Current through Register Vol. 50, No. 9, March 1, 2024
RELATES TO:
KRS
205.520,
42 C.F.R.
435.150
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
Family Services, Department for Medicaid Services has responsibility to
administer the Medicaid Program.
KRS
205.520(3) authorizes the
cabinet, by administrative regulation, to comply with any requirement that may
be imposed or opportunity presented by federal law to qualify for federal
Medicaid funds. This administrative regulation establishes the Medicaid
eligibility provisions and requirements for an individual between the age of
nineteen (19) and under twenty-six (26) years, who formerly was in foster care,
or an out-of-state equivalent to foster care, and was receiving Medicaid
benefits at the time that the individual aged out of foster care, or the
out-of-state equivalent.
Section 1.
Former Foster Care Eligibility Criteria. An individual between the age of
nineteen (19) and under twenty-six (26) years, who formerly was in foster care,
or an out-of-state equivalent to foster care, and was receiving Medicaid
benefits at the time the individual's age exceeded the foster care, or
out-of-state equivalent, age limit shall be eligible for Medicaid benefits if
the individual meets the requirements of this administrative
regulation.
Section 2. Income
Standard. There shall be no income standard for individuals between the age of
nineteen (19) and under twenty-six (26) years and who formerly were in foster
care, or an out-of-state equivalent to foster care, but aged out of foster care
or the out-of-state equivalent.
Section
3. Resource Standard. There shall be no resource standard for
individuals between the age of nineteen (19) and under twenty-six (26) years
and who formerly were in foster care, or an out-of-state equivalent to foster
care, but aged out of foster care or the out-of-state equivalent.
Section 4. Attestation of Having Aged Out of
Foster Care.
(1) An individual between the age
of nineteen (19) and under twenty-six (26) years, who formerly was in foster
care, or an out-of-state equivalent to foster care, and was receiving Medicaid
benefits at the time the individual's age exceeded the foster care, or
out-of-state equivalent to foster care, age limit shall attest, during the
application process, that the individual was receiving Medicaid benefits at the
time that the individual reached the age which exceeded the foster care, or
out-of-state equivalent to foster care, age limit.
(2) An individual who does not attest as
established in subsection (1) of this section shall not be eligible for
Medicaid benefits under this administrative regulation.
Section 5. Citizenship and Residency
Requirements.
(1) The citizenship requirements
established in 42 C.F.R.
435.406 shall apply.
(2) To satisfy the Medicaid:
(a) Citizenship requirements, an applicant or
recipient shall be:
1. A citizen of the United
States as verified through satisfactory documentary evidence of citizenship or
nationality presented during initial application or if a current recipient,
upon next redetermination of continued eligibility;
2. A qualified alien who entered the United
States before August 22, 1996, and is:
a.
Lawfully admitted for permanent residence pursuant to
8 U.S.C.
1101;
b. Granted asylum pursuant to
8 U.S.C.
1158;
c. A refugee admitted to the United States
pursuant to 8 U.S.C.
1157;
d. Paroled into the United States pursuant to
8 U.S.C.
1182(d)(5) for a period of
at least one (1) year;
e. An alien
whose deportation is being withheld pursuant to
8 U.S.C.
1253(h), as in effect prior
to April 1, 1997, or 8 U.S.C.
1231(b)(3);
f. Granted conditional entry pursuant to
8 U.S.C.
1153(a)(7), as in effect
prior to April 1, 1980;
g. An alien
who is granted status as a Cuban or Haitian entrant pursuant to
8 U.S.C.
1522;
h. A battered alien pursuant to
8 U.S.C.
1641(c);
i. A veteran pursuant to
38 U.S.C.
101,
107,
1101, or
1301 with a discharge
characterized as an honorable discharge and not on account of
alienage;
j. On active duty other
than active duty for training in the Armed Forces of the United States and who
fulfills the minimum active duty service requirements established in
38 U.S.C.
5303A(d);
k. The spouse or unmarried dependent child of
an individual described in clause i. or j. of this subparagraph or the
unremarried surviving spouse of an individual described in clause i. or j. of
this subparagraph if the marriage fulfills the requirements established in
38 U.S.C.
1304; or
l. An Amerasian immigrant pursuant to
8 U.S.C.
1612(a)(2)(A)(v);
or
3. A qualified alien
who entered the United States on or after August 22, 1996 and is:
a. Granted asylum pursuant to
8 U.S.C.
1158;
b. A refugee admitted to the United States
pursuant to 8 U.S.C.
1157;
c. An alien whose deportation is being
withheld pursuant to 8 U.S.C.
1253(h), as in effect prior
to April 1, 1997, or 8 U.S.C.
1231(b)(3);
d. An alien who is granted status as a Cuban
or Haitian entrant pursuant to
8 U.S.C.
1522;
e. A veteran pursuant to
38 U.S.C.
101,
107,
1101, or
1301 with a discharge
characterized as an honorable discharge and not on account of
alienage;
f. On active duty other
than active duty for training in the Armed Forces of the United States and who
fulfils the minimum active duty service requirements established in
38 U.S.C.
5303A(d);
g. The spouse or unmarried dependent child of
an individual described in clause e. or f. of this subparagraph or the
unremarried surviving spouse of an individual described in clause e. or f. of
this subparagraph if the marriage fulfills the requirements established in
38 U.S.C.
1304;
h. An Amerasian immigrant pursuant to
8 U.S.C.
1612(a)(2)(A)(v);
or
i. An individual lawfully
admitted for permanent residence pursuant to
8 U.S.C.
1101 who has earned forty (40) quarters of
Social Security coverage; and
(b) Residency requirements, the applicant or
recipient shall be a resident of Kentucky who meets the conditions for
determining state residency pursuant to
42 C.F.R.
435.403.
Section 6. Provision of Social Security
Numbers.
(1) Except as provided in subsections
(2) and (3) of this section, an applicant for or recipient of Medicaid shall
provide a Social Security number as a condition of eligibility.
(2) An individual shall not be denied
eligibility or discontinued from eligibility due to a delay in receipt of a
Social Security number from the United States Social Security Administration if
appropriate application for the number has been made.
(3) An individual who refuses to obtain a
Social Security number due to a well-established religious objection shall not
be required to provide a Social Security number as a condition of
eligibility.
Section 7.
Institutional Status.
(1) An individual shall
not be eligible for Medicaid if the individual is a:
(a) Resident or inmate of a nonmedical public
institution except as established in subsection (2) of this section;
(b) Patient in a mental hospital or
psychiatric facility unless the individual is:
1. Under age twenty-one (21) years of age;
or
2. Under age twenty-two (22) if
the individual was receiving inpatient services on his or her 21st birthday;
or
(c) Patient in a
nursing facility classified by the Medicaid program as an institution for
mental diseases.
(2) An
inmate shall be eligible for Medicaid during the period of time the inmate is
admitted to a hospital if the inmate:
(a) Has
been admitted to a hospital;
(b)
Has been an inpatient at the hospital for at least twenty-four (24) consecutive
hours; and
(c) Meets the Medicaid
eligibility criteria established in this administrative regulation.
Section 8. Application
Process, Initial and Continuing Eligibility Determination.
(1) An individual may apply for Medicaid
benefits by:
(a) Using the Web site located at
www.kynect.ky.gov;
(b) Applying over the telephone by calling:
1. 1-855- 459-6328; or
2. 1-855-326-4654 if deaf or hearing
impaired;
(c) Faxing an
application to 1-502-573-2007;
(d)
Mailing a paper application to Office of Health Benefits Exchange, 275 E. Main
St., 4W-E, Frankfort, Kentucky 40602; or
(e) Going to the applicant's local Department
for Community Based Services Office and applying in person.
(2) An individual shall attest in
accordance with Section 4 of this administrative regulation when applying for
Medicaid benefits.
(3)
(a) An application shall be processed
(approved, denied, or a request for additional information sent) by the
department or other entity involved in processing the given application within
forty-five (45) days of application submittal.
(b) If a trusted source indicates that an
applicant is incarcerated, a request for additional information shall be
generated by the department or other entity involved in processing the
application requesting verification of the applicant's incarceration dates or
status.
(c) If an applicant fails
to provide information in response to a request for additional information
within forty-five (45) days of the receipt of the request, the application
shall be denied.
Section
9. Continuous Eligibility for Children.
(1) An individual who is between the age of
nineteen (19) and under twenty-six (26) who aged out of foster care, or an
out-of-state equivalent to foster care, while receiving Medicaid coverage shall
receive continuous eligibility, consistent with
42 C.F.R.
435.926.
(2) The continuous eligibility period for an
individual who is between the age of nineteen (19) and under twenty-six (26)
who aged out of foster care, or an out-of-state equivalent to foster care,
while receiving Medicaid coverage recipient shall be for a period of twelve
(12) months.
(3) The eligibility
during a continuous eligibility period of an individual who is between the age
of nineteen (19) and under twenty-six (26) who aged out of foster care, or an
out-of-state equivalent to foster care, while receiving Medicaid coverage shall
only be terminated under the following circumstances:
(a) The individual becomes older than twenty
(26) during the continuous eligibility period;
(b) The individual voluntarily requests that
the eligibility be terminated;
(c)
The individual ceases to be a resident of the Commonwealth;
(d) The agency determines that the
eligibility was granted due to:
1. Agency
error; or
2. Fraud, abuse, or
perjury attributed to the individual; or
(e) The death of the individual.
Section 10. Adverse
Action, Notice, and Appeals. The adverse action, notice, and appeals provisions
established in
907 KAR 20:060 shall apply to
former foster care, or out-of-state equivalent, individuals between the age of
nineteen (19) and under twenty-six (26) who aged out of foster care, or an
out-of-state equivalent to foster care, while receiving Medicaid
coverage.
STATUTORY AUTHORITY:
KRS
194A.010(1),
194A.030(2),
194A.050(1),
205.520(3),
42 U.S.C.
1396a(a)(10)(A)(i)(IX).