KFMAM Manual - 8/28/2008
01000: Administrative Information -
01100 Health Benefit Programs - Several health benefit programs are provided to low income Kansans to help cover the cost of health care.
1101 Medicaid - The Medicaid program is a joint federal/state-funded program that covers a majority of low income persons in the State including children and pregnant women. Policies for family related medical coverage are in this manual while polices for other medical programs are located in the KEESM (Kansas Economic and Employment Support Manual).
1102 HealthWave 21 - The HealthWave 21 program is based on a federal block grant program and is intended to serve children under the age of 19 who are uninsured and who are not otherwise eligible for Medicaid.
01120 Basis of Programs and Policies - The Kansas Health Policy Authority (KHPA) has the responsibility to develop state plans for furnishing assistance and services to eligible individuals and to determine the general policies relating to the medical assistance programs. The Kansas programs are independent from programs administered in other states unless otherwise stated in this manual. An application for assistance in Kansas shall be treated as a new application.
Therefore, a new determination of eligibility rendered by another state shall not, in and of itself, affect eligibility in Kansas.
Policies set forth in this manual are based upon various federal and state statutes and administrative regulations. The following citations provide an overview of the primary statutory and regulatory references on which the programs are based.
Medicaid
-42 United States Code Annotated (U.S.C.A.), Subsection 1396a et seq.
-42 Code of Federal Regulations (C.F.R.), Parts 430 - 456
-Kansas Statutes Annotated (K.S.A.), 39-708c, 39-209(e)
-Kansas Administrative Regulations (K.A.R.), Chapter 30, Article 6 and Chapter 129, Article 7
HealthWave 21
-Section 2103 of Public Law 105-32
-Kansas Administrative Regulations (K.A.R.), Chapter 30, Article 14
Fair Hearings
-42 Code of Federal Regulations (C.F.R.), Part 205
-Kansas Statutes Annotated (K.S.A.), 75-3306
-Kansas Administrative Regulations (K.A.R.), Chapter 30, Article 7 and Chapter 129, Article 7
Confidentiality Policies
-Kansas Statutes Annotated (K.S.A.), 39-709b
-Kansas Administrative Regulations (K.A.R.), Chapter 30, Articles 2-11
This manual has been developed to implement the policies set forth in the above-mentioned statutes and administrative regulations. Thus, the provisions of the manual are to be followed by program staff when determining eligibility of applicants or recipients for assistance in accordance with K.A.R. Chapter 30, Article 2.
Providing assistance is a continuing and comprehensive process, embracing all parts of the administration of the welfare program. All of the steps or parts of the process are interrelated and must be planned for, and ultimately judged, in terms of the effectiveness of the complete administration.
1131 Volunteers - May be used in related activities such as outreach or assisting applicants in completing the application, other prescreening activities, and securing needed verification. Individuals and organizations who are parties to a strike or lockout and their facilities may not be used in the certification process except as a source of verification for information supplied by the applicant.
1132 Data Collection of Racial/Ethnic Categories - The Case Manager may request applicants to voluntarily identify their racial or ethnic status on the application form and shall inform the applicant(s) that this designation shall not affect their eligibility.
The Case Manager may ask the applicant to identify his racial/ethnic origin during a telephone contact. However, there are certain stipulations that are necessary when the self-identification process is used in either the application process or a telephone contact.
1132.01 - Applicants shall be assured by the Case Manager that information is used for statistical purposes only in determining if the program is administered without discrimination. Racial/ethnic data shall have no effect on an applicant's eligibility to participate and it will not be used for discriminatory purposes.
1132.02 - The applicant shall be advised that the information is used to ensure that benefits are available to all eligible persons regardless of race, color, or national origin.
1132.03 - Applicants shall be advised that the information given will be confidential and, should they decide not to provide this information, such a decision will not have an adverse effect on determining their eligibility.
01200 Rights and Responsibilities -
1210 Rights of Applicant/Recipient -
1210.01 Right to Make Application - An individual shall have the right to make application regardless of any question of eligibility or agency responsibility. The right of an individual to make application may not be abridged.
1210.02 Right to Information - A client has the right to be provided with information concerning the types of assistance, which are provided by the agency. Upon request, the agency shall furnish the client with informational pamphlets and will explain to him/her the categories of assistance for which he/she may be eligible and the eligibility factors for each.
1210.03 Right to a Private Interview - A client has the right to a private interview whenever he/she is discussing his/her individual situation with the agency.
1210.04 Right to Receive a Prompt Decision - A client has the right to have a timely decision rendered on his/her application. See 1405. A recipient has the right to a decision rendered on any other formal request (such as a request for services or for information) within 30 days of its receipt by the agency. test
1210.05 Right to Restored Benefits - If the client has been wrongfully delayed, denied, or terminated, he/she is due restored benefits.
1210.06 Right to Correct Amount of Assistance - The client, if eligible, shall be entitled to the correct determination of benefits based upon budgetary standards or allowances in accordance with agency policies.
1210.07 Right to Equal Treatment - All clients have a right to equal treatment in similar circumstances and no person shall be denied benefits or be subject to discrimination on the basis of race, color, or national origin, gender, religion, age, disability, political beliefs, sexual orientation, or marital or family status.
The client has the right to file a discrimination complaint with either the Federal or the State agency.
1210.08 Right to A Fair Hearing - A client has the right to request a fair hearing on any agency decision or lack of action in regard to his application for or receipt of assistance.
1210.09 Right to Withdraw from the Program - An applicant has the right to withdraw his application at any time between the date the application is signed and the date the notice of the agency decision is mailed. A recipient may withdraw from a program at any time.
1210.10 Right to an Individual Determination of Eligibility for Assistance - A client shall be given an opportunity to present his request and to explain his situation.
1210.11 Right to Written Notification of Action - A client has the right to a written notification of agency action concerning his eligibility for assistance.
1211 Responsibilities of Applicant/Recipient -
1211.01 Responsibility to Submit Identifiable Application - The applicant shall submit an application containing a legible name and address (unless homeless), and which has been signed.
1211.02 Responsibility to Supply Information - A client has the responsibility to supply, insofar as able, information essential to the establishment of eligibility.
Information which is "time-sensitive" and received in the office through a drop box, mail slot or other such manner at the opening of the business day shall be considered as received during the previous work day. Information which is received as a fax or copy, but is required in original form, shall be considered as received when the fax/copy arrives in the office provided the original document arrives in a timely manner as determined at the local level. In general, a fax or copy of a document shall be acceptable without requiring an original (including an application form or monthly report form). However, an original document shall be required for establishing age, identity and citizenship and alienage status, and when determined to be necessary based on prudent person judgment.
1211.03 Responsibility to Provide Verification - The client has primary responsibility for providing verification (certain exceptions to these requirements are specified in the verification section). See 1325.
1211.04 Responsibility to Authorize Release of Information - A client has the responsibility to give written permission for release of information when needed.
1211.05 Responsibility to Report Changes - Persons have the responsibility to report changes in circumstances within 10 calendar days from the date the change is known. See 7211 for specific changes that change reporting persons are required to report.
1211.06 Responsibility to Cooperate - The client shall cooperate with all program requirements and in supplying required information.
1211.07 Responsibility to Provide Social Security Numbers - Each applicant/recipient shall provide his/her Social Security number. See 2031.
1211.08 Responsibility to Meet Needs - A client has the responsibility to meet his/her own needs insofar as he/she are capable.
1212 Responsibilities of the Agency - Upon request, the agency must explain the rights and responsibilities of clients and the following requirements placed on the agency.
1212.01 Periodic Reviews - The agency is required to make periodic reviews of eligibility if the application is approved. The agency shall notify the client of the expiration of the review period and shall send the client a new application prior to the last month of the review period.
1212.02 Fraud - The agency is required to investigate and refer for legal action any alleged fraud related to the receipt of assistance.
1212.03 Responsibility to Accept an Identifiable Application - The agency shall accept an application containing a legible name and address (unless homeless) and which has been signed. See 1401.
1212.04 Responsibility to Review Recipients Timely - The agency has the responsibility to process all subsequent applications timely so there will be no break in the benefits the client is eligible to receive.
1212.05 Responsibility to Establish Claims of Overpayment - The agency is responsible for establishing claims for overpayment (either fraud, client, or agency error).
1212.06 Responsibility to Restore Lost Benefits - The agency shall restore benefits to the client if benefits were wrongfully denied, delayed, or terminated.
1212.07 Responsibility for Giving Notice of Action - The agency is responsible for giving adequate and/or timely notice of action when appropriate.
1212.08 Case File Documentation - The agency has the responsibility to insure that case file documentation supports the decision to provide, deny or change eligibility, benefits, or services.
1212.09 Cost-Effective Service Provision - Services shall be provided in the most cost-effective manner in order to provide the client with the appropriate services within the resources allowed.
01220 Disclosure of Information to Agency Personnel - Information is not to be disclosed to another Kansas Health Policy and Finance(KHPA) or SRS employee unless the employee has a need for the information in the performance of his official duties. The client's signature on the application form authorizes the disclosure of information concerning a MA/CM, EM, WT, GA, Refugee, Child Care, Medicaid, HealthWave 19 and 21, and/or Food Stamp client if the purpose of such disclosure is connected with the administration of any of the aforementioned programs, the Child Welfare or Child Support programs (under titles IV-B, IV-D, and XX), or any other federal or federally assisted program which provides assistance, in cash or in kind, or services directly to individuals on the basis of need. (Example: SSI, LIEAP.)
1221 Confidentiality of Information Concerning Applicants or Recipients - Information concerning applicants or recipients (present and past) is confidential and may not be disclosed to another SRS employee, the client, or any other nonagency personnel except as set forth in this section.
Information concerning clients or providers who have been referred for investigation is confidential and may not be released unless the Fraud Unit or the prosecuting attorney to whom the case has been referred for legal action authorizes such disclosure.
1222 Disclosure of Confidential Information - The agency may disclose confidential information when the purpose of such disclosure is directly related to: (1) the administration of the Kansas Health Policy Authority (KHPA) program; (2) an investigation, prosecution, or criminal or civil proceeding conducted in connection with the administration of the KHPA program or the SSI program; or (3) the administration of any federal or federally assisted program which provides assistance (in cash or in kind) or services directly to individuals on the basis of need. For exceptions see 1225 and 1226.
Throughout this material related to confidentiality of case records, the term KHPA and SRS employees includes contracted employees (e.g., MAXIMUS employees responsible for HealthWave determinations).
1223 Nature of Information to be Safeguarded - The confidential nature of the following information must be safeguarded:
1223.01 - Names and addresses, including lists of applicants or recipients.
1223.02 - Information contained in applications, reports of investigations, reports of medical examinations, correspondence, and other records concerning the condition or circumstances of any person for whom or about whom information is obtained, and including all such information whether or not it is recorded; and
1223.03 - Records of agency evaluations of such information. General information, not identified with particular individuals, such as total expenditures made, number of recipients, and other statistical information and social data contained in general studies, reports, or surveys of welfare problems, does not fall within the class of material to be safeguarded.
1224 Disclosure of Information to Client - Information entered in the case record is to be made available to the client upon request, for inspection at a time mutually agreeable to the agency and the client, except as set forth below.
1224.01 Information Provided by SRS Programs - Information provided by SRS programs, such as Children and Family Services, Rehabilitation Services, Food Stamp services, Cash Services, and Substance Abuse, Mental Health & Developmental Disabilities is not to be made available to the client unless the respective program regulations authorize such disclosure.
1224.02 Medical and Psychiatric Reports - Medical and psychiatric reports are not to be made available to the client unless signed, written consent is obtained from the medical practitioner who rendered such report.
1224.03 Names and Addresses of Complainants - The names and addresses of complainants are not to be made available to the client.
1224.04 Investigative Reports - Investigative reports concerning welfare fraud or other types of overpayments are not to be made available to the client during the course of the investigation or during the time period in which the case has been referred for legal action unless the Fraud Unit, Legal Division or the prosecuting attorney to whom the case has been referred for legal action authorizes such disclosure.
NOTE: With the exception of 1224.03, all documents and records to be used by the agency at a fair hearing are to be made available, upon request, to the appellant or his representative for inspection and/or copying at a reasonable time mutually agreeable to the agency and the client or his representative prior to the date of the hearing.
1225 Disclosure of Information to Agency Personnel - Information is not to be disclosed to another KHPA or SRS employee unless the employee has a need for the information in the performance of his official duties. The client's signature on the application form authorizes the disclosure of information concerning a MA/CM, EM, WT, GA, Refugee, Child Care, Medicaid, HealthWave 19 and 21, and/or Food Stamp client if the purpose of such disclosure is connected with the administration of any of the aforementioned programs, the Child Welfare or Child Support programs (under titles IV-B, IV-D, and XX), or any other federal or federally assisted program which provides assistance, in cash or in kind, or services directly to individuals on the basis of need. (Example: SSI, LIEAP.)
1226 Disclosure of Information to Nonagency Personnel and the Public - Information is not to be disclosed to nonagency personnel such as courts, school boards, legislators, prosecuting attorneys, policemen, FBI agents, doctors, social service agencies, state employment offices, public housing authorities, landlords, creditors, relatives, etc., except as set forth below.
1226.01 Information Available to the Public - Information Available to the Public - Regulations, Plans of Operation, state manuals, and federal procedures, which affect the public, shall be maintained in the office of the Kansas Health Policy Authority for examination by members of the public on regular workdays during the regular office hours.
1226.02 Directly Related to the Administration of KHPA Programs - Information may be disclosed to nonagency personnel when the purpose of such disclosure is directly related to the administration of KHPA programs or assisting SRS in the administration of there programs. The information concerning a cash, medical, child care, or food stamp client is not to be disclosed without the signed written consent of the client unless the purpose of such disclosure is directly related to one of those programs. Any information disclosed is to be limited to that which is reasonably necessary to accomplish the purpose of such disclosure. Such purposes include establishing eligibility, determining amount of assistance, and providing services to applicants or recipients.
In the course of providing services to clients, disclosure of information should be made to representatives of other welfare agencies or programs only when they can give assurance that:
(1) - the confidential nature of the information will be preserved;
(2) - the information will be used only for the purposes for which it is made available (such purposes should be reasonably related to the purposes of the KHPA program and the functioning of the inquiring agencies); and
(3) - the standards of protection established by the agency to which the information is disclosed are equal to those established by KHPA itself, both with regard to the use of information by staff and the provision of protective office procedures.
1226.03 Federal or Federally Assisted Programs - Information concerning clients is to be disclosed to federal or federally assisted programs which provide assistance (in cash or in kind) or services directly to individuals on the basis of financial need if the requesting agency certifies in writing that the information so requested is necessary to the administration of its program. Example: SSI.
1226.04 Officials Conducting An Investigation, Prosecution, or Criminal/ Civil Proceeding - Information is to be disclosed to the official conducting an investigation, prosecution or criminal or civil proceeding in connection with the administration of the KHPA program if such information is reasonably necessary to the investigation, prosecution or criminal or civil proceeding. This includes welfare fraud investigations and prosecutions. The client's signature on the application/redetermination form authorizes the disclosure of information from the case record necessary to conduct an investigation, prosecution, criminal or civil proceeding related to eligibility for medical assistance.
Information concerning clients is to be disclosed to the official conducting an investigation, prosecution or criminal or civil proceeding in conjunction with the administration of the SSI program if such information is reasonably necessary to the investigation, prosecution, or criminal or civil proceeding.
Information disclosed pursuant to the above paragraphs shall be provided the appropriate official in the following manner:
(1) - The official requesting such information shall be allowed to review pertinent case record material in the agency office during normal working hours.
(2) - Such official, upon request, shall be furnished with copies, or authenticated copies, or originals of pertinent case record materials as necessary at no cost. Prior to the release of an original document, a copy of the document shall be placed in the case record with a notation as to the disposition of the original.
If a question arises as to the pertinency of any requested material, consult the KHPA Legal Division.
1226.05 Intention to Commit Crimes - Information concerning the intention of a client to commit a crime and the information necessary to prevent the crime shall be disclosed to the appropriate authorities.
1226.06 Fleeing Felons and Probation/Parole Violators - The address of any member of a MA/CM household shall be made available, on request, to any Federal, State, or local law enforcement officer if the officer furnishes the name of the individual and notifies the agency that the individual:
(1) - is fleeing to avoid prosecution, or custody or confinement after conviction, for a crime or attempt to commit a crime that is a felony; or
(2) - is violating a condition of probation or parole imposed under Federal or State law; or
(3) - has information that is necessary for the officer to conduct an official duty related to item (1) or (2) above.
The officer must notify the agency that locating or apprehending the member is an official duty and that the request is being made in the proper exercise of an official duty.
1226.07 Information Not Otherwise Authorized to be Disclosed - Information not otherwise authorized to be disclosed by this provision may only be disclosed if the client has the authority to disclose such information and the agency has a signed, written consent on file authorizing the agency to disclose the information to the specific person requesting such information, excepting that such information may be disclosed without signed, written consent in an emergency situation such as death or other serious crises to an appropriate person if the agency deems such unauthorized disclosure to be in the best interest of the client. If such information is disclosed without signed, written consent, the client shall be notified of such disclosure as soon thereafter as possible.
1227 Subpoenas and Testifying in Court Concerning Information Not Otherwise Authorized to be Disclosed - Since all information relative to a client is by law confidential and since clients are advised that any information they reveal is held confidential, any information received by the Case Manager or other person connected with the agency, is by statute, in the nature of a privileged communication just as is the information received by an attorney or physician from his client, or received by a minister in the performance of his function as a spiritual advisor.
The Legal Division must be notified immediately of a subpoena to produce records or of a court order to testify; such notice should be in writing whenever time permits. A staff member who is subpoenaed or whose records are subpoenaed, unless otherwise instructed by the Legal Division, should make appearance at the time and place stated in the subpoena, and should bring the records subpoenaed with him, if any.
After being sworn in he should make the following statement to the court in response to the first material question:
"I am attending the court’s hearing as a result of a subpoena. The law and KHPA policy require that I call the court’s attention to the laws and regulations limiting use and disclosure of information concerning public assistance. K.S.A. 39-709b limits the use or disclosure of information concerning applicants and recipients of assistance to purposes directly connected with the administration of the assistance program, unless there is written consent given by the consumer. These federal laws and regulations also similarly limit use and disclosure":
1227.01 - Section 1902(a)(7) of the Social Security Act, codified at 42 U.S.C. Sec. 1936a(a)(7), and 42 C.F.R. Sec. 431.300, et seq. (the Medicaid Program);
The witness will submit the above statement in its entirety to the court and a copy to the attorney and will testify further according to the ruling and instructions of the court. Testifying and releasing confidential information when ordered to do so directly by a judge in an in-court setting is not considered unauthorized disclosure of information. See 1229.
1228 Questions Concerning Disclosure of Information - When there is some question as to the disclosure of information to another KHPA or SRS employee, the client or other nonagency personnel, the question is to be referred to the legal division for clearance.
1229 Unauthorized Disclosure of Confidential Information - A KHPA employee who discloses confidential information concerning an applicant or recipient (present and past) in violation of the provisions set forth in 1220 and subsections shall be subject to appropriate disciplinary action (official reprimand, suspension, demotion, dismissal, etc.).
Further, any individual who discloses confidential information concerning an applicant or recipient (present, past) in violation of the provisions set forth in 1220 and subsections shall be subject to criminal prosecution, and if convicted, may be fined up to $1,000 and/or sentenced to the county jail for a period not to exceed six months.
01300 Prudent Person - The local Case Manager shall use the prudent person concept in administering the Medical Programs. The phrase, "prudent person" applies to the particular situation that indicates further verification of information is needed. It also applies to the reasonableness of judgments made by an individual in a given situation based on that individual's experience and knowledge of the program.
1310 Staff Responsibility - Staff must be prudent when the circumstances of a particular case indicate the need for further inquiry. Additional substantiation or verification should be obtained whenever the information provided by the applicant or recipient is incomplete, unclear, or contradictory.
Circumstances that require a more thorough analysis of a case include:
1310.01 - An individual who is living at a higher standard of living than known resources or income would permit.
1310.02 - An individual who appears to qualify for potential resources such as Social Security, unemployment benefits, veterans' benefits, medical insurance, etc.
1310.03 - An individual who appears to be confused.
1310.04 - An individual who has a history of providing conflicting or incomplete information.
1310.05 - Documents (birth certificates, Social Security cards, etc.) that appear to have been altered.
01320 Simplified Eligibility - As adopted by the State is a system by which the agency accepts the individual's statement as the basis of eligibility. For some factors of eligibility, additional information will have to be obtained.
1321 - The agency shall use, to the greatest extent possible, the information on the application/redetermination form, as provided by the individual applicant/recipient, for purposes of determining eligibility and extent of entitlement.
1321.01 - Carefully review the form for completeness, clarity, consistency, and lack of error or questionable statement.
1321.02 - Give the applicant/recipient the opportunity to present additional clarification when information on the form is incomplete, unclear, or inconsistent, or where other circumstances in the particular case indicate to a prudent person that further inquiry needs to be made. Negative action as a result of failure to provide the information can be taken only when written notice was given allowing at least 10 calendar days from the date the notice is initiated to return the information.
1321.03 - Consider additional information from agency records.
1321.04 - Advise the applicant/recipient when it is necessary for the agency to go to other sources, and when necessary obtain his consent on the information release form. If he does not consent to the necessary contacts, it may not be possible to determine that initial or continuing eligibility exists. Each applicant and recipient gives consent to a full field investigation when he signs the application/redetermination form, but a signed informational release form may be necessary to obtain the needed information. See 1211.04.
1321.05 - See 2040 for requirements regarding citizenship/identity verification.
1322 Sources of Verification -
1322.01 Documentary Evidence - Shall be used as the primary source of verification. Documentary evidence consists of a written confirmation of a household's circumstances. Examples are wage stubs, rent receipts, utility bills, medical reimbursement statements, and, for Social Security numbers, such evidence as BENDEX printouts, Social Security cards, or any official document containing the Social Security number.
Although documentary evidence shall be the primary source of verification, acceptable verification shall not be limited to any single type of document and may be obtained through the household or other sources.
Alternate sources of verification, such as collateral contacts shall be used whenever documentary evidence cannot be obtained.
1322.02 Collateral Contacts - A collateral contact is a verbal confirmation of a household's circumstances made by a person outside of the household. The collateral contact may be made either by mail or over the telephone. The acceptability of a collateral contact shall not be restricted to a particular individual but may be anyone who can be expected to give an accurate third party verification of the household's statements. Examples of acceptable collateral contacts are employers, landlords, social service agencies, migrant service agencies, and neighbors of the household.
1322.03 Discrepancies - Where information from another source contradicts statements made by the household; the household shall be afforded a reasonable opportunity to resolve the discrepancy prior to an eligibility determination. Information needed to resolve the discrepancy shall be requested from the household, however, if the household fails to provide the necessary information, staff may elect to verify the information directly. Households are to be given 10 days to provide necessary verification. If the client does not or refuses to provide adequate verification to resolve the discrepancy, the case may then be closed or the application denied if that is the appropriate case action.
1323 Responsibility for Obtaining Verification - The household has the primary responsibility for providing documentary evidence to support its statements and to resolve any questionable information. Households may supply documentary evidence by mail, fax, or by an authorized or personal representative. Any reasonable documentary evidence provided by the household shall be accepted by the local office/CH (Clearinghouse). The local office/CH shall be primarily concerned with how adequately the verification proves the statements on the application. If it would be difficult or impossible for the household to obtain documentary evidence in a timely manner, the Case Manager shall offer assistance to the household in obtaining documentary evidence in a phone call and/or send a notice that includes the offer of assistance to all households.
See 2040 for requirements regarding citizenship/identity verification.
1323.01 - The household shall not be held responsible when a person outside of the household fails to cooperate with a request for verification.
1324 Documentation - Case files must contain documentation to support the determination to approve or deny program benefits. Documentation means that a written statement regarding the type of verification and a summary of the information obtained has been entered in the case record. Such statements must be in sufficient detail so that a reviewer would be able to determine the reasonableness of the determination. For example, when income is verified by the presentation of pay stubs, the gross amount of income on each pay stub, and the frequency of receipt of income are included on a copy of the pay stub in the case record or are recorded by the Case Manager elsewhere in the case file.
Where verification was required to resolve questionable information, the Case Manager shall document why the information was considered questionable and how the questionable information was resolved. The Case Manager shall also document why any alternate sources of verification were needed and, if a collateral contact was rejected, the case file shall contain documentation of why the collateral contact was rejected and an alternate chosen.
1325 Verification Provisions - Verification is the use of documentary evidence & collateral contacts to establish the accuracy of statements on the application.
1325.01 Mandatory Verification That Affects Eligibility for Program Benefits - The Case Manager shall verify the following information prior to approval for clients initially applying:
(1) - Gross Nonexempt Income - Shall be verified prior to approval. However, where all attempts to verify the income have been unsuccessful because the person or organization providing the income has failed to cooperate with the household and the Case Manager, and all other sources of verification are unavailable, the Case Manager shall determine an amount to be used based on the best available information.
(2) - Alien Status - The Case Manager shall determine from information on the application if clients identified, as aliens are eligible aliens, as defined in 2042, by requiring that verification be presented for each alien client. If the verification of alien status is not provided for any alien client, that person shall be disqualified until the necessary verification of his/her status is provided. This requirement does not apply to aliens seeking emergency medical services coverage per KEESM 2691.
See KEESM 4100 for treatment of income for an alien excluded from the program under this provision.
Alien applicants must be given a reasonable opportunity to submit documentary evidence of their eligible alien status prior to any action being taken to reduce, deny, or terminate eligibility or benefit level. A reasonable opportunity shall be at least 10 days from the date of the agency's request for an acceptable document. If the 10-day period ends before the timely processing deadline and documentation has not been submitted, the applicant may not be approved until the documentation is submitted. If the 10-day period will end after the timely processing deadline and the household is otherwise eligible, benefits must be provided within normal or expedited time frames as appropriate.
(3) - Social Security Numbers - An applicant is required to supply their Social Security Number or verification of application for the required SSN prior to approval of coverage unless the individual claims good cause. See 2033.
(4) Documentation of the identity of each person is required prior to receiving Title 19 Medicaid coverage for individuals claiming to be U.S. citizens. This requirement does not apply to the following individuals:
- Current or former SSI recipients
- Current or former Medicare beneficiaries
- Current or former recipients of Social Security Disability beneftis
- Children in foster care or recipients of foster care maintenance
- Children who are recipients of adoption support payments
(5) Acceptable sources of Verification of Pregnancy include:
- Physician or clinic records;
- Statement from a certified medical professional such as a nurse or nurse midwife; or
- Statement from any healthcare provider or clinic (including family planning services as long as the statement is signed legibly and includes the name of the facility/agency).
1325.02 Mandatory Verification That Affects Program Benefits - The following information shall be verified prior to a determination of the benefit amount for households initially applying. Failure to provide verification of these items is not grounds for denial, rather the application would be processed without allowing a deduction for the claimed expense.
(1) - Medical Expenses - Medical expenses used to meet spenddown. The amount of any medical expenses shall be verified prior to initial approval.
(2) - Dependent Care Expenses (MA CM Only) - All payments made for dependent care must be verified prior to certification. If verification is not provided, the expenses shall not be allowed. If a portion of the expense is verified, that amount shall be allowed. If verification is provided later, the verification shall be treated as a change in circumstances and the household's benefit shall be redetermined with the updated verification. Also See INVALID LINK - Please ensure that there is a "^" after the section number and the section number you are trying to link to is currently active..
1326 Verification of Questionable Information - The Case Manager shall verify all other factors of eligibility prior to approval only if they are questionable and affect the household's eligibility. To be considered questionable, the information on the application must be inconsistent with other information on the application or previous applications or inconsistent with information received by the agency. When determining if information is questionable, the decision shall be based on each household's individual circumstances. Also see 1310 and 1320.
1326.01 Household Composition - If questionable, the Case Manager shall verify any factors affecting the composition of a household.
1326.02 Citizenship - Documentation of citizenship for each person is required prior to receiving Title 19 Medicaid coverage for individuals claiming to be be U.S. citizens. All documents used to verify citizenship must be recorded on the KEESM form ES-3850, Record of Identity and Citizenship, and retained in the case file indefinitely per 1602.08.
If the household is unable to provide this verification, the Title 19 member whose citizenship is not verified shall be excluded from participation until verification of his/her U.S. citizenship is provided. Refer to 5110.03 for treatment of the income and resources of a person excluded under this provision.
Because it is often not clear which poverty level category a child will qualify for at the time an application is received and to prevent pending an application multiple times, staff must ask for citizenship and identity verification of all individuals for whom coverage is being requested. If citizenship and/or identity verifications are not submitted, negative action cannot be taken on a child who would fall into the Title 21 program category of assistance.
The Reasonable Opportunity to Provide Documentation requirements of 2046.01 are also applicable to request for citizenship verification. Acceptable documents and hierachalprotocol for obtaining acceptable documents are described in the KEESM Appendix Item A-12.
01400 Application Process/General Information -
1401 General Information - Submittal of a signed paper application or an on-line application shall be considered a request for assistance.
Based on the provisions of 3000, an application shall include all persons who are required to be in the assistance plan. This includes those persons who later join an existing assistance unit such as an older child, or a returning absent parent.
The application form together with the Case Manager's records (if any), the necessary forms (budgets, notices of action, narratives, etc.), and any required verification must substantiate eligibility or ineligibility.
At the time of application processing, each month shall be viewed separately in determining eligibility or ineligibility. For example, if an application is filed in July but processed in August, ineligibility in August shall not effect the eligibility determination for the month of July.
Applications for either Medicaid poverty level coverage (HealthWave 19) (see 2270) or HealthWave 21 coverage (see 2400) for children can be filed via the HealthWave application. Such applications are to be mailed to the HealthWave Clearinghouse and can also be accepted at the local SRS office. A central HealthWave Clearinghouse has been established to determine eligibility for either of these programs if the family is accessing only Medicaid poverty level or HealthWave medical benefits for children. The current contractor managing the Clearinghouse is MAXIMUS. If the family accesses other benefits such as food stamps or childcare, eligibility could be established at the local SRS office and managed at the Clearinghouse.
1402 How to Apply - Application forms can be requested from any local SRS office, SRS access site, or the HealthWave Clearinghouse. An application can be filed in person, by mail, or electronically by fax or computer. Each household has the right to file an application on the same day it contacts the SRS office during office hours or mails the application to the HealthWave Clearinghouse.
When an application is requested in person, the local office shall encourage the household to file the application that same day. When an application is requested from the local office over the telephone, the local office shall encourage the applicant to appear in person and file the application that same day, or offer to mail the application that same day, when possible, or the following business day. When an application is requested over the telephone from the HealthWave Clearinghouse, it shall be mailed the same day, when possible, or the following business day. When an application is requested in writing, the local office or HealthWave Clearinghouse shall mail an application to the household the same day the request is received, when possible, or the following business day.
NOTE: If the applicant household is homeless and they have no street address to list, the application shall be so noted and accepted by the agency.
For ongoing recipients who apply for additional assistance under a different program (e.g., a medical recipient who requests cash assistance) and for situations in which an additional program is added to a pending application based on a client's request, the following provisions shall apply:
NOTE: The provisions below are not applicable to instances in which the agency initiates the new program, e.g., closing TAF but continuing medical for a pregnant woman.
1402.01 - If the new program is requested within the month following the month of application, or in the first month of the new review period, neither an application nor signature is required.
1402.02 - If the new program is requested after the month following the month of application or after the first month of the review period, an application is required.
1402.03 - If a request is made for a new medical program after the month following the month of application or after the first month of the new review period and there are less than six months left in the current review period, an application is required.
1403 Application date - The date of receipt in a local SRS Service Center or the HealthWave Clearinghouse (for the HealthWave program and some Medicaid programs) of a signed paper application is considered the application date for establishing initial eligibility. Giving a signed paper application to an SRS worker during a face-to face- interview at an off-site location, such as a home visit or at an SRS Access Point, shall also establish the date of application.
Note: Date stamping of an application by an SRS Access Point does not constitute a date of receipt for application processing.
For an on-line application, the date the application is submitted on-line shall be considered the application date for establishing initial eligibility if the signed signature page is received in the local SRS office or the HealthWave Clearinghouse within 10 calendar days following the date the on-line application is submitted. Signature pages can be returned by fax as well as mail. If the signature page is not received within 10 calendar days of the date the on-line application is submitted, the application shall be denied see 1406.02(6). The on-line application shall be registered in KAECSES when received prior to receipt of the signature page.
Upon receipt of the online application at the HealthWave Clearinghouse, all applicants shall be mailed the signature page, even when the applicant has not indicated that they require one. The signature page shall be mailed on the same day the on-line application is submitted if submitted on a workday during business hours. The consumer must then sign and return the page within 10 calendar days or the application shall be denied as noted above.
When the on-line application is submitted after hours or on a weekend or holiday, the signature page shall be mailed on the first workday following the date the application is submitted.
For information regarding a faxed or copied application form see 1211.02.
1404 Who May File - An application for assistance shall be made by the individual in need or by another person able to act in the individual's behalf. See 2010. If the applicant or his representative signs by mark, the names and addresses of two witnesses are required. Obtaining the signatures of all persons in the family group who are requesting assistance and able to act in their own behalf per 2010 is encouraged, but cannot be required.
1404.01 Filing on Behalf of a Deceased Person - For medical, an application may be made on behalf of a deceased person by any responsible person. Application must be made in the month of death or within the three following months.
1404.02 Filing for Institutionalized Individuals - When possible, all necessary information and signed forms will be obtained by institutional personnel. Parents, spouses, guardians/conservators and others who may apply on behalf of the individual per 2010 must always be given the opportunity to apply on behalf of an institutionalized person not able to act in his own behalf. If institutionalized personnel are unable to obtain the required forms from the patient or any of the above individuals, the administrator of a licensed facility may apply on behalf of the patient. General hospitals are not regarded as a licensed facility for this purpose.
Complete applications will be forwarded to the SRS office or CH for processing.
All information pertinent to eligibility and known by institutional staff will be communicated to the local office. When the institution acts as an employer to the patient, institutional personnel will be responsible for reporting all earnings to the local SRS office.
Generally the local SRS office where the institution is located will process new applications. However, when appropriate, the local office or CH shall determine whether the individual is currently included on an open medical case before processing. If the individual is included on a currently open case, the application shall be denied. The referral and a copy of the application shall be sent to the current county or CH where the appropriate case action will be taken to certify eligibility to the institution. (See 7300) For individuals who currently have an unmet spenddown, the institution should be notified as no FFP can be claimed until the spenddown is met. Medical expenses incurred at the institution shall be considered toward the unmet spenddown and eligibility certified when the spenddown is met.
1404.03 Withdrawing the Application - The household may voluntarily withdraw its application at any time. The agency shall document in the case file the reason for withdrawal, if any was stated by the household, and that contact was made with the household to confirm the withdrawal. The household shall be advised of its right to reapply at any time subsequent to withdrawal.
1404.04 Universal Access - An individual or family can apply for benefits where they choose. All family medical cases will be transferred to and maintained by the HealthWave Clearinghouse once processed. The SRS Service Center where the application is filed shall inform the consumer about the transfer to the HealthWave Clearinghouse.
1405 Time In Which Application is to be Processed and Case Disposition - All applications shall be approved or denied on a timely basis except when a determination of eligibility cannot be made within the required period due to the failure of the applicant or collateral to provide required information. Written notice must be given to the applicant by the end of the required period giving the reason(s) for the delay. The approval of an application from an alien who is otherwise eligible may not be delayed beyond the timely processing time frame due solely to the fact that no USCIS response to a request for verification of immigration status has been received.
Timely action is defined as follows:
1405.01 Medicaid Poverty Level and HealthWave - Within 15 calendar days of receipt of a completed application and all necessary supporting documentation; but no later than 45 days.
For pregnant women entitled to expedited service, the application shall be processed so the pregnant woman receives a medical card no later than 10 calendar days from the date of application. See 1407.
1405.02 All Other Medical Applications - Within 45 days of the agency's receipt of a signed application. For management purposes the agency shall strive to process applications within 30 days.
1406 Disposition of Applications - Disposition of Applications - The purpose of this section is to provide instructions regarding the procedures that follow the determination of eligibility or ineligibility for assistance. Eligibility/ineligibility is certified using KAECSES procedures. A copy of the Notice of Action is to be sent to medical providers to certify eligibility/ineligibility on medical cases when required.
One of the following case actions must occur within the established time period outlined in 1405.
1406.01 Approval - A notice of approval shall be sent for all programs determined eligible. Notices must contain the program approved for and the beginning and ending dates of the review period.
The application will be approved for medical, if automatically eligible, or if determined eligible with respect to all factors including financial.
(1) - Approved - Suspended - If the applicant is eligible with respect to all factors other than financial but there is a spenddown (see 6500), the application will be approved in a spenddown status if there appears to be a likelihood that the spenddown will be met within the 6 month eligibility base period using evidence provided by the client. This is an administrative procedure to meet the application disposition time requirements and to preserve the original application date. However, there is no eligibility until the spenddown is met. See 1412 concerning suspension.
Upon certification of eligibility initially or after suspension, a medical identification card may be issued by the regional/local SRS office or the HW Clearinghouse, covering any months for which a card will not be issued automatically. Subsequent medical cards are issued by the fiscal agent.
1406.02 Denial - A denial shall be processed to assure that the applicant is provided with his/her denial notice in a timely manner. A notice of denial shall be sent at the time of denial, explaining clearly the reason for the denial.
(1) - Found Ineligible - An application shall be denied if the applicant is found to be ineligible (i.e., excess income, excess resources, etc.) as soon as possible, but no later than 45 days following the date the application was filed. If participation is subsequently desired, such households must file a new application. In no case does the denial of the application abridge that individual's right to reapply at any time.
(2) - Failure to Provide Required Information/Cooperation - An application shall be denied after a period of 10 days from the date of a written request for information, but no later than 45 days from the date of application when the applicant has failed to provide required information or cooperate with eligibility requirements. The applicant must be informed writing of the 10-day standard and the date by which the verification /cooperation must be received.
If the information is subsequently received or the household cooperates within the 45 day application processing time period, the application shall be reactivated and, if eligible, benefits prorated from the date of application. If the information/ cooperation are not received within the above time frames, then the client must re-apply.
(3) - Spenddown - When a spenddown is established for a minor who would otherwise be eligible for Title 21 coverage, eligibility staff must ascertain the likelihood that the spenddown will be met. In order to make this determination and prevent delaying Title 21 approval, contact with the applicant must be made as quickly as possible. The applicant must be informed of the spenddown amount and given a 10 day notice to respond to the likelihood that the spenddown will be met within the 6 month eligibility base period. If the applicant fails to respond or it does not appear that the spenddown will be met, the application will be denied (or MA case closed for failure to meet the spenddown) and Title 21 coverage will be authorized. In spenddown cases where there is no possibility of Title 21 eligibility, the spenddown is established and the case remains open throughout the base period. At the end of the base period, staff determines if there is a need for further spenddown coverage.
(4) - Another Agency Assumes Responsibility - The agency may dispose of the application if another agency assumes complete responsibility for meeting the applicant's need.
(5) - Cannot be Located - The agency may dispose of the application if the applicant has moved and cannot be located. The agency shall not send a notice of decision.
(6) – Failure to Return Signature Page - If the signature page of an on-line application is not signed and returned to the local SRS office within 10 calendar days, the application will be denied. If it is later returned within 30 days of the date the application was originally submitted, the previously submitted application shall be reinstated and a new application is not required. Assistance shall then be determined from the date the signature page is returned.
1406.03 Pending - If a decision cannot be made on an application within the applicable timely processing period because of agency delay, the application shall not be denied. The Case Manager shall notify the applicant(s) that its application is still pending, and what action, it must take to complete the application process and what date the action must be taken or the case will be denied.
1407 Expedited Medical Service for Pregnant Women Program - Expedited service shall be provided to eligible applicants for pregnant women who apply for medical assistance. Specific requirements are delineated in the sections that follow.
Expedited Medical Eligibility for Pregnant Women - All pregnant women who apply for medical assistance, shall be initially assessed for expedited medical eligibility. If eligible based on the criteria listed below the pregnant woman shall receive a medical card no later than 10 calendar days from the date of application.
In order to qualify for expedited medical eligibility, the pregnant woman must:
1407.01 - Meet the financial requirements of the poverty level program in accordance with 2280; and
1407.02 - Meet all general eligibility requirements as referenced in 2270 except for the completion of an SS-5 for those who do not have or cannot provide a Social Security number.
If all of the above criteria are met, the pregnant woman shall be initially approved for expedited medical assistance only within the 10 day time frame. Only the pregnant woman is eligible for expedited medical assistance. A formal determination of eligibility would then be completed based on the normal processing time guidelines for the pregnant woman. If the pregnant woman is not eligible for expedited medical assistance, the formal determination process shall then be initiated.
For purposes of determining expedited medical eligibility, the simplified eligibility concept of 1320 shall be used to the greatest extent possible. The information on the application/ redetermination form and statements of the pregnant woman shall be accepted as long as eligibility can be determined from that information. If the information provided is inconsistent or incomplete (e.g., estimate of income not provided) so that eligibility cannot be determined, expedited eligibility shall be postponed until sufficient information is provided. All verifications may be postponed including the pregnancy verifications in order to meet the 10 day processing time. However, such verifications will need to be provided in order to complete the formal determination process.
Expedited medical eligibility status shall not extend beyond two months following the month of application for assistance. If the pregnant woman were later determined ineligible for assistance, the case would be closed allowing for timely and adequate notice. Any resulting overpayments will be subject to recovery. The continuous eligibility provisions of 2301 would not be applicable if the income used to determined expedited eligibility was incorrect and the revised amount actually exceeded the poverty level standard from the beginning.
If the anticipated category of assistance is apparent based on the initial assessment, the case could be opened using the appropriate program. Otherwise the case should be initially opened on a poverty level program.
1408 Presumptive Eligibility for Children - Temporary medical assistance is available to children determined eligible by a qualified entity beginning July 1, 2006. Coverage for this group is provided under the Balanced budget Act of 1997.
Presumptive Eligibility (PE) is when a qualified entity determines that a child appears eligible for coverage because the family income is below the applicable Medicaid or HealthWave 21 guidelines.
In the Presumptive Eligibility for Children program, staff at designated Qualified Entities makes limited eligibility determinations for children under the age of 19, who are Kansas residents, and are U.S. citizens or meet the qualified alien criteria.
A child is allowed one presumptive eligibility coverage period within any twelve-month time period.
1408.01 Qualified Entities - KHPA is responsible for certifying all entities qualified to make Presumptive Eligibility decisions. Certain Medicaid enrolled hospitals and Safety Net Clinics have been designated Qualified Entities allowed to make presumptive eligibility decisions.
Additional types of Qualified Entities may be considered at a later date. Refer all requests to become a Qualified Entity to the Family Medical Policy Manger with the Kansas Health Policy Authority. All entities must complete training and receive certification by KHPA prior to making any determinations.
KHPA is responsible for developing and maintaining copies of the electronic and paper Presumptive Eligibility Determination tools that are used by a Qualified Entity in determining a child’s eligibility. Initial copies and updated versions of each tool are distributed to each Qualified Entity through the Kansas Medical Assistance Program provider bulletin process.
1408.02 Qualified Entity Responsibilities - Staff at each Qualified Entity are responsible for identifying children who could benefit from the Presumptive Eligibility Program.
Qualified Entity staff will make presumptive decisions as well as inform families of the program. They will also assist families who wish to apply for coverage with completing the HealthWave application form. This assistance shall include completion and submission of the HealthWave application, assistance in obtaining supporting documentation, and follow-up with the family to provide support through the application process.
The following processes must be completed when making a presumptive determination:
1. The Qualified Entity completes a determination of presumptive eligibility using the Presumptive Eligibility Determination Tool created and provided by KHPA. Information provided by the family is used by the Qualified Entity when completing the tool.
The Presumptive Eligibility determination is final. The applicant household does not have appeal rights regarding the outcome of their presumptive determination.
Each Qualified Entity maintains records of all of the Presumptive Eligibility determinations they complete.
2. The Qualified Entity submits the completed Presumptive Eligibility Determination tool to the HealthWave Eligibility Clearinghouse within 2 business days of the determination.
3. The Qualified Entity provides each child determined eligible verification of their coverage start date. This eligibility verification is in the form of a paper medical card which includes the adult caretaker’s name, the household’s address, the child’s name, the child’s date of birth, and the child’s Social Security Number (if known). The eligibility verification is proof that the child is covered for up to 7 days. After 7 days, the child has their medical card and uses this as proof of eligibility or the provider must verify eligibility through the MMIS.
4. The Qualified Entity informs families of the reason a child was found ineligible for PE coverage and encourages the household to complete the formal application process even though the child was not presumptively eligible. A presumptive determination is based on household statements and may not have the same outcome as the formal eligibility determination completed by KHPA.
5. The Qualified Entity forwards each completed HealthWave application form, regardless of whether the children are found presumptively eligible for coverage, to the HealthWave Eligibility Clearinghouse for a determination of ongoing eligibility.
6. Qualified Entity staff assists the family, as much as possible, with providing verifications and other household information to the HealthWave Eligibility Clearinghouse for the ongoing formal eligibility determination.
1408.03 HealthWave Eligibility Clearinghouse Responsibilities - Staff at the HealthWave Eligibility Clearinghouse record the results of each Presumptive Eligibility determination and enter presumptive coverage in the KAECSES system.
Presumptive Eligibility is determined on the KAECSES system under the MK program and with a PE program subtype. The following individual medical subtypes are recorded on the KAECSES MERE screen:
1. PN - for HealthWave 19 (Medicaid) coverage.
2. PT - for HealthWave 21 (SCHIP) coverage.
A notice of action is sent from the KAECSES system describing the presumptive eligibility coverage period and communicating to the family the importance of completing the formal application process.
The HealthWave Eligibility Clearinghouse is responsible for completing the determination of ongoing eligibility for presumptively eligible children under MA-CM, HealthWave 19, HealthWave 21, or Medically Needy.
The HealthWave Eligibility Clearinghouse makes certain that presumptive coverage ends when the formal determination of eligibility for the child is complete. Coverage shall end at the end of the month following the month of the presumptive determination when the HealthWave application is not received.
1408.04 Applicant Responsibilities in the Presumptive Eligiblity Process - The adult applicant household member is responsible for providing the Qualified Entity staff with household information to be used in making the Presumptive Eligibility determination (see 1211.02.) Information provided to each entity for purposes of making a presumptive eligibility determination must be true and correct (see 8410.)
1408.05 Period of Presumptive Eligibility - Presumptive Eligibility coverage begins on the date staff at the Qualified Entity approve the PE Determination Tool in the presence of the family. The approval letter provided to the family by the Qualified Entity reflects this date as when the child’s coverage begins. Coverage is not provided for days prior to the completion of the presumptive determination. The family must complete the HealthWave application (and request assistance with unpaid medical bills, if applicable) in order to be determined for potential eligibility for the time period prior to the approval of presumptive coverage.
Presumptive Eligibility coverage ends the month following the presumptive eligibility determination.
If the HealthWave application is received during the presumptive eligibility period, a child may continue to receive presumptive coverage until the formal application is processed and a determination of the child’s formal eligibility is made. This includes allowing the applicant a reasonable opportunity period to provide necessary citizenship and identity documents as defined in KFMAM 2046.
A child may only be provided with one Presumptive Eligibility coverage period within a twelve-month time frame. The twelve-month period begins with the month the child is determined eligible for presumptive coverage. For example, Billy is approved for presumptive eligibility on July 10th, 2007. July is the first month of the twelve-month period. Billy cannot receive additional presumptive coverage until July 1, 2008.
Presumptive eligibility coverage periods have no impact on continuous eligibility provisions. Continuous eligibility is not applicable until the formal application is processed (See 2310.)
Adequate notice is required to end temporary presumptive benefits.
The household does not have a right to continuation of benefits upon pending an appeal of the termination of presumptive benefits because the receipt of these benefits is time-limited.
01410 Case Disposition - Assistance may be suspended for individuals who are temporarily not eligible. It may also be suspended in instances in which it would appear to affect eligibility but there is not enough information to make a final determination. Action to suspend must follow the advance notice requirements of 1422.
1411 Provisions Specific to Medical Eligibility - Suspension of medical benefits does not shorten an established medical eligibility base period and a new application is not required to reinstate assistance within the period. Regardless of the procedure used, medical eligibility shall not be suspended without meeting notice requirements related to adverse action. Benefits shall not be suspended for more than 6 months except in rare cases where there is clear documentation that circumstances have changed so that medical eligibility can reasonably be expected within the next 6 month period. If the case is not to be closed, medical eligibility on a medical only case will be suspended. Refer to the KAECSES User Manual for procedures when:
1411.01 - An unmet spenddown is documented at application or due to a change in circumstances. (See 1406.01); or
1411.02 - Information needed to determine eligibility is lacking but appears to be forthcoming.
1412 Termination of Assistance - When a recipient no longer meets the eligibility requirements, action to terminate assistance and, taking into account timely and adequate notice in 1422, notification requirements related to information obtained through federal computer match in 1425 and fiscal processing deadlines. Medical closures will always be effective the last day of a given month. To protect credibility with medical providers, the termination date may not be changed after issuance of a medical card. However, the date of death will be used in the KAECSES system for a deceased individual since there are no eligible services after that date.
01420 Written Notice of Case Action - An applicant or recipient of assistance shall be notified promptly of the action taken on his case. The recipient of assistance shall also be notified of other changes such as an increase or decrease in the spenddown, suspension, or reinstatement after suspension.
1421 Notice of Action - Shall be sent promptly to the applicant or recipient with a copy of any manually prepared notices filed in the case record. When appropriate, a copy must be made available on approvals, suspensions or closure to social services, CSE, or HCBS case manager. Specialized notice forms are required for all cases involving a spenddown, and for all cases in which the medical program will assume at least partial payment for care situations.
Notices shall indicate clearly the action taken, the effective date, and such other information as the situation may require. For all medical approvals, notice must include the beginning and ending dates of the review period. If an application is denied, the applicant shall be informed of the basis for this action. A similar procedure shall be followed for all other changes.
For medical notices the statement shall not, however, indicate:
1422 Timely and Adequate Notice - The agency shall give timely and adequate notice of agency actions to terminate, suspend, or reduce assistance except as provided for in 1422.01 regarding dispensing with timely notice and in 1425 regarding negative actions resulting from information obtained through federal match data. See 7420 for further information on notice provisions for reviews.
1422.01 Adequate Notice - Adequate means a written notice that includes a statement of what action the agency is taking, the reasons for the intended agency action, the specific manual references supporting such action, an explanation of the individual's right to request a fair hearing, and the circumstances under which assistance may be continued if a fair hearing request is made. All notices must be adequate.
1422.02 Timely Notice - Timely means that the notice is mailed at least 10 clear days before the effective date of action. Neither the effective date of action nor the mailing date shall be considered in determining this 10 day period. Closure notices must be mailed no later than the 20th of the month in 31 day months or the 19th of the month in 30 day months to be considered timely since the effective date of action for closures is always the last day of the month. For other negative actions, specifically benefit decreases or spenddown/liability increases, notices must be mailed no later than the 21st of the month in 31 day months or the 20th in 30 day months as these actions take effect on the 1st day of a month.
1423 Adequate Notice Only - When only adequate notice is required, such notice may be received by the household at the time reduced benefits are received or if benefits are terminated, at the time benefits would have been received if they had not been terminated. The agency is not required to send timely notice but must send adequate notice not later than the date of action when:
1423.01 - The agency denies an application for assistance. However, denials resulting from information obtained through federal match data shall be subject to the provisions of 1425.
1423.02 - The agency has factual information confirming the death of a client or of the payee when there is no relative available to serve as new payee.
1423.03 - The agency receives a clear written statement signed by a client indicating that he no longer wishes assistance, or that gives information which requires termination or reduction of assistance, and the client has indicated, in writing, that he understands that this must be the consequence of supplying such information.
1423.04 - The client has been admitted to an institution and further medical assistance will not be provided to that individual.
1423.05 - The client has been placed in a Medicaid approved institution for long term care or begins HCBS and will receive Medicaid payment for the cost of care.
1423.06 - The client's whereabouts are unknown and agency mail directed to him has been returned by the post office indicating no known forwarding address.
1423.07 - A client has been accepted for assistance in a new jurisdiction and that fact has been established by the jurisdiction previously providing assistance.
1423.08 - MA CM child is removed from the home as a result of a judicial determination, or voluntarily placed in foster care by his legal guardian.
1423.09 - Assistance is approved and negative case action such as a closure is incorporated into the initial notice of action to the client. However, negative action resulting from information obtained through federal match data shall be subject to the provisions of 1425.
NOTE: Timely and adequate notice must be given for any termination in benefits resulting from information obtained by the consumer or other sources.
1423.10 - A client is disqualified for fraud through a court of appropriate jurisdiction.
1423.11 - A premium requirement is established or increased for a HealthWave case per 2440.
1424 Automatic Benefit Adjustments for Classes of Clients - When changes in either state or federal law require automatic adjustment for classes of clients, timely notice of such adjustments shall be given which shall be adequate if it includes a statement of the intended action, the reasons for such intended action, a statement of the specific change in the law requiring such action, and a statement of the circumstances under which a hearing may be obtained and assistance continued.
1425 Notice of Actions Resulting from Federal Match Data - Based on the provisions of the Computer Matching and Privacy Protection Act, no immediate action to suspend, terminate, reduce, or deny assistance in the medical program may be taken as a result of information obtained through federal match data which has not been determined to be accurate and reliable by the federal agency producing the data. When the federal information has not been determined to be accurate and reliable, the individual must be given 30 days from the date the notice of action is received to verify or contest the match data. This means that such notice must be sent at least 35 days prior to the effective date of action for recipients or the date the application is to be processed for applicants.
Federal matches currently affected by these provisions include the SIEVS (IRS and BEER data) match and VA match. It does not include BENDEX, SDX, SAVE information from INS, and third party queries obtained through SSA as all of these data exchanges are either considered to be accurate and reliable or involve a computer match process between state and federal records. It also does not include Employment Security matches as this is not a direct federal-state match.
If the individual does not respond to the notice, final action based upon the match data can be taken upon expiration of the 35 day notice period and allowing for timely and adequate notice of action. All or part of the 10 day timely notice period may run concurrently with the 35 day notice period. However, all BEERS and IRS-related match data is to be considered as a lead only and not to be used as primary verification or evidence without further independent verification.
If the individual confirms the validity of the information prior to the expiration of the 35 day period, action can be taken immediately allowing for 10 day timely and adequate notice. In addition, for applicants, action can be taken to deny the application without a 35 day notice period, if the individual has already confirmed the match data through verification provided or information which was incorporated on the application form.
If the individual contests the data during the 35 day notice period, no action can be taken until the information is further verified. If the individual cannot provide verification in regard to IRS or BEER data, contact with such sources as the financial institution, employer, etc. will need to be made.
Client cooperation in the verification process will be essential for any action prior to the 35 day notice period. If the client refuses to cooperate and/or contests the information and verification cannot be otherwise obtained, action can be taken on the case following the expiration of the 35 day notice period and allowing for timely and adequate notice of the action.
1501 Request for a Hearing - A request for a fair hearing is defined as a clear expression, or written, to appeal a decision or final action of any agency or employee of the Kansas Health Policy Authority or the Department of Social and Rehabilitation Services. The Office of Administrative Hearings in the Department of Administration administers the agency's fair hearing program pursuant to the Kansas Administrative Procedure Act (K.S.A. 77-501 et seq.).
The rights, responsibilities, and procedures for fair hearings for other interested persons are similar to those applicants/recipients as explained in this section except that hearings for other interested persons shall be held in Topeka.
The following persons may request a fair hearing:
1501.01 - Any person who is an applicant, recipient, or other interested person including inmates and taxpayers may request a fair hearing.
1502 Time Period For Requesting A Hearing - The date of request shall be the date the agency received the request.
1502.01 - Unless preempted by federal law, a request for a fair hearing shall be in writing and received by the agency within 33 days from the date the notice of action is mailed. When a request for a fair hearing is received prior to the effective date of action as prescribed in 1503, assistance may be continued.
Such request may relate to an applicant's request for assistance, which is denied, or is not acted upon with reasonable promptness, and to any recipient who is aggrieved by any agency action resulting in suspension, discontinuance, or termination of assistance.
1503 Continuation of Benefits - If a written request for a fair hearing is received within 10 days of the date the notice of adverse action is mailed; assistance shall not be suspended, discontinued, or terminated until a decision is rendered after a hearing, unless:
1503.01 - A determination is made at the hearing by the hearing officer that the sole issue is one of state or federal law or regulation, or change in state or federal law and not one of incorrect application of a policy (when appropriate, local SRS staff or HealthWave Clearinghouse staff should raise this issue in the hearing in order for the referee to render a decision).
1503.02 - A change (except the matter under appeal) affecting the recipient's assistance occurs while the fair hearing decision is pending and the recipient fails to request a hearing after notice of the change.
1503.03 - The request for a fair hearing concerns a discontinued program or service.
1503.04 - The review period expires. The household may reapply and may be determined eligible for a new review period with a benefit amount as determined by the agency.
1503.05 - A mass change affecting the household's eligibility or basis of issuance occurs while the hearing decision is pending.
Assistance shall also be continued at its prior level if the client or agency submits a timely request for review by the State Appeals Committee. See 1507.
NOTE: In any case where action was taken without timely notice, if the recipient requests a hearing within 10 days of the mailing of the notice of action, and the agency determines that the action resulted from other than the application of state or federal law or policy or a change in state or federal law, assistance shall be reinstated and continued until a decision is rendered in the matter as set forth above.
1504 Client's Rights Related to a Fair Hearing - The client or the client's representative shall have adequate opportunity to:
1504.01 - Complete a written request for a fair hearing, which may be on the Request for Administrative Hearing form, regarding any agency action. However, a hearing need not be granted if the request concerns only the validity of federal or state law or regulation. In addition, a hearing need not be granted when either state or federal law requires automatic adjustments for classes of recipients unless the reason for an individual appeal is incorrect computation. See 1503.01.
1504.02 - Examine the contents of his case file and all documents and records to be used by the agency at the hearing at a reasonable time before the date of the hearing as well as during the hearing. Refer to 1500 regarding confidential case file information.
1504.03 - At his option, present his case himself, or with the aid of an authorized representative, and bring witnesses.
1504.04 - Establish all pertinent facts and circumstances and advance any pertinent arguments without undue interference.
1504.05 - Question or refute any testimony or evidence, including opportunity to confront and cross-examine adverse witnesses.
1504.06 - Submit evidence to establish all pertinent facts and circumstances in the case.
1505 Responsibilities of the Local Office and HealthWave Clearinghouse - Every applicant/recipient shall be informed in writing at the time of application and at the time of any subsequent action affecting medical assistance of the right to a fair hearing, the method of obtaining such hearing, and that representation may be by an authorized representative such as legal counsel, relative, friend, or other spokesperson. Information printed on the application/redetermination form and notices of action will provide this information.
Agency hearing procedures shall be uniform, clearly written, and available to any interested party. At a minimum, the procedures shall include time limits for filing requests for appeals, advance notice requirements, hearing timeliness standards, and the rights and responsibilities of persons requesting a hearing. The booklet, Fair Hearing Procedures, shall be used for this purpose.
1505.01 Standard Procedures - The procedures set forth below shall be followed whenever a client makes an inquiry concerning a fair hearing, asks for fair hearing forms, or files a request for a fair hearing.
(1) - The Case Manager or supervisor should find out why the client is questioning the agency action.
(2) - If the client is only disagreeing with a federal or state law or policy, the reason for such policy should be discussed with the client.
(3) - If a client appears to be questioning the application of a federal or state law or policy to his individual situation (incorrect grant computation or use of incorrect facts), an administrative review shall be conducted to determine if the agency action was correct. Upon reconsideration, the agency may amend or change its decision at any time before or during the hearing. The hearing shall not be delayed or canceled because of this preliminary review. If a satisfactory adjustment is reached prior to the hearing, the agency shall submit a written report to the hearing officer but the appeal shall remain pending until the client submits a signed written statement withdrawing the request for a fair hearing.
(4) - If the client is questioning the decision regarding disability and the decision was made related to an SSI or SSA application for benefits, the client is to be referred to the SSA office to file an appeal. See KEESM 2637.
(5) - If the client is questioning the decision regarding disability and the decision was made by Disability Determination and Referral Services (DDRS) based on an SRS request via the DD-1104 and DD-1105, the appeal will be processed through DDRS as specified in KEESM 2662.1.
1505.02 Agency Conference - Local offices and the Clearinghouse shall offer agency conferences to households wishing to contest an adverse agency action. Local office and Clearinghouse staff shall advise households that use of an agency conference is optional and that it shall in no way replace or delay the fair hearing process. The following procedures apply:
(1) - The agency conference may be attended by the Case Manager responsible for the agency action and shall be attended by an EES/CH Supervisor or EES Field Administrator, and by the household and/or its representative. An agency conference may lead to an informal resolution of the dispute. However, a fair hearing shall still be held unless the household makes a written withdrawal of its request for a fair hearing.
Such conferences shall be scheduled within 2 working days of the date the appeal is filed, unless the household requests that it be scheduled later or states that it does not wish to have an agency conference.
1505.03 Completion of Summary - Within 15 days after the appellant has filed a request for a fair hearing, the agency shall furnish the appellant and the Office of Administrative Hearings with a summary setting forth the following information:
(1) - Name and address of the appellant;
(2) - a summary statement concerning why the appellant is filing a request for a fair hearing;
(3) - a brief chronological summary of the agency action which led to the appeal and the agency's action after receiving the request for fair hearing;
(4) - a statement of the basis for the agency's decision;
(5) - a citation of the applicable policies relied upon by the agency;
(6) - a copy of the notice which notified the appellant of the decision in question;
(7) - applicable correspondence; and
(8) - the name and title of the person or persons who will represent the agency at the hearing.
(9) - For Appeals of a DDS disability decision
see KEESM 1614.3(9).
If, through an agency conference as discussed in 1505.02, the appellant has withdrawn the appeal, completion of the summary is not necessary. The Request for Administrative Hearing form should then be submitted, along with the Notice of Withdrawal of Appeal, to the Office of Administrative Hearings within 7 days of the date of the request for a fair hearing.
1505.04 Informing the Client of Termination of Assistance - The agency shall promptly inform the client in writing if assistance is to be terminated pending the fair hearing decision.
1505.05 Dismissal of Fair Hearings - Dismissal of Fair Hearings - Kansas statute K.S.A. 75-3306(h) states: "The Department of Social and Rehabilitation Services and the Kansas Health Policy Authority shall not have jurisdiction to determine the facial validity of a state or federal statute. An administrative law judge from the Office of Administrative Hearings shall not have jurisdiction to determine the facial validity of an agency rule and regulation." So, clients have no right to a fair hearing if they simply disagree with a regulation that results in a loss of eligibility. However, clients may have a hearing if they believe that the agency incorrectly applied such regulation to the client’s individual situation (use of incorrect facts). The issue is whether the client is only challenging the validity of the regulation or really presenting a factual dispute. If there is no dispute between the client and the agency as to the facts involved, the client’s request for a fair hearing in most instances will be dismissed by the hearing officer before the hearing.
As such, if the client is only disagreeing with a federal or state law or regulation (whether a current regulation or one that is changing) and, after following the procedures set forth in 1505.01, wishes to file a request for a fair hearing (or fails to withdraw a request previously filed), the agency should complete a Motion to Dismiss form. (See the Appendix Section of KEESM.) The form is to be submitted to the Office of Administrative Hearings within 10 days of the request for a hearing. A copy of the appropriate Notice of Action and the Request for Administrative Hearing form should be attached to the motion. Do not submit an appeal unless the motion is denied. KHPA or SRS must mail a copy of the Motion to Dismiss to the appellant. The Case Manager should complete the Certificate of Service and sign it. Write the actual mailing date on the certificate, as well as the appellant's name and address. On the Motion to Dismiss, the line "Such action is based on" should reflect the appropriate law or regulation. (Contact KHPA as needed for this information.) For dismissal requests regarding major program changes or cutbacks, specific citations will be provided from the KHPA.
Fair hearings shall also be dismissed if the request is not received within the time periods specified in 1502, or the household or its representative fails, without good cause, to appear at the scheduled hearing.
Assistance shall continue as noted in 1503 until a decision is rendered concerning the dismissal. If the dismissal request is approved, assistance shall be terminated unless the appellant requests State Appeals Committee review within the 15 days allowed. If the dismissal request is denied, assistance must continue until the presiding officer issues an initial order affirming the agency action, unless there is a State Appeals Committee review request.
1506 Place and Conduct of Fair Hearings - Fair hearings for applicants or recipients shall be held in the Social and Rehabilitation Services' administrative area in which the applicant or recipient resides unless another site has been designated by the hearing officer. At least 10 days prior to the hearing, advance written notice shall be mailed to all parties involved to permit adequate preparation of the case.
The hearing officer may conduct the fair hearing or any prehearing by telephone or other electronic means if each participant in the hearing or prehearing has an opportunity to participate in the entire proceeding while the proceeding is taking place. A party may be granted a face to face hearing or prehearing if good cause can be shown that a fair and impartial hearing or prehearing could not be conducted by telephone or other electronic means.
At a hearing, the hearing officer shall regulate the course of the proceedings. To the extent necessary for full disclosure of all relevant facts and issues, the hearing officer shall provide all parties the opportunity to respond, present evidence and argument, conduct cross-examination and submit rebuttal evidence, except as restricted by a limited grant of intervention or by a prehearing order.
The hearing officer may, and when required by statute shall, give nonparties an opportunity to present oral or written statements. If the hearing officer proposes to consider a statement by a nonparty, the hearing officer shall give all parties an opportunity to challenge or rebut it and, on motion of any party, the hearing officer shall require the statement to be given under oath or affirmation.
A hearing officer need not be bound by technical rules of evidence, but shall give the parties reasonable opportunity to be heard and to present evidence. Evidence need not be excluded solely because it is hearsay.
All testimony of parties and witnesses shall be made under oath or affirmation. Statements of nonparties may be received as evidence.
Any part of the evidence may be received in written form if doing so will expedite the hearing without substantial prejudice to the interests of any party. Documentary evidence may be received in the form of a copy or excerpt. Upon request, parties shall be given an opportunity to compare the copy with the original if available.
The hearing officer may not communicate, directly or indirectly, regarding any issue in the proceeding while the proceeding is pending, with any party or participant, with any person who has a direct or indirect interest in the outcome of the proceeding or with any person who presided at a previous stage of the proceeding, without notice and opportunity for all parties to participate in the communication.
1507 Fair Hearing Decision and Request for Review - A fair hearing decision shall be rendered by the hearing officer no later than 90 days after receipt of the request on a Request for Administrative Hearing form or similar document and the decision shall be sent to the client and the local office or HealthWave Clearinghouse.
The client/respondent shall be informed of his right to have the State Appeals Committee review the decision of the hearing officer and also his right to petition to the District Court. A request to the State Appeals Committee must be made within 18 days of the date of the fair hearing decision. The client/respondent may also have the right to request a re-hearing in order to submit additional information or evidence. This request must also be made within 18 days of the date of the fair hearing decision.
Assistance shall be continued at its prior level if the client or the agency requests a review by the State Appeals Committee. Assistance shall continue until a decision is rendered by the State Appeals Committee.
The decision of the Appeals Committee is final and binding upon the client and the agency on the date of the decision. This is true even if one of the parties should appeal the matter to the District Court. Assistance shall not continue at its prior level following the decision of the State Appeals Committee unless there is a court order to the contrary.
1508 Agency Actions Following Fair Hearing Decisions - The decision of the hearing officer shall be implemented immediately upon receipt (including decisions related to disability) if the decision is favorable to the client and the agency does not intend to request a review by the State Appeals Committee. A report of such action shall be submitted to the Administrative Hearings Section. If the agency requests such a review, the decision shall not be implemented until a final decision by the State Appeals Committee has been rendered. Also, if the decision is unfavorable to the client, the decision shall not be implemented until the 18th day following the date of the mailing of the initial decision to allow the client the opportunity to request a review by the State Appeals Committee. If a request is made within the 18 day period, the decision shall not be implemented.
1508.01 Retroactive Payments - When the hearing decision is favorable to the client, or when the agency decides in favor of the client prior to the hearing, the agency shall promptly make corrective coverage.
1508.02 Recovery of Overpayments - When the hearing decision upholds agency action, any overpayment made during the fair hearing process is subject to recovery, except in situations where the action being appealed is the application of a CSE penalty.
01520 Complaints and Grievances -
1521 Complaint Procedures - A complaint is a verbal or written grievance concerning an agency action or program policy.
1521.01 Complaints Received in the Regional office or CH - Upon receipt of a complaint, the Regional Office or CH Shall:
(1) - Review the situation and determine if corrective action is indicated. The determination should be made by the EES/CH Supervisor or EES Field Administrator after consulting with the Case Manager.
(2) - Explain the action or policy to the complainant in writing or verbally. If corrective action is necessary, it should be initiated immediately. If corrective action is not indicated, inform the complainant of his right to request a fair hearing and the request procedure.
1521.02 Complaints Received in Central Office - Complaints received in central office will be referred to KHPA for a response. If the response requires local input, a telephone call or e-mail message outlining the nature of the complaint will be made to the EES Field Administrator/Clearinghouse Administrator or designee. This person will review the case and determine the appropriateness of the agency's action. If the agency is in error, the EES Field Administrator/Clearinghouse administrator will mandate that corrective action be initiated immediately.
Once the determination is completed, the EES Field Administrator/Clearinghouse administrator or designee will telephone or e-mail KHPA and provide details of the agency's actions as well as any corrective measures taken. KHPA will then answer the verbal or written complaint. If the EES Field Administrator/Clearinghouse administrator wishes to respond to a telephone complaint directly, KHPA will notify the complainant to expect a telephone call from the EES Field Administrator/Clearinghouse administrator or designee within a pre-determined time period.
Complaints filed through the above system shall not include complaints alleging discrimination. Refer to 1530 for discussion of Civil Rights complaints. This system shall also not include complaints that should be pursued through the fair hearing process.
01530 Civil Rights Complaints - Kansas shall maintain a system to ensure that no person in Kansas shall, on the grounds of race, color, national origin, gender, age, sex, disability, political belief, religion, sexual orientation, marital or family status, be excluded from participation in, or be denied the benefits of any Family Medical Program, or be otherwise subjected to discrimination. This applies to all Family Medical programs.
1530.01 - Public Notification, Data Collection, Maintenance, and Reporting
(1) - All applicants and participants shall be informed of the following at the time of the initial application and at each subsequent review:
(a) Rights and responsibilities;
(b) KHPA and SRS's policy of nondiscrimination;
(c) The steps necessary for participation;
(d) Procedures for filing a complaint through the local SRS office, KHPA Central Office, the Civil Rights/EEO Section.
(e) Procedures for filing for a fair hearing.
(2) - The Case Manager shall encourage the responsible person completing the application to complete all questions regarding race or identity on the application. The applicant shall be informed that the information will be used for statistical purposes and will have no effect on his/her eligibility. However, if the applicant fails to provide this information, the Case Manager shall complete the questions by observation if possible.
01600 General Information about Other Programs and Miscellaneous -
1601 Case Records - Case records are required for all assistance cases and are to be separate from social service records. The Family Medical Program record shall include required forms to establish eligibility for assistance and additional information and decisions reached regarding eligibility, notices to the client, and authorization forms. Local EES/CH supervisors shall provide training for Case Managers in preparing adequate records and in knowing how and what information to obtain to establish eligibility, determine appropriate assistance, and prepare adequate notices.
1601.01 Order of Material in the Family Medical Case Records - For the purpose of uniformity and convenience in use, the material contained in the case folder shall be organized in like groups and fastened together chronologically with the most recent material on top.
1601.02 Correspondence - Notices affecting the eligibility shall become a permanent part of the agency's record.
(1) - Content of Notices - All notices should contain sufficient information to make clear their purpose, the information desired, and how the information is to be used. The wording should be clear, direct, and adequate to cover the subject. Care should be taken to avoid misunderstanding or misinterpretation.
(2) - Filing - Letters from clients are to be retained if they contain significant material.
(3) - Letters, newspaper clippings, and other material, when not of standard size, should be fastened to full-sized sheets of paper for case filing. They should be dated and properly identified.
1602 Disposition of Obsolete Case Record Material - Destroy any material which is older than 36 months and is not currently in effect on active cases with the following exceptions:
(1) - The last application which opened the case;
(2) - For AABD cases converted to SSI (whether open for medical or not), the application and budget in effect for Decembr 1973 must be retained indefinitely;
(3) - Retain indefinitely all documentation needed to establish current eligibility such as income verification, progressive penalty occurrences, etc;
(4) - Retain indefinitely a copy of the individual's Social Security card when it has been provided. In addition, the PA-3120.4 (Welfare Enumeration) form and copies of all documents used for enumeration purposes shall also be maintained indefinitely;
(5) - Retain indefinitely all material pertaining to unrecovered overpayments, including all documentation for the amount and cause of the overpayment;
(6) - Retain indefinitely all material pertaining to verification of the immigration status of aliens;
(7) - Retain indefinitely all materials pertaining to documentation of common-law marriages or paternity;
(8) - Retain indefinitely all documents used to verify citizenship and identity of the individual, including the ES-3850.
1602.01 Disposition of Closed Cases - Closed medical cases may be destroyed after they have been closed for 36 months except for (1) all material pertaining to unrecovered overpayments, or (2) cases that have a designated period of ineligibility which exceeds the retention period (e.g.; first time conviction of fraud, etc.)
1603 Voter Registration - The National Voter Registration Act of 1995 requires voter registration to be available in public assistance offices. The Act also requires that anyone applying for or receiving public assistance, including TAF, GA, Food Assistance, Medicaid, Child Care, and LIEAP, be offered the opportunity to register to vote at the time of initial application, each eligibility review, and each report of a change of address. Each individual must be informed of this registration service and offered assistance in completing the voter registration form or declining the registration activity. The ES-3100, Application for Cash, Medical, Child Care, and Food Stamp Benefits, offers everyone the opportunity to register to vote or to decline to register. Completion of the voter registration page of the ES-3100 is not a condition of eligibility for assistance. If an individual does not sign or complete this page of the application, it is considered a declination of voter registration and has no bearing on case processing or eligibility. Those applying on-line are offered the opportunity to link to the Secretary of State’s voter registration site. Change of address forms developed by local offices must include the same voter registration and declination information as is included in the ES-3100. SRS staff taking a report of a change of address or name change by telephone or in person should inform the individual that a change of address or name requires new voter registration and ask the individual if they wish to register to vote. All those who answer "yes" are to be handed or mailed a voter registration application. The individual’s response to the offer to register to vote is to be recorded on a declination form. Local offices must keep all declination forms for at least two years. See KEESM Appendix Item #88 for a copy of the Voter Registration Application.
1604 Estate Recovery - The estate recovery program has been established as a means to recover medical care costs from the estates and property of certain medical assistance recipients. See KEESM 1725
01700 Delivery of Medical Cards - All medical cards issued must be delivered by mail to the address of the payee unless otherwise requested. If the payee requests a different mode of delivery, the agency shall consider the appropriateness of the request. When deemed appropriate the agency may use other modes of delivery including P.O. Boxes, General Deliveries, addresses of friends or relatives, or the address of the agency when it is necessary to hand deliver the warrant or medical card to the client, particularly for situations involving a homeless client. No materials may be included in the envelope containing the medical card except those directly related to the administration of the welfare program.
Procedures for temporarily detaining or redirecting benefits through "Hold" processes can be found in the KAECSES User Manual and the General Services Manual.
02000: General Eligibility Requirements -
02010 Act in Own Behalf - The client must be legally capable of acting in his or her own behalf.
2010.01 Legally Incapacitated Persons - Legally incapacitated persons are not eligible to receive assistance unless such assistance is applied for by a guardian or conservator.
2010.02 Not Legally Incapacitated - For medical applications, the spouse, personal representative, (as defined in KEESM 1522), person with a durable power of attorney (for financial decisions), or representative payee for Social Security benefits may apply on behalf of an adult who has not been determined legally incapacitated.
For any other individual to apply, a signed written authorization from the person for whom they are applying must be obtained. The ‘Appointment of Authorized Agent’ X-3 form, found in the KEESM Appendix may be used for this purpose and must be signed by the applicant and at least one witness. The designated medical representative shall act in the place of the individual for whom they are applying. The medical representative shall receive copies of all notices and is responsible for completing review forms and reporting changes.
The medical representative should be someone who is trusted and knowledgeable about the individual’s circumstances and needs, including their income, resources, and household situation. Except in very limited circumstances, it would not be appropriate to appoint or accept a medical representative who has little or no prior experience with the individual. This would include those whose primary interest is in collecting on outstanding medical bills rather than in fully representing the interests and needs of the applicant for medical assistance.
In rare instances where the individual is unable to file their own application and obtaining written consent is not possible, the application sha