Basic Eligibility Requirement for Health

Benefit Programs


DHCF offers medical assistance to help cover health care costs. We have three major plans for persons who qualify:

  • Medicaid - Our largest program. It covers low-income persons. These persons include pregnant women, children, persons with disabilities and senior citizens. We provide Medicaid through many special programs.
  • HealthWave 21 - Our Children’s Health Insurance Program. It covers children up to age 19 who don’t qualify for Medicaid.
  • MediKan - Our state-only program. It covers people who are trying to get Social Security disability benefits. These people also receive General Assistance cash payments.

Medical assistance covers persons who meet certain rules. Some rules apply to all groups. Other rules apply just to special groups. Most plans also have income or asset levels. Two groups also have premium payments. We have listed the general rules below. These rules apply to all groups.

Covered Groups:

Only members of certain groups may get medical assistance. If persons do not fall into one of these groups, they do not qualify. We have listed the groups here:

  • Children up to age 19; including those who are in foster care or who get adoption support payments
  • Pregnant Women
  • Persons who are blind or disabled by Social Security rules
  • Persons age 65 or older
  • Persons receiving inpatient treatment for tuberculosis
  • Low income families with children (people who qualify TAF cash assistance)
  • Persons screened and diagnosed with breast or cervical cancer through the Free to Know program

General Rules:

These rules apply to all medical plans

  • Kansas Residency - persons must live in Kansas or be temporarily absent
  • Citizenship and Immigrant Status - persons must be citizens or immigrants with a certain status. Some immigrants must wait 5 years before they can get coverage.
  • Household - The household is the group of people living with you. This group may impact your eligibility. If minor children need coverage, the parents are part of the household. If adults request coverage, the spouse is part of the household. Others who live with you are not part of your household. This includes friends or other relatives.
  • Other Health Insurance - If a person has other health insurance, they must use it first. Then we will pay for medical bills.
  • Coverage Date - Except for HealthWave 21, we usually base medical assistance on the month of application. Sometimes persons may receive coverage for three prior months.
  • Reviews -We review medical assistance each year. People must reapply for coverage. We mail the application form to the household.

Income Rules:

Every medical group has different income rules. The household’s income must be less than the income level for most groups. We look at earned income. This is the money you get from jobs. We also look at unearned income. This is the money you get from other sources like Social Security, child support, unemployment, VA or pensions. For persons with disabilities and the elderly, we give a credit for some work-related expenses. Please remember that we use the gross income (amount before taxes and other deductions).

Resources or Assets:

Resources are assets that you or someone in your household owns. Examples of resources are bank accounts, cars, property and stocks. Most plans for the elderly and persons with disabilities limit the amount of resources you may have. Plans for families and children do not have a limit on the amount of resources a household can own.

Other Rules:

In addition to the general rules, each group has its own set of rules. Persons must meet all of the general rules plus any rules for the plan they are applying for.

Medical Benefits:

All medical assistance plans provide prescription drugs, mental health services and medical (doctor) coverage. We also cover inpatient hospital, hearing, dental, and eye-wear coverage for most persons. A managed care network serves many families and children. We pay enrolled providers directly for the medically necessary services they perform.

Groups:

You may get more information on DHCF medical groups on these pages. Choose from the following options:

Children and Families (DCF)

  • Coverage for pregnant women
  • Coverage for low income families with children
  • Coverage for children (including poverty level and HealthWave)
  • Medically Needy (spenddown)
  • SOBRA (emergency program for immigrants)

Elderly and Persons with Disabilities (DCF)

  • Nursing Facility Coverage
  • Home and Community Based Services
  • Medicare Savings Plans
  • Coverage for breast and cervical cancer
  • Working Healthy
  • Medically Needy (spenddown)
  • MediKan program
  • SOBRA (emergency program for immigrants)