Due to changes in federal legislation, children with SOBRA coverage are eligible for a continuous eligibility period. Essentially, since SOBRA is a limited coverage and only covers qualifying emergency services, what this means is that once a SOBRA child is initially approved on SOBRA coverage for an emergency medical service, they are automatically eligible to be reinstated on SOBRA coverage for a future date of service if they request SOBRA coverage again and have another qualifying emergency service within the next 12 months (even if they haven’t submitted an app). CE for SOBRA children doesn’t mean they get a full year of coverage; however, they do not need another KanCare application or new financial determination to receive SOBRA benefits if they have another qualifying emergency service in the same 12 months of receiving coverage.
What this means for staff is that when a child has a request for SOBRA for an approved emergency service, staff need to check to see if the child had a recent SOBRA approval within the past 12 months. If so, they need to reinstate that child on SOBRA coverage and approve them for the new dates of service. If they’re closed, they have to reapply them in order to reinstate them and fill out the other program assistance record and then run EDBC to approve them again.
Determine if a SOBRA approval determination has been completed for the child in the last 12 months.
If SOBRA coverage is approved, reapply the program block.
Follow the steps in the user manual to reapply. The first day of the request month may be used to register if a new application hasn't been received. See Reapply Program – Medical.
Add Other Program Assistance record for child and fill out the appropriate dates of service. See SOBRA – Family Medical.
Run EDBC to approve SOBRA coverage for emergency service dates. Continue running EDBC through the come-up month to discontinue coverage.
Ensure notices are correct.
Append verbiage from the SCP: {Name} will be eligible for coverage of any additional qualifying emergency medical services or treatments received from {first day of approval month} through {last day of 12 months following}. If additional emergency services are received during that time, please let us know.
Create a Journal using the following approved Journal language:
WA676 was used to continue SOBRA coverage for <consumer names>. Due to the CE rules for children's Medicaid, <consumer name> was eligible to apply for SOBRA services without an additional financial determination since they were approved SOBRA coverage within the last 12 months.