Presumptive Eligibility

The State of Kansas Presumptive Eligibility Medicaid coverage allows health care providers to treat an individual who is not enrolled in the KanCare Medicaid program. It provides consumers with temporary medical coverage. In order to be found eligible, an individual must have an application submitted for them by a Certified PE worker during their stay at a Qualified Hospital or Clinic. Individuals will be notified immediately of their eligibility determination and must follow up their Presumptive Eligibility application with a KanCare application for full Medicaid coverage.

Eligibility Requirements

Consumers may be eligible for Medicaid under the Presumptive Eligibility program if they:

  1. Fall into one of these categories:
    • Pregnant Women with income up to 171% of the Federal Poverty Level (FPL)
    • Infants and Children under the age of 19 up to 232% of the FPL
    • Parents and Other Caretaker Relatives with income up to 38% of the FPL.
    • Former Kansas Foster Care Children ages 18-26
    • Breast and Cervical Cancer recipients diagnosed and currently receiving treatment through the Early Detection Works program
  2. Are a resident of Kansas
  3. Are a US citizen or an eligible non-citizen

Coverage

Individuals found eligible for KanCare Presumptive Eligibility (PE) will be able to receive all Medicaid services covered by KanCare. Exception: Pregnant women found eligible under PE are only able to receive prenatal outpatient ambulatory care related to the pregnancy. Coverage for PE will begin on the date an eligibility determination is completed and will end on the date a full Medicaid eligibility determination is made. If an individual does not file a full Medicaid application, the Presumptive Eligibility coverage will end on the last day of the month following the original determination.

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