Medicaid & HealthWave

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Medicaid & HealthWave

The Medicaid and HealthWave division of KHPA is responsible for purchasing health services for children, pregnant women, people with disabilities, and the elderly through the Medicaid program, the State Children’s Health Insurance Program (SCHIP), and the state-funded MediKan program. On average, over 300,000 Kansas are enrolled in these programs and more than 240,000 Kansans receive these health care services through these programs each month.

Medicaid (Title XIX) is a federal/state matching funds program that is used to purchase preventive, primary, and acute health services for low-income individuals, children, and families. It also pays for certain long-term care services, like nursing homes, for the elderly or people with disabilities. The federal government provides approximately 60 percent of the cost of Medicaid services. In other words, for every Medicaid dollar spent in Kansas, about 60 cents comes from the federal government; the State provides the remaining 40 cents. Medicaid is an open-ended entitlement for states. That is, as long as covered services are provided to eligible beneficiaries as specified in the State Medicaid Plan, the federal government must participate in sharing the costs of those services.

SCHIP (Title XXI) provides health care coverage for low-income children who do not qualify for Medicaid coverage. The federal government provides approximately 72 percent of the cost of SCHIP and the State contributes the remaining 28 percent, as well as any excess spent above the federal allotment. Unlike Medicaid, SCHIP is not open-ended; states are awarded yearly allotments.

Medicaid services are purchased through either a fee-for-service model or a managed care model. In the fee-for-service model, the State pays the provider directly. In the managed care model, the State pays a managed care organization (MCO) a monthly payment for each beneficiary. The MCO contracts with providers and pays them for services. SCHIP is provided only in a managed care model. Medicaid managed care and SCHIP are combined into a program, called HealthWave, designed to provide one seamless managed care option for families.

The MediKan health program 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.


For more information about either Medicaid or SCHIP go to the Centers for Medicare and Medicaid Services website or the Kaiser Family Foundation website.