Kentucky Medicaid Eligibility - Kymmis.com

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

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

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

Reference
Member Services Call Center 800-635-2570 or e-mail
MS.Services@ky.gov.
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:
http://kidshealth.ky.gov.
MSP Mail in applications can be found at:
http://chfs/ky.gov/dms/Eligibility.htm.