Kentucky Medicaid Eligibility

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1 Kentucky Medicaid Eligibility Cabinet for Health and Family Services Department for Medicaid Services Division of Member Services Eligibility Policy Branch

2 Medicare vs. Medicaid Medicare Title XVIII of the Social Security Act Uses Federal money Coverage and eligibility is the same all over the U.S. Medicaid Title XIX of the Social Security Act Uses Federal and State money Coverage and eligibility vary from State to State

3 DMS/DCBS Partnership The Department for Medicaid Services (DMS) is the single state agency responsible for the administration of the Medical Assistance Program authorized by the Social Security Act. DMS contracts the Department for Community Based Services (DCBS) to determine Medicaid eligibility.

4 Medicaid Application Process Supplemental Security Income (SSI) recipients - An application for SSI is also an application for Medicaid. Non SSI recipients DCBS determines Medicaid eligibility.

5 Non-DCBS applications There are 2 Medicaid groups whose eligibility is not determined by DCBS staff: Presumptive Eligibility for Pregnant Women - Qualified providers use a web-based application to approve coverage for pregnant women who appear to be Medicaid eligible. Breast and Cervical Cancer Treatment Program - Health Departments use a web-based application to approve uninsured women who have been screened for breast or cervical cancer and who require treatment.

6 Who May Apply? At the DCBS office, an authorized representative may file an application for any needy individual. An authorized representative may be: The payee of the applicant. The spouse of the applicant. The parent or legal guardian of a dependent child. The Power of Attorney (with documentation). An interested party; however, a Form MAP-14 is necessary if none of the above apply.

7 Categories of Assistance Applicants must be a member of an eligible group with limited income and resources. Family MA Children under 19 years old Caretaker relative of a child who is deprived of parental support Pregnant Women Adult MA Aged (65 or older) Blind Totally and Permanently Disabled.

8 Family MA Technical Requirements Must be a US citizen or qualified alien Must verify identity Must be resident of Kentucky Must have SSN or apply if needed Must comply with Third Party Liability Child must be deprived of parental support due to: Death of parent Involuntary absence Voluntary absence Incapacity Unemployment/underemployment

9 Adult MA Technical Requirements Must be a US citizen or qualified alien Must verify identity Must be resident of Kentucky Must have SSN or apply if needed Must comply with Third Party Liability (TPL) Must be aged (65 or over); blind; or totally and permanently disabled.

10 Categories of Assistance (2) Kentucky Children s Health Insurance Program Must be uninsured KCHIP 1 & 2 Must be under age 19 with income below 150% FPL Must be uninsured KCHIP 3 Must be under age 19 with income below 200% FPL Will be subject to premium payment. Ineligible for EPSDT and Non-Emergency Medical transportation Applications can be made in the DCBS office or by filing out an on-line application and sending to DCBS.

11 Categories of Assistance (3) Medicare Savings Program (MSP) Provides assistance to Medicare recipients by paying for Part A and B premiums. There are 3 levels: QMB income limit of 100% FPL. Assistance includes help with co-payments, co-insurances and deductibles. SLMB income limit of 120%. Pays premiums only. QI1 income limit of 135%. Pays premiums only. Applications can be made in the DCBS office or by filing out an on-line application and sending to DCBS.

12 TIME-LIMITED ALIENS Any alien, legal, illegal or legalized who, does not meet the qualified alien requirements for ongoing Medicaid, may be eligible for time-limited Medicaid due to an emergency medical condition. The alien must still meet the technical and financial requirements, with the exception of enumeration. Time-limited Medicaid coverage includes the first day of the month in which the emergency medical condition begins and continues through the following month. The normal delivery of a baby is considered an emergency and a covered service. An extension for time-limited Medicaid may be requested if the emergency medical condition continues.

13 Reference Member Services Call Center or To locate the phone number for the local DCBS office: https://apps.chfs.ky.gov/office_phone/index.aspx. KCHIP Mail in applications can be found at: MSP Mail in applications can be found at:

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