Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 11/21/2024
01000 >>> 01420
01410
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, cost share, 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. 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, notices must include the beginning date 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.
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. For closures, the consumer must receive the notice prior to the last day of eligibility. For increases in premium, the consumer must receive the notice prior to the 1st of the month for which the change is effective. The Processing Deadlines Code Card Chart on the KEES Repository shall be used to identify the last day in which action can be taken in order for timely notice to be provided for the various scenarios.
An increase in an unmet spenddown does not require timely notice; however, a change which results in the spenddown changing from met to unmet does require timely notice. When a spenddown for a base period changes from met to unmet, the consumer is notified both by the KanCare Clearinghouse and by MMIS. The MMIS notification must be received before the first day they return to having an unmet spenddown.
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 no 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 - A 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 CHIP case per 2440.
1423.12 - The agency receives a request to end coverage on the basis of the cost of the CHIP premium obligation.
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 PARIS, 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.