Updating income eligibility requirements for the state children's health insurance program.

Session of 2025
HOUSE BILL No. 2386
By Committee on Appropriations
Requested by Representative W. Carpenter
2-14
AN ACT concerning the state children's health insurance program; relating
to eligibility; updating income requirements therefor; amending K.S.A.
38-2001 and repealing the existing section.
Be it enacted by the Legislature of the State of Kansas:
Section 1. K.S.A. 38-2001 is hereby amended to read as follows: 38-
2001. (a) The department of health and environment shall develop and
submit a plan consistent with federal guidelines established under section
4901 of public law 105-33 (, 42 U.S.C. § 1397aa et seq.;, title XXI).
(b) The plan developed under subsection (a) shall be a capitated
managed care plan covering Kansas children from zero to 19 years which
of age that:
(1) Contains benefit levels at least equal to those for the early and
periodic screening, diagnosis and treatment program;
(2) provides for presumptive eligibility for children where applicable;
(3) provides continuous eligibility for 12 months once a formal
determination is made that a child is eligible subject to subsection (e);
(4) has performance based performance-based contracting with
measurable outcomes indicating age appropriate utilization of plan
services to include, including, but not limited to, such measurable services
as immunizations, vision, hearing and dental exams, emergency room
utilization, annual physical exams and asthma;
(5) shall use the same prior authorization standards and requirements
as used for health care services under medicaid to further the goal of
seamlessness of coverage between the two programs;
(6) shall provide targeted low-income children, as defined under
section 4901 of public law 105-33 ( , 42 U.S.C. § 1397aa, et seq. ),
coverage subject to appropriations; and
(7) shall provide coverage, subject to appropriation of funds and
eligibility requirements, for children residing in a household having a
gross household income (A) for 2009, at or under 225% of the 2008
federal poverty income guidelines and (B) for 2010 and subsequent years,
at or under 250% of the 2008 federal poverty income guidelines ;. The
participants receiving coverage shall contribute to the payment for such
coverage through a sliding-fee scale based upon ability to pay as
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established by rules and regulations of the secretary of health and
environment; and
(8) contains a provision which requires the newly enrolled
participants with a family income over 200% of the federal poverty
income guidelines to wait at least 8 months before participating in this
program, if such participants previously had comprehensive health benefit
coverage through an individual policy or a health benefit plan provided by
any health insurer as defined in K.S.A. 40-4602, and amendments thereto.
This waiting period provision shall not apply when the prior coverage
ended due to loss of employment other than the voluntary termination,
change to a new employer that does not provide an option for dependent
coverage, discontinuation of health benefits to all employees, expiration of
COBRA coverage period or any other situations where the prior coverage
ended due to reasons unrelated to the availability of this program.
(c) The secretary of health and environment is authorized to contract
with entities authorized to transact health insurance business in this state to
implement the health insurance coverage plan pursuant to subsection (a)
providing for several plan options to enrollees which are coordinated with
federal and state child health care programs, except that when contracting
to provide managed mental health care services the secretary of health and
environment shall assure that contracted entities demonstrate the ability to
provide a full array of mental health services in accordance with the early
and periodic screening, diagnosis and treatment plan. The secretary of
health and environment shall not develop a request for proposal process
which excludes community mental health centers from the opportunity to
bid for managed mental health care services.
(d) When developing and implementing the plan in subsection (a), the
secretary of health and environment to the extent authorized by law:
(1) Shall include provisions that encourage contracting insurers to
utilize and coordinate with existing community health care institutions and
providers;
(2) may work with public health care providers and other community
resources to provide educational programs promoting healthy lifestyles
and appropriate use of the plan's health services;
(3) shall plan for outreach and maximum enrollment of eligible
children through cooperation with local health departments, schools, child
care facilities and other community institutions and providers;
(4) shall provide for a simplified enrollment plan;
(5) shall provide cost sharing as allowed by law;
(6) shall not count the caring program for children, the Kansas health
insurance association plan or any charity health care plan as insurance
under subsection (e)(1);
(7) may provide for payment of health insurance premiums, including
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contributions to a health savings account if applicable, and, in conjunction
with an employer sponsored insurance premium assistance plan, may
provide that supplemental benefits be purchased outside of the capitated
managed care plan, if it is determined cost effective, taking into account
the number of children to be served and the benefits to be provided;
(8) may provide that prescription drugs, transportation services and
dental services are purchased outside of the capitated managed care plan to
improve the efficiency, accessibility and effectiveness of the program; and
(9) shall include a provision that requires any individual to be a
citizen or an alien lawfully admitted to the United States for purposes of
establishing eligibility for benefits under the plan and to present
satisfactory documentary evidence of citizenship or lawful admission of
the individual. The criteria for determining whether the documentation is
satisfactory shall be no more restrictive than the criteria used by the social
security administration to determine citizenship. A document issued by a
federally-recognized Indian tribe evidencing membership or enrollment in,
or affiliation with, such tribe, such as a tribal enrollment card or certificate
of degree of Indian blood shall be satisfactory documentary evidence of
citizenship or lawful admission.
(e) A child shall not be eligible for coverage and shall lose coverage
under the plan developed under subsection (a) of K.S.A. 38-2001, and
amendments thereto, if such child's family has not paid the enrollee's
applicable share of any premium due. If the family pays all of the
delinquent premiums owed during the year, such child will again be
eligible for coverage for the remaining months of the continuous eligibility
period.
(f) The plan developed under section 4901 of public law 105-33 (, 42
U.S.C. § 1397aa et seq., and amendments thereto) is not an entitlement
program. The availability of the plan benefits shall be subject to funds
appropriated. The secretary of health and environment shall not utilize
waiting lists, but shall monitor costs of the program and make necessary
adjustments to stay within the program's appropriations.
(g)(f) Eligibility and benefits under the plan prescribed by subsection
(b)(7) are not and shall not be construed to be entitlements, are for legal
residents of the state of Kansas and are subject to availability of state and
federal funds and to any state and federal requirements and the provisions
of appropriation acts. If the secretary of health and environment
determines that the available federal funds and the state funds appropriated
are insufficient to sustain coverage for the income eligibility levels
prescribed by subsection (b)(7), a lower income level shall be adopted and
implemented by the secretary of health and environment, within the limits
of appropriations available therefor, and all such changes shall be
published by the secretary of health and environment in the Kansas
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register.
Sec. 2. K.S.A. 38-2001 is hereby repealed.
Sec. 3. This act shall take effect and be in force from and after its
publication in the statute book.
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