Medicaid, SCHIP, and Federal Authority²

In September 2006, Kansas received approval from CMS to establish a benchmark benefit for its Working Healthy Ticket to Work Medicaid Buy-In program.  The benchmark benefit was approved as a state plan amendment under DRA authority. Working Healthy provides working individuals with disabilities who have incomes below 300 percent FPL the State Plan Medicaid coverage, in addition to the following benefits: Personal assistance services, which can be self-directed or agency directed, including a "Cash and Counseling" model; Assessment to determine personal assistance and related service needs; Independent living counseling; and Assistive services.

High-Risk Pool    

The Kansas Health Insurance Association (KHIA) offers health benefits for residents who are unable to purchase coverage in the private market for a pre-existing condition, who qualify for HIPAA protections or COBRA rights, who have been quoted a rate higher than the KHIA rate, or who have exhausted health coverage.

KHIA premium rates are set to be self-sustaining, but the insurance industry may be assessed to cover pool losses. As of the end June 2006, approximately 1,700 individuals were enrolled in the program.

Group Purchasing Arrangements  

In 2001, Kansas implemented a small employer pooling mechanism called the Kansas Business Health Partnership. The pool, a non-profit organization, purchases coverage via the private market with the goals of employee choice, minimized administrative costs, and benefits that meet standards of federal and state law. The original legislation would have made subsidies available for low-income workers to purchase health insurance through the partnership, but budget difficulties delayed the subsidy. In 2005, the Kansas Legislature authorized $500,000 for subsidies.

The original partnership has been dissolved and will be reorganized under the leadership of the Kansas Business Health Policy Committee (BHPC). The BHPC has issued an RFP for carrier participation. Two carriers bid for the pilot program through a bid process that closed April 28, 2006.  Efforts are now being weighed to pursue alternative sources of additional funding.

Other

MediKan - MediKan is health program that covers adults with disabilities who do not qualify for Medicaid, but are eligible for services under the State's General Assistance program. MediKan provides limited benefits to adults whose applications for federal disability are being reviewed by the Social Security Administration. Health benefits include the provision of medical care in acute situations and during catastrophic illness.

Overall, the scope of services covered by MediKan is similar to that covered by Medicaid, but a number of restrictions and limitations apply. A majority of the individuals who qualify for MediKan are in the process of applying to the federal Supplemental Security Income (SSI) program. After these individuals qualify for SSI, they will transfer to the Medicaid program.

Notes and Sources

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