Healthcare Coverage
Review public and private insurance options for Kansans with disabilities, including coverage for children, adults, and individuals eligible for Medicaid or Medicare-related supports.
Education | Social Security | Employment | Healthcare & Medicaid | Caregiver | HCBS Waivers | Basic Needs | Decisions | Resources
This section will cover the following:
Want to jump to a specific section? Click any of sub-categories below:
Every section includes:
✓ Overview ✓ Eligibility. ✓ How to Apply. ✓ Helpful Resources
Access to healthcare coverage is essential for individuals with disabilities to maintain health, receive necessary treatments, and live as independently as possible. Kansans with disabilities have multiple options for coverage, including private insurance, employer-sponsored plans, military programs, Medicaid (KanCare), Medicare, and specialized state programs like EPSDT, CHIP, and the Special Health Care Needs (SHCN) program. Each program has different eligibility requirements, benefits, and application processes, making it important for individuals and families to understand their options. This section provides an overview of these programs, helping Kansans with disabilities and their families navigate coverage, access critical medical services, and make informed choices to support long-term health and well-being.
Private Insurance Coverage Through a Parent/Guardian (until age 26)
About
The Affordable Care Act (ACA), also known as Obamacare (P.L. 111-148), was passed in 2010 by the 111th Congress and made changes to improve the health insurance system. One of these changes allows children and young adults to remain on their parents' or guardians' health insurance plan until the age of 26. The law is managed at the federal level by the Department of Health and Human Services (HHS) and carried out in Kansas by the Kansas Department of Insurance.
Eligibility
Up until the age of 26 years old
How To
How a parent or guardian adds their child to their health insurance can look different depending on the type of coverage they have:
Marketplace plans: a health insurance plan that offers individual health insurance for people who do not have access to an employer or government-sponsored health plan.
A parent/guardian can add a dependent to their plan during the initial application process, during the yearly Open Enrollment Period, or a Special Enrollment Period.
To qualify, one of the following must be true:
The individual is or will be claimed as their guardian's tax dependent.
The parent/guardian pays the full cost of their Marketplace plan without a tax credit (Financial help)
Job-based plans: a health insurance plan offered by an employer to its employees and their eligible dependents as part of a benefits package.
A parent/guardian can add a dependent to their plan during their employer's yearly Open Enrollment Period or a Special Enrollment Period, and should check with their plan or their employer's benefits department for details.
Generally, an individual can be covered by their parents' job-based plan until they turn 26, even if they:
have gotten married
adopted a child
Enrolled in or leaving school
Living separately from or in their parents' home
Are not claimed as a tax dependent
Are eligible for their own job-based coverage
In both types of insurance plans, once the individual turns 26, they qualify for a Special Enrollment Period to apply for and enroll in their own health insurance coverage.
Kan Be Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) (through age 21)
About
The Social Security Act amendment of 1967 (P.L. 90-248), passed by the 90th Congress, created the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit as part of the Medicaid program. EPSDT helps ensure that children and teens under the age of 21 receive regular checkups and the necessary healthcare to grow and stay healthy. The program is run at the national level by the Centers for Medicare & Medicaid Services (CMS), part of the U.S. Department of Health and Human Services. In Kansas, it is managed by the Kansas Department of Health and Environment (KDHE).
Eligibility
Kansas must provide EPSDT services to anyone under 21 through the state's Kan-Be-Healthy program. These services are meant to find and treat health problems early. They must be medically necessary, meaning they help treat a condition or make it easier to live with one.
Kan-Be-Healthy covers four main types of health screenings:
Vision screenings
Hearing screenings
Dental screenings
Medical screenings
If any health issues are found during these screenings, Kan-Be-Healthy must also cover the follow-up care and services needed to treat them. These services may include:
Home health services
Attendant care services
In-home nursing services
medical respite services
How To
To receive these services, upon request from the guardian, the child's doctor must conduct a screening and complete a request form that outlines the necessary care and explains why it is medically necessary, along with a checklist of services covered under EPSDT. That form is sent to the person's managed care organization (MCO).
The MCO will review the request and usually send a letter called a "Notice of Action" to let you know if the request is approved or denied.
If the request is approved, the MCO will start setting up the services for your child.
If it is denied, the letter will include instructions on how to appeal the decision. If chosen to appeal, keep the Notice of Action and make sure to file the appeal within 33 days of the denial.
The Children’s Health Insurance Program (CHIP)
About
The Balanced Budget Act of 1997 (P.L. 105-33), passed by the 105th Congress, created the Children's Health Insurance Program (CHIP). CHIP is a federal and state program that provides health coverage for children who do not have insurance and whose families make too much to qualify for Medicaid, but not enough to afford private or job-based health plans. The income limit varies by state, but in Kansas, the income limit is generally up to 232% to 242% of the Federal Poverty Level. The program is run at the national level by the Centers for Medicare & Medicaid Services (CMS), part of the U.S. Department of Health and Human Services. In Kansas, CHIP is managed by the Kansas Department of Health and Environment (KDHE).
CHIP coverage can include:
No deductibles
No co-pays
No co-insurance
Monthly household premiums ranging from $0 to $50
Free annual checkups and screenings, including dental care
Choice of three medical carriers, each offering different benefits
Coverage is accepted by most doctors
Services covered by CHIP may include:
Routine checkups
Immunizations
Doctor visits
Prescriptions
Dental and vision care
Inpatient and outpatient hospital care
Lab tests and X-rays
Emergency services
Behavioral health services
Routine physicals and dental visits are covered at no cost under CHIP. However, there may be a copayment for some other services. Targeted Case Management (TCM) is not a covered benefit under CHIP, which can be important for families who may be expecting this service.
Eligibility
CHIP provides coverage for three groups of people:
Children under the age of 19
Pregnant women
Targeted low-income children (from conception through the end of pregnancy)
How To
To apply for the Children's Health Insurance Program (CHIP) in Kansas, administered through KanCare, call 800-792-4884 or complete an online application on the KanCare website. The application requires information such as household size, income, current health coverage, and all household members. After submission, additional documents may be requested to verify eligibility. A notice will be sent by mail with the eligibility decision, and coverage typically begins once the application is approved.
Kansas Special Health Care Needs (SHCN) Program (birth to 21)
About
Kansas Statute Annotated (K.S.A.) 65-5a01, Article 5a of Chapter 65, established the Kansas Special Health Care Needs (SHCN) Program. SHCN is an income-based program that primarily provides specialized medical services and support for children and youth with specific disabilities or long-term health conditions. The program is managed at the state level by the Kansas Department of Health and Environment (KDHE).
SHCN services may include:
Diagnostic evaluations
Hospitalizations
Surgery
Durable medical equipment
Medications related to the eligible condition
Physical therapy
Occupational therapy
Care coordination
Direct Assistance Programs
Diagnostic services are limited to a one-time evaluation to determine medical eligibility. This initial evaluation is provided without considering family income. Prior authorization is required and must be obtained either by phone or letter from SHCN program staff before services begin. All diagnostic consultations must be scheduled with specialty providers contracted by SHCN. Please note that second opinions are not covered.
Eligibility
To be eligible for SHCN Program, an individual must:
Be of the required age range (birth up to 21)
Be a resident of Kansas
Have a diagnosed, eligible condition
Meet financial guidelines, though diagnostic support is available regardless of income for a one-time evaluation
Children receiving SSI are automatically eligible for care coordination services.
How To
If an individual is found medically eligible after the diagnostic evaluation, a full application, including financial eligibility, must be completed before accessing additional services.
To apply for the Kansas Special Health Care Needs (SHCN) Program, contact your local SHCN office or complete the application online and submit it to your local office.
Private Coverage for Adults with IDD in Kansas
About
Private Insurance is a plan that provides health coverage by privately operated insurance companies, as opposed to government-run programs like Medicare or Medicaid. This coverage can be obtained through an employer or union, or purchased directly by individuals and families.
Under the ACA, private plans cannot deny coverage or charge more due to pre-existing disabilities
Beneficiaries with disabilities can opt for private Medicare Advantage plans, which often provide extra benefits
Disabled beneficiaries (under 65) have legal rights to purchase Medicare Supplement policies, though state laws vary regarding guaranteed issue
Private health insurance requires a monthly payment, called a premium. The total cost of the plan is based on several factors. This may include:
Coverage level
Age
Location
Additional costs may include:
Deductibles: The amount of money that the insured person must pay before their insurance policy starts paying for covered expenses
Copayments: A set amount that the insured person pays for certain covered services or prescriptions when receiving the service
Coinsurance: The percentage of covered health costs the insured person is responsible for paying after meeting the deductible
Services covered by private health insurance may include:
Doctor visits
Emergency medicine
Hospitalization
Lab services
Maternity care
Mental health services
Prescriptions
Preventative visits
Specialist care
ETC
However, private health insurance typically does not include or cover long term attendant care or other waiver like services.
Eligibility
To be eligible for private health insurance, the individual typically must:
Be a U.S. Citizen or have Lawful Presence in the Country
live in the United States
Not be incarcerated in prison or jail
Enroll during the Open Enrollment Period or have a qualifying life event for Special enrollment
Additional requirements and qualifications may apply, determined by the specific private health insurance plan the individual selects.
How To
To apply for private health insurance, individuals can find and enroll in a plan online or by calling the specific Insurance they are interested in. Plans can differ in what they cover and the cost of services, so it is necessary to review each plan before officially enrolling in coverage.
Resources
At Healthcare.gov , individuals can find, compare, review multiple plans, and apply for a plan that meets their specific needs. After reviewing their options, the individual can select a plan, apply, and, if approved, begin receiving benefits.
TITLE
About
The Social Security Amendments of 1965 (P.L. 89-97), passed by the 89th Congress, created the Kansas Medicaid Program, also known as KanCare. KanCare provides public health insurance for certain people and families with limited income and resources, including:
Children
Pregnant women
Older adults
People with disabilities
Parents and caregivers
KanCare is federally overseen by the Centers for Medicare & Medicaid Services (CMS) and is managed at the state level by the Kansas Department of Health and Environment (KDHE) and the Kansas Department for Aging and Disability Services (KDADS).
Under the Social Security Act and Medicaid rules, KanCare must provide mandatory benefits to all Medicaid enrollees. Some of these benefits may include:
Transportation to medical care
Inpatient and outpatient hospital services
Rural health clinic services
Federally qualified health center services
Laboratory and X-ray services
Nursing facility services
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services for children
Physician services
And more
Eligibility
To qualify for Kansas Aged, Blind, and Disabled (ABD) Medicaid, individuals must:
Live in Kansas
Have U.S. citizenship or a qualifying immigration status
Financial limits also apply:
For a single applicant, the income limit is $967/month, and the asset limit is $2,000
For married applicants, the 2025 income limit is $1,450/month combined, and the asset limit is $3,000 combined
Please note that eligibility for Medicaid in general does not qualify one for an HCBS (Home and Community Based Services) waiver.
How To
To apply for KanCare in Kansas, individuals can submit an application online at the official KanCare website, or call the KanCare Clearinghouse at 1-800-792-4884 to apply over the phone or request a paper application by mail. Applications are processed by the Kansas Department of Health and Environment (KDHE), and individuals can check the status of their application or upload documents through the Medical Consumer Self-Service Portal on the KanCare website.
Kansas Dual Eligible Special Needs Plan (D-SNP)
About
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (P.L. 108-173), passed by the 108th Congress, created the Dual Eligible Special Needs Plan (D-SNP) in Kansas. D-SNP is a special type of Medicare Advantage health care plan designed for people who qualify for both Medicare and Medicaid and meet certain income and special needs requirements.
D-SNP offers benefits and helps coordinate care beyond what traditional Medicare and Medicaid usually provide. D-SNP services may include:
Hospital stays
Doctor visits
Prescription drugs
Coordination of care between Medicare and Medicaid
Dental care
Non-emergent and social needs transportation
Other services that support overall health and independent living
D-SNP benefits help remove barriers to care by supporting people's personal and social needs. These benefits additionally help individuals maximize their limited income by covering services that support their health and daily living.
The program is federally overseen by the Centers for Medicare & Medicaid Services (CMS) and managed at the state level by the Kansas Department of Health and Environment (KDHE).
How To
To apply for D-SNP, individuals should explore the Plan Options available to them. Some of these plans may include:
Eligibility and benefits can vary depending on the plan; therefore, it is important to select a plan that best suits your needs. Once a plan is found, individuals can apply online or call their specific plan's service number during:
The Initial Enrollment Period: the 7-month period starting three months prior to the month in which your 65th birthday takes place
The General Enrollment Period: January 1 to March 31 of each year
The Special Enrollment Period: triggered by a qualifying life event like becoming eligible for Medicaid or moving out of your current plan's service area
The Open Enrollment Period: This period runs from October 15 to December 7 each year.
Choosing the right plan during the appropriate enrollment period ensures you receive the full range of benefits that D-SNP offers. Because eligibility and benefits can vary by plan, it is essential to review your options and apply on time carefully. Enrollment dates may vary depending on the plan selected, so be sure to verify current enrollment periods and deadlines directly with the plan to ensure timely application.