Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 11/21/2024
02000 >>> 02010
02000
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 one of the following:
a. Guardian or conservator.
b. Medical Representative
c. Representative Payee for Social Security
d. Tax filer who claims (or intends to claim) the adult as a dependent on his or her federal tax return
A legally incapacitated adult shall be defined as any adult who is impaired both physically and mentally by reason of mental illness, mental deficiency, physical illness or disability to the extent that he or she is unable to understand or communicate responsible decisions concerning his or her person, or to the extent the adult cannot effectively manage or apply his or her estate to necessary ends for whom a guardian or conservator has been appointed by the court.
2010.02 Not Legally Incapacitated - A competent adult may apply for assistance for himself or herself. Any adult who has not been determined to be legally incapacitated is presumed to be able to act in their own behalf. Act in own behalf is further defined as being able to perform all activities that a consumer would perform for themselves, including the ability to appoint an additional Medical Representative or Facilitator.
For medical applications, the following individuals may apply on behalf of an adult who has not been determined legally incapacitated:
- Spouse,
- Opposite sex partner with whom there is a mutual child,
- Tax filer - a tax filer may apply for anyone they claim or intend to claim as a dependent,
- 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, they must be appointed by the applicant as a Medical Representative. A signed written authorization from the person for whom they are applying must be obtained. The KC6100 Medical Representative Authorization Form or medical representative section on the application form may be used for this purpose and must be signed by the adult. Two witness signatures are required if the applicant/recipient signs with a mark. Attorneys representing the consumer must provide a statement on the attorney’s letterhead indicating they are representing the consumer in their Kansas Medicaid matter. 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 the review and reporting changes.
Once appointed, the Medical Representative(s) shall have authority to act on behalf of the consumer until revoked or the Medical Representative passes away.
The medical representative(s) 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 shall be accepted and a referral completed to Adult Protective Services (APS) to have a guardian or conservator appointed if appropriate. For example, an individual may have been in an automobile accident and is in a coma. The application would not be denied or delayed because an appropriate person is not available to file.
When someone other than the individual is acting in their behalf, all notices must still be sent to the applicant/recipient in addition to the authorized representative.
2010.03 Facilitators - An individual may grant limited authority to a person who is assisting in the medical application process. This individual would not be a medical representative and may not apply on behalf, sign an application for the adult, nor request a fair hearing on behalf of the individual. They may share and receive information concerning the case depending on the scope of authority granted. This individual would not be responsible for completing review forms or reporting changes. Their role would be confined to helping the individual with the application process.
A signed written authorization from the person for whom they are assisting must be obtained. The KC6200 Facilitator Authorization Form or Facilitator authorization section on the paper application form may be used for this purpose and must be signed by the adult. Two witness signatures are required if the applicant/recipient signs with a mark.
For Facilitators, the length of appointment is dependent on the form used to appoint. The appointment of a community organization, medical provider or staff cannot exceed 12 months.
a. KC6200 form – Six months from date of signature or through the application period, whichever is later, unless a specific date of expiration is provided by the individual. If a specific date of expiration is listed which exceeds six months, the appointment shall last through the date specified or twelve months from the date the form is signed, whichever is shorter.
b. Facilitator form within the KanCare paper application – Through the end of the application period.
Note: The application period is the month following the month of eligibility determination.
2010.04 Applicants for Pregnant Woman Coverage - In addition to what is outlined in 2010.02 above, the following additional individuals are permitted to act on behalf of a pregnant woman applying for medical assistance.
a) The adult father of the unborn child of an adult pregnant woman
b) The adult father of the unborn child of a pregnant minor may apply on her behalf when residing with the minor and there is not another caretaker in the home.
c) When a minor pregnant woman is residing with the minor father of the unborn child, his caretaker may apply on behalf of the pregnant woman. This could be his parents or other another person who meets the caretaker definition of 2011.
2010.05 Release of Protected Health Information - An individual may grant a specific person or organization to share and receive information concerning the case. This does not give authority to act on behalf of the individual or request a fair hearing on behalf of the individual.
A signed written authorization from the person for whom they are requesting to share or receive information must be obtained. The Release of Protected Health Information form may be used for this purpose and must be signed by the adult. The length of appointment shall be the date entered on line 8 of the form, or 12 months, whichever is shorter.
2011 Minors - Minors who are unable to act in their own behalf are not eligible to receive assistance unless such assistance is applied for by a person meeting one of the following criteria:
a) A court-appointed legal guardian, custodian, or conservator.
b) A representative payee for the minor's Social Security benefits.
c) A responsible adult with whom the child resides, who meets the definition of a caretaker according to 2110.
d) An individual, with whom the child resides, who claims the minor child, or intends to claim the minor child on his/her federal income taxes.
e) A responsible adult, with whom the child resides, who does not meet any of the above criteria can apply for the minor child if they are appointed as the authorized agent by the minor's parent or legal guardian. This authorization is only for purposes of application and maintenance of the minor child's medical assistance case with the KDHE-DHCF and DCF. A completed Required Authorization for Medical Agent for Minor must be on record. This form is generated in KEES as Form # V075.
If the child's parent or legal guardian cannot be located to assign an authorized agent, the relationship of the responsible adult to the child must be confirmed or substantiated. An individual's statement and two corroborative pieces of evidence shall meet the burden of proof unless there is an independent reasonable basis to doubt the veracity of the statement. Corroborative evidence may include but is not limited to a written statement from a public or private licensed social agency, clergy, attorney, school official, medical provider, or other professional.
f) An individual who meets one of the above criteria to apply on behalf of a child may also request prior medical coverage for the child. This is true even if the individual did not meet the criteria or was not living with the child during the prior medical period. However, eligibility shall be determined based upon the child's situation in the month, see3100 – MAGI Budgeting Units. Refer to 2110 to determine who is eligible to receive medical assistance on the basis of being a caretaker of a child.
Note: Anytime a minor's health, safety, or current medical condition is judged to be at risk, a referral to the Protection and Prevention Services' (PPS) Report Center is appropriate.
2011.01 - Minors can act in their own behalf and receive assistance under the following circumstances:
(1) - The minor is determined to be emancipated. An emancipated minor is a person who is:
(a) Age 16 or 17 and is or has been married; or
(b) Under the age of 18 and who has had the rights of majority conferred upon him or her by court action; or
(2) The minor is unemancipated (i.e., does not meet the criteria in (1)(a) or (b) above), there is no adult or emancipated minor exercising parental control over the child, and one of the following circumstances exist:
(a) The parents of the minor are institutionalized per MKEESM 8113 or the minor has no parent who is living or whose whereabouts is known, and there is no other caretaker who is willing to assume parental control of the minor; or
(b) The health and safety of the minor has or would be jeopardized by remaining in the household with the minor's parents or other caretakers. Such status must be documented by an independent source such as social services, law enforcement, religious authorities, or a battered person's shelter.
If local arrangements are made between the Division of Health Care Finance and Prevention and Protection Services (PPS), a referral may be made to PPS for assistance in determining the status of the minor's parents or other caretakers and any health and safety issues that would exist in such living arrangements. The determination of a minor's ability to act in own behalf under this provision must be approved by the KanCare Clearinghouse Manager, the Eligibility Policy Manager or his or her designee.
The determination must be documented in the case record. Minors able to act in their own behalf are eligible for medical benefits and can qualify under any family medical program (e.g., Medicaid poverty level or CHIP).
(3) The minor is placed into independent living by DCF. In situations where the minor's needs are being met by PPS or a foster care contractor, the minor cannot apply for his/her own needs but may apply on behalf of his/her child providing the child resides with the minor and is not in DCF custody.