Kansas Medical Assistance

Overview of Programs for Elderly
and Persons with Disabilities

9/2008

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Many medical programs are available to assist the elderly and persons with disabilities. These programs are for people 65 or older or for those who meet Social Security's disability rules. There are several general rules that must be met to quality for these programs, including state residency and citizenship. Each program may also have its own requirements. These programs can be a great financial help to those who are eligible.

The general rules for all medical program are found on the General Medical Assistance pages for the Kansas Health Policy Authority. Also on these pages is information on income, resources and assets that are counted. Most plans have asset limits. Some assets may not be counted, including the home where you live, one car, some burial plans, furniture, and household items. Assets that are counted are bank accounts, most life insurance policies, stock and bonds.

The estate recovery program recovers assets from some estates. Funds are recovered from the estates of certain deceased Medicaid consumers. This may include estates of persons age 55 or older. It also may include estates of persons who received long term care services. Estate recovery does not recover funds for Medicare Cost Sharing Plan. See the Estate Recovery fact sheet for more information.

The cost of the Medicare Part B premium is paid for most people who qualify for Medicare medical coverage. Prescription drug expenses through Medicare Part D are also covered through Medicare Part D Subsidy.

Medical programs and their requirements for the elderly and disabled include:

SSI Recipients: Supplemental Security Income (SSI) is a Social Security program. This program provides cash to help meet basic needs for food, clothing and shelter. Seniors age 65 and older and those with disabilities who have little or no income may qualify.

Those who receive SSI benefits usually qualify for medical assistance. Children who are disabled also may receive SSI. Applying for SSI is a simple process. Proof of any health insurance in needed.

Medicare Cost Savings Plans: These plans pay Medicare out-of-pocket expenses. This includes premiums and co-payments. A single person must have assets below $4000. A couple must have assets below $6000. There are three different savings plan programs:

Working Healthy: This program offers medical assistance to working people with disabilities. It is for those ages 16-64. Its income and asset limits are higher than other programs. A single person’s monthly income must be below $2600. A couple’s monthly income must be below $3500. Only half of the money counts toward the limit. The asset limit is $15,000. Some must pay a premium. Premiums start at $55.00 per month.

Medically Needy or Spenddown: Those with higher income may qualify for Medically Needy coverage. This program is for the elderly or disabled, pregnant women, or children under 19. Single persons must have less than $2000 in assets. Couples must have less than $3000 in assets. There is no asset limit for pregnant women and children.

A spenddown works like an insurance deductible. A person must pay their own medical costs equal to the spenddown amount before Medicaid will pay. When a person meets their spenddown, Medicaid will pay the remaining amount. The spenddown is usually figured for a six-month base period. The person’s income is used to figure their spenddown amount. Any person with income over $495 will have a spenddown. Spenddown amounts are different for each person. For more information about spenddowns, go to the Spenddown fact sheet.

MediKan: This plan is for those with disabilities. Most who qualify have a pending application for SSI with Social Security. They may receive MediKan for 2 years. MediKan has limited services. These services include prescription drugs and medical. People must receive General Assistance to get MediKan.

SOBRA: This plan is for those who do not meet citizenship rules. It covers life-threatening emergency care costs and baby deliveries only. The program may also cover families with children, elders, and persons with disabilities. Persons must meet income and asset rules to qualify.

Breast and Cervical Cancer: This plan is for women with breast or cervical cancer. The Early Detection Works program must diagnose the condition. The Early Detection Works program offers a free breast and cervical cancer screening to some women ages 40-65. For information on the Early Detection Works program, call toll free: 1-877-277-1368. A nurse with the Early Detection Works program will help women apply for the program.

Inpatient Tuberculosis Care: This plan only covers tuberculosis treatment in a hospital setting. There are very few rules for this group.

Nursing Facility Coverage: This program is for those in a nursing home or similar facility. The person must have assets below $2000. The value of their home will not be counted if the person intends to return home. Money or property cannot be given away to qualify. Assets may not be sold or transferred to others. A penalty may be assessed for doing this. SRS will look at all asset transfers within the past 5 years.

There usually is not an income limit for nursing home care. The person’s monthly income is used to find their share of the nursing home costs. The patient may keep $60 a month for personal needs. They may also keep enough to pay private health insurance. The rest of their income is applied to their nursing home costs. Medicaid pays the remaining nursing home costs. Those in nursing home care will also get a medical card. This card helps with prescription drugs and other medical expenses.

There are special rules for married persons in a nursing facility. These rules are referred to as Division of Assets or Spousal Impoverishment. For more information about these rules, go to the Division of Assets fact sheet. Please review the Kansas Department on Aging fact sheet for frequently asked questions and answers on this topic.

Home and Community Based Services (HCBS): This program offers services in the community instead of in the nursing home. HCBS is much like nursing home health care coverage. Participants must have a medical need for the special care. There must be an open space in the HCBS program. The asset limit is $2000 for singles. Usually, those receiving HCBS must also share in the cost of their care. Those with income more than $747 a month help pay for care. People on HCBS also get a case manager. The case manager oversees the medical care.

Program of All-Inclusive Care for the Elderly (PACE): This is a program for persons ages 55 and older who live in Sedwick County (Wichita). This program provides long term care through a managed care network. This only covers the medical expenses from providers in the managed care network. For people living in their homes, the HCBS rules apply. For people who move to a nursing facility, the nursing facility rules apply.

For more information about these programs call or visit the nearest SRS office. To find the Social and Rehabilitation Services Office or an Access Point nearest you, click on the Locations link at the top or bottom of this page.

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