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Provider Handbook

Categories of Eligibility for T-XIX

T-XIX beneficiaries who will be eligible for substance abuse services include:

Population

Population Codes

AFDC adults and children

30-36

Poverty Level Eligible

43-46

Supplemental Security Income

10-12

Medical Support

20-22

Working Disabled

26

Medically Improved

27

Medical Assistance

40-42

Breast/Cervical Cancer

75

Adoption Support

67

Foster Care

60-69

MA Child Institution

73

    1.  T-XIX Beneficiaries Not Eligible for the Contract:
    2. All T-XIX beneficiaries are automatically enrolled for provision of covered T-XIX services under this Contract except for the following excluded eligibility categories:
    3. T-XIX beneficiaries who reside in Nursing Facilities (NF) or Intermediate Care Facilities for the Mentally Retarded (ICF/MR).
    4. T-XIX beneficiaries who receive services through the S-CHIP program. Kansas has a stand-alone S-CHIP program.
    5. Sixth Omnibus Budget Reconciliation Act of 1986 (SOBRA) eligibles for an emergency condition only.
    6. Individuals participating in the refugee resettlement program.
    7. Beneficiaries who have an eligibility period that is only retroactive.
    8. Beneficiaries who reside in an Adult Care Home.
    9. Beneficiaries who reside in a State Institution.
    10. Beneficiaries who have not yet met spend-down requirements.
    11. Beneficiaries who are being treated in a Psychiatric Residential Treatment Facility (PRTF).

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