2690 Other Covered Groups - This section sets forth eligibility guidelines related to other groups of persons who may qualify for medical assistance.
2691 Emergency Service Coverage for Non-Citizens -"See Policy Memo #00-12-03 re: "Access to Benefits for Qualifying and Non-qualifying Aliens and Their Families".
Non-citizens who are not documented or do not meet the qualifying categories specified in 2140, may receive medical coverage for an emergency if provided they would otherwise qualify for any Medicaid program (including those found in the Kansas Family Medical Assistance Manual, see 2600), except for alienage status. Persons admitted in the country for temporary purposes, such as foreign students, visitors, tourists and diplomats may meet state residency requirements if they intend to reside within the state. See 2150.
Eligibility exists under this section only if a person has experienced an approved emergency medical condition. The emergency service must be required after the sudden onset of a medical condition (including labor and delivery) manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in:
When determining if the emergency criteria are met, an analysis of the medical condition as well as the location in which treatment was provided are completed. Only the SOBRA program manager in the Kansas Health Policy Authority or designated fiscal agent staff may determine if an allowable emergency has occurred. The MS-2156 form shall be used to capture information pertaining to the condition in order to make this determination. The completed MS-2156 and required supporting documentation, obtained from the provider shall be sent to the fiscal agent for a decision. An MS-2156 is required to be submitted for every alleged emergency, except labor and delivery. For women requesting assistance only for labor and delivery resulting in a live birth, eligibility may be determined without an MS-2156. Verification of a live birth is required. Payment for services other than labor and delivery requires a completed MS-2156 with information regarding the medical reason for the services. Where an MS-2156 is required, action to approve or deny eligibility is not taken until a medical determination is rendered. An MS-2156 is not required for persons who fail to meet other eligibility criteria. Eligibility can be granted for more than one emergency. Coverage is limited for individuals eligible under the SOBRA coverage group to only the emergency service. No other services shall be covered.
NOTE: If a subsequent emergency occurs, a new MS-2156 must be obtained and evaluated as described above.It must be sent to the fiscal agent for review as well. This is true even if the emergencies occur in the same month.
The general eligibility requirements of 2100 and subsections must be met except for the SSN requirements of 2130 and the alienage provisions of 2140. In addition, eligibility shall be based on the appropriate medical program (e.g., poverty level for children and pregnant woman meeting poverty guidelines, MA for dependent children, MS for disabled persons, Family Medical, etc.). Although coverage is restricted to meeting a specific emergency and no further ongoing medical eligibility will be permitted, eligibility shall be determined under normal procedures including the appropriate base period rules. (See 7330.) In addition, the spenddown provisions of 7530 (2) are also applicable except for poverty level eligibles. Care must be taken to ensure eligibility is properly displayed in MMIS.
The case is to be closed as rapidly as possible due to the time-limited nature of the coverage and is not to remain open through the entire base period. Should eligibility be determined under a 6 month base and the client again requires emergency services later in that base, eligibility is to be redetermined using the same 6 month base. If spenddown was met with the previous emergency and there are no other changes in circumstances, the client would be eligible.
2692 Mandated TB Care - Individuals diagnosed as tubercular and are found in need of treatment for this condition by the Tuberculosis Control and Prevention staff at the Kansas Department of Health and Environment (KDHE) are eligible for limited medical assistance coverage. Coverage is limited to inpatient hospital care or necessary alternative community based care as approved KDHE. Only those services deemed necessary on the care plan developed by KDHE and approved by DCF Medical Policy staff are covered. KDHE and local health department staff are responsible for ensuring the care plan is cost effective. No other services or items, such as prescription and physician services are covered.
Eligibility is solely based on a TB diagnosis and an approved care plan from KDHE. No further eligibility requirements must be met including financial, SSN and citizenship/alienage. Persons must be screened for Medicaid coverage prior to approval for TB-Only coverage. If eligible for full coverage Medicaid, persons must enroll in Medicaid. Persons receiving Medically Needy coverage may receive TB coverage in addition to MN. See 1411.3 (3) for application process.
Medical coverage shall be authorized for the period approved by KDHE only. The MS program on KAECSES is used along with a Special Medical Indicator (PICK code) of TB. If coverage is authorized for a period exceeding 6 months, a new application is not necessary but the continued need for coverage must be confirmed with KDHE TB program staff.
All applications for TB coverage are processed by the TB Eligibility Specialist in the KanCare Clearinghouse. Persons requesting coverage are referred to KDHE.
FFP is not available for any services provided under the TB only program. A monthly medical card will be issued to each participant, but coverage is limited as explained above.