted (TA) Program
The TA Program serves individuals between ages 0 through 21 that are chronically ill or medically fragile and dependent on a ventilator or medical device to compensate for the loss of vital bodily function. Individuals require substantial and ongoing daily care by a nurse similar to the level of care provided in a hospital setting, or another qualified caregiver under the supervision of a nurse in order to avert death or further disability; or an individual that is hospitalized or at imminent risk of hospitalization, whose illness or disability, in the absence of home care services, would require admission to a hospital.
Traumatic Brain Injury (TBI) Program
The HCBS/TBI program is for individuals that have sustained a traumatic brain injury. It provides services needed after an injury to ensure that individuals can remain safely in their homes and be as independent as possible. The HCBS/TBI program serves individuals from age 16 to 65 that would otherwise require institutionalization in a TBI Rehabilitation Facility.
Kansas Medicaid FAQs
- What is Medicaid?
Medicaid is a state funded insurance that that provides coverage to low-income families, pregnant women, newborns, and children that may not be able to afford to purchase their own care.
- Who is eligible for Medicaid?
The following groups are eligible for Medicaid in Kansas:
- Children 0 - 12 months with a household income below 166% of the Federal Poverty Level (FPL);
- Children 1 - 5 with a household income below 149% of the FPL;
- Children 6 - 18 with a household income below 133% of the FPL;
- Parents with a household income below 33% of the FPL
- How do I find out if I am eligible for Medicaid?
To find out if you are eligible for Medicaid, you must fill out an application for Medicaid or CHIP. You may fill out an application at any time of the year. See more on Medicaid.
- Will Medicaid cover my children?
Your household income level will determine if your child or children can be covered by Medicaid.
- What is CHIP?
CHIP is a program that supports children in families that cannot afford private health insurance, but whose household income is too high to qualify for Medicaid.
- Does Medicaid satisfy the health insurance requirement?
Yes, Medicaid will satisfy the Affordable Care Act (Obamacare) health insurance requirement for the covered individuals.
- What information and documents should I have when I'm signing up for Medicaid?
Depending on the Medicaid program being applied for, you will need the following: Identity, Social Security, proof you live in Kansas, proof of income, proof of medical costs, and bank account information.
- How does Obamacare work with Medicaid?
Because of Kansas's Medicaid eligibility requirements, Obamacare does not impact people who qualify for Medicaid and vice versa. As such, tax credits are only available for people who are not eligible for other plans.
- What is KanCare?
KanCare is the Medicaid option for pregnant women, newborns, and children in Kansas. This is the program that provides the majority of the coverage for Kansas residents that qualify for Medicaid.