The Beacon explains how to check eligibility, apply for coverage and compare KanCare plans — and how long it might take to get a decision.
by Miranda Moore November 28, 2022
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Close window Xby Miranda Moore, Beacon: Kansas City
November 28, 2022
In any given month, about 450,000 Kansans rely on Medicaid to pay for health care. The program is paid for by the federal government with states providing a match and administering the program. As with any assistance program, it can be difficult to determine if you qualify. Who qualifies depends on many factors, only one of which is income.
In Kansas, adults who are not disabled, not elderly and without children are not eligible for Medicaid. Parents with children may be eligible if their family’s income is low enough. As an example, a single parent with two children would need income of less than $2,169 a month, or roughly $26,000 a year. Income limits go up for larger families and down for smaller ones.
People who do not qualify for Medicaid and do not receive health insurance may qualify for health insurance subsidized by the federal government through the Affordable Care Act – but not everyone. Because the Kansas Legislature has repeatedly refused to expand Medicaid, a coverage gap remains where as many as 45,000 people make too much to qualify for Medicaid but not enough to qualify for ACA plans.
To help uninsured Kansans determine whether they qualify for Medicaid, The Beacon has prepared a guide to answer some of the most frequently asked questions about the Medicaid program.
KanCare is how Kansans receive Medicaid, the federal government program that provides health care coverage to low-income people. KanCare was launched in 2013. There are three health plan providers — also called managed care organizations, or MCOs — that provide KanCare coverage to recipients. Those plans are managed by Aetna, Sunflower and UnitedHealthCare.Those who qualify for Medicaid may choose between these plans.
KanCare is also how Kansans receive CHIP, or the Children’s Health Insurance Program, which provides health insurance for children up to age 19 in families who earn too much to qualify for Medicaid. Adults over 19 without children may not receive benefits through CHIP. Participants in the CHIP program may pay a monthly premium up to $30.
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More information about these plans and programs can be found on the KanCare website.
Kansas residents who have low or very low income may be eligible for Medicaid benefits through KanCare if they are also:
A chart with the maximum allowed monthly income to qualify under different family situations is available on the KanCare website.
Kansans may also check their eligibility using an online self-assessment.
In April 2022, Kansas extended how long pregnant beneficiaries may continue Medicaid coverage after giving birth from two months to 12 months.
Kansans may apply for KanCare online at https://cssp.kees.ks.gov/apspssp/.
The application includes questions about members of the household, including their ages, household income and financial assets, along with questions about medical conditions like disabilities or pregnancy.
If applicants would like to see the entire application before filling it out online, full document versions of the application are available online as PDFs. Applicants may also print the form and submit it by mail. Families with children should fill out the KC-1100 form, while the elderly and disabled should fill out the KC-1500 form.
Applicants may receive a follow-up request to submit additional documents within a few days of submitting an application.
Kansas is one of 12 states that have not yet expanded Medicaid coverage eligibility. Each of Kansas’ neighboring states — Missouri, Oklahoma, Nebraska and Colorado — has expanded Medicaid eligibility.
In states that adopted Medicaid expansion under the Affordable Care Act, anyone with a household income under 138% of the federal poverty level may qualify for Medicaid benefits, regardless of age, disability or if there are children in the household. For a family of three, that would be roughly $32,000. It would also include adults without dependents or disabilities.
In states like Kansas where Medicaid expansion has not been adopted, the state sets the eligibility criteria, including income limits.
Applicants should hear back within 45 days of applying, though most should hear much sooner. If applicants haven’t heard anything within 45 days, they should call 1-800-792-4884.
If the application was denied because of an error, applicants should call 1-800-792-4884 to request a correction.
If the application was denied and there were no errors, or if the application was denied a second time after errors were corrected, applicants may appeal the decision. Hearings for appeals are processed by the Office of Administrative Hearings.
For those who are not eligible for Medicaid benefits under KanCare, plans offered under the Affordable Care Act provide rates subsidized through tax credits for those who earn an income at least equal to the federal poverty level (the federal government publishes those rates annually). Normally there is an income ceiling to qualify for ACA-subsidized plans, but under the American Rescue Plan, that ceiling is lifted through 2025.
However, for those who earn too little to qualify for subsidized plans, but do not qualify for Medicaid in Kansas — for example, adults without dependents or disabilities — there are not many options available. This is called a coverage gap, and it impacts around 45,000 Kansans.
Short of earning more money or moving to a state that has expanded Medicaid — both of which are easier said than done — Kansans in the gap may have the option of purchasing short-term health insurance, but that can be risky. Short-term health insurance is not regulated under the ACA, so it does not provide the same consumer protections that the ACA does. Things that must be covered under the ACA, like maternity care or preexisting conditions, are not required coverage under short-term health insurance plans.
Gov. Laura Kelly twice vetoed a bill that would have extended how long someone might be allowed to take out short-term health insurance. Kelly wrote in her veto that under these less-regulated insurance plans, families risked becoming bankrupt.
Uninsured Kansans have several options for receiving health care at a low or reduced cost. The KanCare Ombudsman prepared a list of clinics, prescription assistance programs, optometrists and dental services that provide care to those who are uninsured.
Community care clinics treat patients regardless of ability to pay. The Community Care Network of Kansas lists 86 community clinic locations across 41 counties in Kansas, including six in Johnson County, 19 in Sedgwick County and eight in Wyandotte County.
Some hospitals have programs that provide patients with financial assistance that would allow the hospital to write off all or some of a patient’s bill.
To reduce the cost of prescriptions for the uninsured, retailers and manufacturers often offer discounts on medication. Pharmacies statewide offer discounts on prescriptions via the Kansas Drug Card, which is free to join; it is not a government-affiliated program. RxAssist provides a searchable directory of patient assistance programs offered by drug manufacturers.
The KanCare Ombudsman is available to answer questions about the program. People with questions may call the KanCare ombudsman toll-free at 1-855-643-8180 or contact one of two satellite offices set up to assist beneficiaries. To contact the Johnson County office directly, beneficiaries may call 913-942-3161. For the Wichita office, beneficiaries may call 316-978-3567.
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