Kansas State Medicaid Requirements Analysis

Step One

1. Question 1

Compared to the federal minimum requirements, Kansas State considers a lesser group of persons. Kansas State eligible persons include children, pregnant women, seniors and disabled and adult parents/caregivers (Kansas Department of Health and Environment, 2021). The federal government categorically needs eligibility requirements; however, it goes beyond the Kansas state Medicaid eligibility requirements by further considering other persons like illegal aliens and former WV foster children (WV Income Maintenance Manual, 2013). However, the Kansas state Medicaid requirements are less stringent with the federal state minimum requirements for the categorically needy, stipulating the following mandatory requirements: those who are disabled, as well as other groups, must be receiving SSI, but Kansas state requirements do not stipulate SSI qualification or registration as a mandatory requirement (Kansas Department of Health and Environment, 2021).

2. Question 2

Yes, Kansas state Medicaid eligibility includes the medically needy category, even though there is a stipulation on the maximum amount of income and assets at the individual and couple levels, that is: For income, individuals should have an income limit of $475, and couples should have an income limit of $475. As for assets, individuals are expected to have a limit of $2000 (State Health Facts, 2018).  In this case, the medically needy category also considers individuals with hefty medical and whose income surpasses the maximum limit for the individual and couple asset and income limits highlighted above, but who would nonetheless be still eligible for Medicaid based on federal stipulations (State Health Facts, 2018). Kansas is among the 34 states with medically needy provisions for their Medicaid program (State Health Facts, 2018).

3. Question 3

Those newly eligible for Medicaid have some form of disability but are not yet 65 years of age. According to Kansas state Medicaid stipulations, the aged and people with disabilities are considered as different groups, and this means that the newly eligible are covered based on the requirements for Medicaid for those who are disabled. Kansas State also provides the newly eligible based on them needing long-term care in a nursing home or various rehabilitation institutions. Typically, the maximum monthly income expected of a newly eligible is $1,441 for a one-person household (Kansas Department of Health and Environment, 2021). Nevertheless, there are some exclusions; for instance, a single person who is disabled but can work may be considered for Medicaid with a monthly wage as high as $3,189 (Kansas Department of Health and Environment, 2021). For most persons under this category, Kansas additionally imposes a boundary on countable assets. Countable assets include things like stocks, bank accounts, different vehicles, and life insurance. However, the state often might not consider an individual's primary home, household items, and one car. The limit for asset value for a single person is typical $2,000, but persons working with a disability might be enabled to achieve up to $15,000 in assets (Kansas Department of Health and Environment, 2021). 

4. Question 4

As part of Kansas State Medicaid Eligibility provisions, those who have qualified for Medicaid are also eligible for KanCare that provides health care insurance for children through KanCare to those who have qualified and are aged below 19. KanCare is accessible additionally for children in Kansas who are eligible for either Children's Health Insurance Program (CHIP). For families in some wage groups, monthly premiums that range between $20 and $50 for every family apply (Kansas Medicaid Eligibility and Enrollment, 2021). KanCare is typically a program in Kansas State through which the state administration provides Medicaid. KanCare comprises a joint effort between the state, Amerigroup, Sunflower, and United. Children who are considered infants (1-5 years) are eligible if their household income is less than 149% of the Federal Poverty Level, $2,141 for a two-person household (Kansas Medicaid Eligibility and Enrollment, 2021). However, children aged between 6 and 18 are eligible if their household income is less than 113% of the Federal Poverty Level, $1,624 for a two-person household. Children aged 19 may be eligible for a KanCare CHIP plan with a household earning that does not exceed 232% of the Federal Poverty Level. With the CHIP plan, the families of beneficiaries' children should pay a monthly premium of between $20 and $50 (Kansas Medicaid Eligibility and Enrollment, 2021). 

5. Question 5

The National Conference of State Legislatures (2017) explains that in Kansas State, green card holders or permanent resident immigrants qualify for CHIP and Medicaid, but on the condition that they have stayed there for a minimum period of 5 years, and on the same foundation as U.S. citizens. Immigrants also have to meet all the other requirements of the Medicaid program (National Conference of State Legislatures, 2017). Unauthorized immigrants, nevertheless unqualified to receive any form of Kansas health insurance programs, can only qualify for more discrete programs such as the emergency medical assistance under Medicaid in hospitals that state qualified health centres. The Kansas State has provisions for immigrants founded on the Affordable Care Act (ACA) program that has instituted a marketplace healthcare provision to U.S citizens with an extension of eligibility to legal immigrant populations living in the U.S (National Conference of State Legislatures, 2017).

Step Two

1. Question 1

According to Kansas Medicaid requirements, Stanislaus is eligible for the Medicaid program since he has a medical condition that makes him fall into the disabled. He might, however, qualify as newly eligible if he is below the age of 65 as per the Kansas State Medicaid requirements. Concerning this, the Kansas Department of Health and Environment (2021), KanCare, a Medicaid program, can also be applied in conjunction with Medicaid benefits, thereby including benefits like long-term care and nursing home care—Stanislaus thus stands also to receive these benefits.

2. Question 2

No, even though Peter has other eligibility requirements for Kansas State Medicaid Coverage based on the fact that he is of the age of 19 years and above, works, and is a U.S citizen, his monthly wage is above the stipulated $475 per month that the Kansas Medicaid Program requires. According to the American Council of Aging (2021), for Kansas Medicaid eligibility purposes, all income that a person applying for Medicaid receives is considered in the approval process. This income includes income from employment, as well as income from any other sources, for instance, Veteran’s benefits, income from friends and family, Railroad Retirement benefits, annuity payments, alimony payments, pension payments, Social Security Disability Income (SSDI), IRA withdrawals, Social Security Income (SSI), and stock dividends. In the case of Peter, he received money from employment, his employment at the fast-food restaurant and this is, therefore, considered in evaluating his eligibility for Medicaid. According to the American Council of Aging (2021), if Peter were nevertheless a beneficiary of the COVID-19 stimulus, the benefits would have been exempted from the considerations on his application. The American Council of Aging (2021) also reveals that the maximum salary requirement for Kansas Medicaid is very low, which justifies why seniors who receive SSI payments routinely qualify for Medicaid in the state, as it is with the federal SSI and Medicaid stipulations.  

3. Question 3

Based on the citizenship status of Maria as an undocumented immigrant, she is not eligible for Kansas Medicaid. According to a Program Review of Emergency Health Care for Undocumented Persons (2009) for undocumented people, Kansas State Medicaid provisions might only be applied if there is a need for life-threatening emergency health care services or delivery or labour services for women expectant. SOBRA (The Sixth Omnibus Budget Reconciliation Act) instituted in 1986 by Congress makes provisions for these services for all the states, in this case, Kansas, that offer Medicaid (Program Review of Emergency Health Care for Undocumented Persons, 2009).  In Kansas, eligibility for SOBRA is via SRS (Social and Rehabilitative Services). If the medical emergency relates to delivery and labour, the care staff can validate SOBRA eligibility. However, suppose a crisis is not in line with delivery or labour. In that case, those providing SOBRA services in Kansas State will receive a form to fill out and forward the record to a Medicaid Electronic Data Systems Manager or Medicaid fiscal agent who receive this request and ask for the opinion of a SOBRA program manager who will ultimately either deny or approve eligibility. There were 576 requests in 2007 for delivery and non-labour medical cases, but 295 such claims were also rejected (Program Review of Emergency Health Care for Undocumented Persons, 2009). The principal limit to running this program is the dependable application of the state description of emergency services. Even though this is a worry, the review of SOBRA every quarter for claims for errors with payment indicates a current error rate that is not more than 1%. The Kansas SOBRA 2007 expenditures for close to 6,000 claims were about $10 M (Program Review of Emergency Health Care for Undocumented Persons, 2009). More than $7 M from this amount was paid for delivery and labour services, with the balance of $3 M releases for fatal emergency services like trauma, tracheotomies, and coronary events. The expenses for FY 09 were projected at $10-$12 million (Program Review of Emergency Health Care for Undocumented Persons, 2009).

4. Question 4

Given that children born in the U.S from both undocumented immigrants and U.S citizens are considered U.S citizens, both Peter and Maria's children will be eligible for the Kansas health care programs like KanCare. KanCare is administered under the provisions of Medicaid and varies in prerequisite for children aged 1-5, 5-18 and those aged 19 years. According to Shah (2019), Kancare, also known as State Children Health Insurance Program (SCHIP), provides low-cost and, most importantly, affordable health insurance to uninsured children and U.S citizens living in Kansas. Children of low-income parents may additionally be considered eligible for this health insurance. To receive KanCare, since it is a Medicaid run program, applicants are cross-examined for Medicaid qualifications to identify the funding source. This ensures that you are also informed of all the medical bills that you are eligible to (Shah, 2019). According to Shah (2019), to qualify for the Kansas KanCare program, one has to be below the age of 18 years of age or be a primary caregiver with one or more children, be a U.S. National, Citizen, or a Non-Citizen lawfully admitted into North America, and finally and most importantly be uninsured (and unqualified for Medicaid). Despite this KanCare health program, however, Shah (2019) reveals that ½ (52.7%) of Kansas children enrolled in the program live in the most populated counties (like Johnson, Douglas, Sedgwick, Wyandotte, and Shawnee), disadvantaging children that are born in less crowded cities.

Nevertheless, the percentage of children enrolled in the program are high in the southwest regions and southeast. Shah (2019) also reveals that a projected 37,982 children in Kansas were 2017 uninsured by KanCare, and when 67% of them (25,436) qualify for the program. Finally, Shah (2019) explains that several Kansas counties recorded considerably high rates of uninsured people amongst children who are likely eligible for the program, a statistic even over the statewide rate of only 7.2%.

 

5. Question 5

As in the case of Stanislaus, through the KanCare, which is a Medicaid program also be applied in conjunction with Medicaid benefits, Elzbieta is eligible for benefits like long-term care and nursing home care (Kansas Department of Health and Environment, 2021). According to Bruffett & Huang (2017), since the previous edition of their 2014 report in the Medicaid system has maintained a state of operation and development as KanCare—the state’s wide-ranging run care program which justifies why it has developed and as new state regulations concerning the administration of the program have been released. The inmplication of this is that Stanislaus has to be ready for more adjustment to the KanCare following the continued amendment of the Affordable Care Act (ACA). These amendments have so far influenced healthcare costs in Kansas, although Kansas has not lengthened its Medicaid program to entail adults up to 138 % of the federal poverty level (FPL), as the ACA permits (Kansas Department of Health and Environment, 2021).

Step Three

1. Question 1

Stanislaus is eligible for the KanCare medical aid, which is a program under Medicaid in Kansas State that offers long term care service to patients with a disability like in the case of Stanislaus, who has a heart condition that requires long term care for management (Kansas Department of Health and Environment, 2021). According to Kansas Department of Health and Environment (2021) for KanCare, enrollees are eligible to enroll like Stanislaus are allotted to 1 of 3 managed care organizations (MCOs).These MCOs are sent monthly reimbursements from the state founded upon the number of persons who have enrolled and historical costs linked with the several population groups. The reimbursement however, exposes the MCOs at risk for the care cost for their members, and to make sure that those enrolled to KanCare get services that assist then minimize the cost over time by refining their quality of life and health, these MCOs are incentivized (Kansas Department of Health and Environment, 2021). The Kansas State’s agreements with MCOs necessitate them to provide services formerly accessible via Medicaid, including well-child visits, prenatal care, preventive services, medication, nursing facility care, in-home care, hospital care, and community-based services. The MCOs additionally have to make sure that services are accessible statewide and at Medicaid-necessary levels. The organizations might offer extra services not conventionally insured by Medicaid to assist avert institutionalization or hospital admissions (Kansas Department of Health and Environment, 2021).

2. Question 2

Peter, despite not being qualified for Medicaid as his monthly wage is way above the maximum $475 stipulated for an individual under the Kansas Medicaid program. Stanislaus, however, has a chance to try enrollment for SSI that considers income levels, as explained by Shah (2019).  However, Peter has to be informed that according to the federal benefit rate, the income limit for SSI as of 2021 is $794 monthly for an individual and $1,191 monthly for a couple (Shah, 2019). SSI also considers both income from employment and from other sources of income for example gifts from friends and family.

3. Question 3

According to the Program Review of Emergency Health Care for Undocumented Persons (2009) and founded on Maria is an undocumented immigrant in the U.S, through the SOBRA program, Maria is eligible for emergency medical services related to delivery and labor. As opposed to many other states, Kansas does not have an age restriction for the beneficiaries of their SOBRA program. In other states like Alabama, these benefits can only be availed to children aged 18 years and below and in some cases, even as low as 6 years and below only (Program Review of Emergency Health Care for Undocumented Persons, 2009). As an immigrant in the U.S who is undocumented, Maria is thus still covered.

4. Question 4

Since as seen earlier, both Maria and Peter’s children qualify as U.S citizens, which qualifies them for Kansas State Medicaid under the requirement that they are children, disabled, and U.S citizens, then they are eligible to KanCare program and also other Kansas Medicaid benefits that relate to disability support like long term care (Kansas Department of Health and Environment, 2021). The conditions they have (potential ADHD, need for eyeglasses, and earaches) require long term care, hence the importance of these benefits.

5. Question 5

Given Elzbieta’s hip dislocation and the need for nursing home placement, she is eligible for KanCare as a disabled person who requires long-term care and nursing home care. Kansas State residents who have disabilities, additionally like Elzibieta, also qualify for Medicaid. This category entails person also that need long-term care in a nursing home or health care facility. Usually, the monthly maximum wage for a one-person household stands at $1,414 (Kansas Medicaid Eligibility and Enrollment, 2021). Nevertheless, there are some exemptions, like in a single person who is disabled but can work like in the case of Elzibieta, they are eligible for Medicaid with a monthly wage high as $3,189. For most persons in this category, Kansas State additionally imposes a limit on countable assets. This implies that Elzibieta's Kansas Medicaid will be dependent on her income and countable assets. Countable assets entail stocks, like bank accounts, different vehicles, and life insurance. However, the state often exempts people's one car, primary home, and household items. The maximum countable asset Kansas Medicaid requirement for a single person is normally $2,000, but those working with a disability might be allowed up to $15,000 worth of maximum countable assets (Kansas Medicaid Eligibility and Enrollment, 2021). Elzibieta, therefore also needs to take consideration.

Long-term care services that Elzibiet might attain entail services offered by home and community-based services (HCBS) and adult care homes. According to Bruffett & Huang (2017), these services accounted for close to 39% of total reimbursements MCOs arrived at on behalf of their members in the 2016 state fiscal year. Nursing services that Elzibieta is eligible for include nursing facilities and intermediate care facilities—however, take note that this does not include state hospitals (Bruffett & Huang, 2017).

According to Bruffett & Huang (2017), Elzibiet is also eligible for the Working Healthy program that provides Medicaid coverage to persons between 16 and 64 with disabilities if she can work or decides to work in her state. Resource and income limits however apply. Nevertheless, these are higher in comparison to other Medicaid programs. Persons in the Work Healthy program also have to remit a premium for medical services, which is dependent on their income. The program covered around 1,200 persons averagely per month in the 2016 Kansas State financial year and cost the state close to $6 million. Cumulative costs, plus the federal share, were close to $15 million (Bruffett & Huang, 2017).