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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, the aged, and the elderly through the Medicaid program, the State Children’s Health Insurance Program (SCHIP), and the state-funded MediKan program. On average, about 300,000 Kansas are enrolled in these programs each month.

Medicaid is a federal-state program that provides health and long-term care services to people with low-incomes. All states currently participate in the Medicaid program and federal matching funds are available for the costs of these services. As a condition of state participation, each state must agree to cover certain populations and provide certain services (Fig. 1).  KHPA is directly responsible for the purchase of health care services funded through the Medicaid program, while the Department on Aging and the Department of Social and Rehabilitation Services are responsible for administering long-term care services and mental health services. 

Nearly all health care services purchased by KHPA are financed through a combination of state and federal matching dollars either through Title XIX (Medicaid) or Title XXI (the State Children’s Health Insurance Program, or SCHIP) of the Social Security Act. Under Title XIX, the federal government provides approximately 60 percent of the cost of Medicaid services with no upper limit on what the federal government will reimburse the State. The State provides the remaining 40 percent of the cost of Medicaid services. 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.  Under Title XXI, the Federal government provides approximately 72 percent of the cost up to a maximum allotment, and the State provides the remaining 28 percent and any excess spent above the federal allotment.  Health care services are purchased through both traditional fee-for-service and managed care models as described below.

SCHIP provides health care coverage for low-income children living in families with incomes that exceed Medicaid limits. 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. Kansas provides low-cost health insurance coverage to children who are under the age of 19, do not qualify for Medicaid, have family incomes under the 200 percent of the federal poverty level, and are not eligible for state employee health insurance and are not covered by private health insurance.

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 one 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.