Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 11/21/2024
01000 >>> 01320
01310
01320 Simplified Eligibility - The applicant is the primary source of information used by the agency for purposes of determining eligibility. For some factors of eligibility, additional information will have to be obtained. The agency shall use, to the greatest extent possible, the information on the application/redetermination as provided by the individual applicant/recipient, for purposes of determining eligibility and extent of entitlement.
1320.01 - Carefully review the application for completeness, clarity, consistency, and lack of error or questionable statement.
1320.02 - Consider additional information from agency records.
1320.03 - 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 give 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.
1320.04 - 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 12 calendar days from the date the notice is initiated to return the information.
1321 Resolving Conflicting Information - When conflicting or contradictory information is discovered, the eligibility staff person shall research the medical case file and other sources, such as interfaces, to determine if a reasonable explanation exists.
If the discrepancy is not resolved, contact with the consumer is required. First, phone contact must be attempted. If the issue remains unresolved a written request for information is issued, as per 1332.01 below. Eligibility cannot be denied or terminated solely based on the discrepant information until the consumer has been given the opportunity to explain the discrepancy. Unless the consumer consents to negative action based upon their request, a written request for information must be issued prior to any negative action.
Staff are responsible for updating the case file (e.g., journal) with information regarding the discrepancy as well as the resolution. If the staff person made a judgement call regarding a specific situation, an explanation of the facts of the case as well as the factors that lead to the decision are also included in the journal. As each situation is unique, the extent and content of the necessary journal entry will depend upon the circumstance of the case.