Presumptive Eligibility is a process that allows qualified entities to determine if an individual can receive short-term Medicaid. It provides individuals with temporary Medicaid coverage while KanCare processes their application for Medicaid.
Facilities such as hospitals, clinics, health departments, schools, etc. can become a Qualified Entity. The facility will notify KDHE of its intention to make presumptive eligibility determinations by submitting a statement of interest. They agree to make presumptive eligibility determinations following KDHE policies and procedures. The qualified entity will assist individuals with the process of submitting the Medicaid application. During the medical application process, the qualified entity will help individuals understand and submit requested documents to KanCare. Qualified entities will be paid the Medicaid reimbursement rates while consumers are receiving Presumptive Eligibility Coverage.
To learn more about becoming a Qualified Entity, select the "Becoming a Qualified Entity" in the Links & Resources section below.
General Eligibility Requirements can be defined as specific conditions which must be met for a consumer to be eligible for medical benefits.
Qualified entities can make presumptive eligibility determinations for Pregnant Women, Children, Former Foster Care, Breast or Cervical Cancer (BCC) patients currently receiving treatment, parents, and other caretakers. These consumers must be a resident of Kansas, a U.S. Citizen, or eligible Non-Citizen, and meet income guidelines.
To learn more about General Eligibility Requirements, select the "PE Specialist Training Documents & Materials” in the Links & Resources section below.