Kan. Admin. Regs. § 28-4-413 - Financial eligibility
(a)
(1) The uniform standard for determining
eligibility shall be the annual margin as calculated in paragraph (2). If the
annual margin is zero or below, the person shall be eligible for financial
assistance under the hemophilia program. If the annual margin is above zero,
the person shall not be eligible for financial assistance, except as provided
in subsections (d) and (e). The factors to be utilized in calculating the
annual margin shall be the following items:
(A) the family income;
(B) cash assets ;
(C) family living allowance;
(D) anticipated specialized health care
expenditures for the eligible person and other family members; and
(E) the benefits available under health
insurance coverage for the eligible person .
(2) The annual margin shall be calculated by
the following method:
(A) add the amount of
the family income to the amount of cash assets above the maximum allowed under
subsection (c); and
(B) subtract
from the total of paragraph (a)(2)(A) the following:
(i) The family living allowance as determined
in subsection (b); and
(ii) The
amount of the anticipated health care expenditures for the person that will not
be paid by the person 's health insurance coverage.
(b) The family living
allowance shall be 185 percent of the poverty guidelines updated annually in
the federal register by the U.S. department of health and human services under
the authority of section 673(2) of the omnibus reconciliation act of 1981,
effective July 1 following the publication.
(c) The maximum cash assets allowed for a
family shall be 15 percent of the family living allowance.
(d) If within 12 months after application the
family spends down the annual margin to zero or below per subsection (e)
through the family 's actual or obligated expenditures for medical care for any
family member, the person shall be, at that time, financially eligible for
assistance for the remainder of the 12-month period. These expenditures shall
be in addition to any expenditure or reimbursement made by health insurance
carrier or other third-party payor.
(e) In order to spend the annual margin down
to zero, the family shall agree to pay the following expenses:
(1) medical expenses and travel expenses
related to medical treatment , or health support services, supplies or
equipment; or
(2) a portion of
actual or anticipated medical expenses, and travel expenses related to medical
treatment or a portion of health support services, supplies or equipment as
documented in the health care plan .
Notes
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