Kansas Economic and Employment Services Manual

2000 General Eligibility

10-17

2640 MediKan - MediKan is a state only funded medical assistance program for adults who meet the following eligibility criteria.

2641 General Eligibility Requirements - The general eligibility criteria of act in own behalf (2110), cooperation (2120), SSN (2130), citizenship and alienage (2140), and residency (2150) must be met. The assistance planning rules of 4310 are also applicable. Persons convicted of medical assistance fraud per 11221 (5) are not eligible.

2642 Age - The MediKan program is limited to adults age 18 to 64.

2643 Other Assistance - MediKan coverage is not available to an individual who is entitled to SSA disability or SSI benefits, or who is eligible for or receiving Medicaid assistance.

2644 Disability - MediKan eligibility is dependent upon meeting disability criteria. All mandatory filing unit members of the family group must be included in the assistance plan in accordance with 4310. The mandatory filing unit shall consist of either a single individual or a married couple living together. Assistance shall be limited to those individuals meeting the Tier II disability level as defined in KEESM 2662(3)

For a married couple living together, both spouses must meet the disability criteria. If one spouse is Tier II, and the other spouse is Tier I (or already meets SSA disability criteria, or is 65 or older), the Tier II spouse may qualify for MediKan while the other spouse may be eligible for Medicaid. If only one spouse is Tier II and the other spouse is not disabled (or 65 or older), there is no MediKan eligibility for either spouse.

2645 Time Limited - Assistance under the MediKan program shall be limited to a fixed 12 month coverage period beginning with the first eligible month. Once established, the coverage period continues to run even if the individual becomes otherwise ineligible (ie: excess income or resources, moved out of state, marries a non-disabled person). There is no MediKan eligibility after the expiration of this period. If only one spouse has reached the limit, the other spouse is not eligible while living together.

2646 Reintegration Program - Reintegration is a special MediKan coverage program that has been established to provide time-limited medical assistance to eligible adults being discharged from Medicaid approved psychiatric hospitals or released from the Larned Correctional Mental Health Facility Central Unit or from the Larned State Security Program.

1. An approved discharge plan shall be established for each individual and must include:
   
   
   1. Submission to the PMDT a copy of the ES-3903, Presumptive Medical Disability Determination Questionnaire;
      
      
   2. One copy of the ES-3904, HIPAA compliant Authorization to Disclose Information to KDHE-DHCF; and
      
      
   3. A completed ES-3901, Presumptive Medical Disability Team Referral
      
      
2. Eligibility under this process shall be based on the patient's reported income, resources and other information contained on the completed application form, including the client's living arrangement following discharge. If the client is in need and is not obviously ineligible for some other program factor, eligibility shall be approved.
   
   To help facilitate the Reintegration discharge process, a resident may have medical assistance coverage administratively reinstated without an application if discharged within a previously established 12 month review period.
   
   A medical card shall be available to the client at the end of discharge.
   
   
3. If the person being discharged is returning to live with his or her spouse or is going directly into a nursing facility or other institutional setting (other than specialized living arrangements), there is no eligibility for MediKan coverage. Persons eligible for SSI, including those in a suspended status, but who have not received benefits at the time of release, are eligible for MediKan in the interim period prior to receipt of the initial or reinstated SSI benefits.
   
   
4. Because a complete eligibility determination has not been completed, assistance under the Reintegration program is limited to the month of discharge and the two following months. In most instances the full medical eligibility determination should be completed by the second month following the month of discharge. In rare situations, the time limitation can be extended for good cause (e.g., presumptive eligibility could continue as long as the client is cooperating in providing required information in order for the agency to make a final eligibility determination).
   
   
5. Coverage months under the Reintegration program do not count against the 12 month lifetime MediKan coverage period (2645). Nor does Reintegration approval start the fixed coverage period for regular MediKan. As long as all eligibility requirements are met, there is no limit on the number of times Reintegration may be approved.