Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 11/21/2024
02000 >>> 02060
02050
02060 Cooperation with Child Support Services (CSS) - As a condition of eligibility in the Caretaker Medical program, the caretaker who is receiving assistance shall cooperate with the Child Support Services division of the DCF agency. At the time of initial application, it is assumed that the Caretaker will cooperate with CSS. See 2066 for information about applicants who were previously discontinued for failing to cooperate with CSS.
See 2064 for effect on eligibility for failure to cooperate with CSS.
2061 Referral to Child Support Services - Eligibility Staff are responsible for referring cases to CSS where there is one or more parents absent from the household (including a deceased parent). Only participating adults who are receiving coverage on the Caretaker Medical program shall be referred. Families requesting medical coverage only for children may elect to participate with CSS but are not required to be referred. See 2068 for voluntary referrals.
It is the function of the eligibility staff to determine continued parental absence and the function of the CSS staff to obtain support on behalf of the spouse and/or child(ren). Parental absence is based on self-attestation of household members.
For Family Medical, the referral is an automatic process in KEES following completion of the non-custodial referral and authorization of the program. Referrals are not made when there is no absent parent or when parental rights have been severed. See the KEES User Manual for further information on system processing.
2062 Cooperation - Cooperation involves providing information to CSS to establish the paternity of a child born out-of-wedlock and in obtaining medical support payments for such caretaker and for the respective child. For purposes of establishing paternity, the legal parent is presumed to be the biological parent.
For Medicaid there is no requirement that paternity be formally established. Self-attestation is accepted as to the paternity of a child. If DCF determines paternity for a child that differs from what was previously self-attested, KDHE will accept the verified paternity status.
CSS is responsible for determining whether the caretaker has cooperated in establishing paternity and/or in obtaining support. Cooperation is defined as:
2062.01 - Appearing at the local CSS office or the Court Trustee Office as necessary to provide information or documentation relative to establishing paternity of a child born out-of-wedlock, identifying and locating the absent parent, and obtaining support payments;
2062.02 - Appearing as a witness at court or other proceedings necessary to achieve the CSS objectives; and
2062.03 - Providing information, or attesting to the lack of information, under the penalty of perjury.
2063 Good Cause for Failure to Cooperate - In rare instances the caretaker may be deemed to have good cause for refusing to cooperate in establishing paternity and securing support payments. Examples of such cases would be those in which it has been determined that pursuing paternity/support is against the best interest of the child or the caretaker. Eligibility Staff have the ultimate responsibility for determining the validity of good cause claims; however, CSS and Protection and Prevention Services (PPS) staff may alert the Eligibility Staff of the need to evaluate for good cause.
The caretaker has the primary responsibility for providing documentary evidence required to substantiate a good cause claim. When necessary, the agency shall assist the client in securing any evidence that the client cannot reasonably obtain.
Good cause for failure to cooperate must relate to one of the following criteria:
2063.01 - The child was conceived as a result of incest or rape;
2063.02 - There are legal proceedings for adoption of the child pending before a court;
2063.03 - The caretaker is currently being assisted by a public or licensed private social agency to resolve the issue of whether to keep the child or relinquish the child for adoption;
2063.04 - The caretaker was a victim of domestic violence whereby compliance with program requirements would increase risk of harm for the individual or any children in the individual's case. Domestic violence includes acts on the part of perpetrators that result in:
(1) - physical acts resulting in, or threatening to result in, physical injury;
(2) - sexual abuse, sexual activity involving dependent children, or threats of or attempts at sexual abuse;
(3) - mental abuse, including threats, intimidation, acts designed to induce terror, or restraints on liberty, or;
(4) - deprivation of medical care, housing, food or other necessities of life.
2063.05 - Good cause claims must be confirmed or substantiated. Uncorroborated statements of the caretaker do not constitute documentary evidence; the mere belief that pursuing paternity or support is not in the client's or the child's best interest is not sufficient evidence. An individual's statement and one corroborating piece of evidence shall meet the burden of proof unless there is an independent reasonable basis to doubt the veracity of the statement. Evidence may include, but is not limited to:
(1) - Police or court records,
(2) - Court documents which indicate that legal proceedings for adoption of the child are pending,
(3) - Protection from abuse (PFA) or Protection from stalking (PFS) orders (filed for and/or obtained),
(4) - Written statement from a public or licensed private social agency substantiating the fact that the client is involved in resolving the issue of whether to keep or relinquish the child for adoption,
(5) - Documentation from a shelter worker, attorney, clergy, medical or other professional from whom the client has sought assistance,
(6) - Other corroborating evidence such as a statement from any other individual with knowledge of the circumstances which provide the basis for the claim, or physical evidence of domestic violence or any other evidence which supports the statement.
Exception: Regardless of the policy in this section regarding uncorroborated statements by caretakers, in extremely rare situations such as when an individual is in hiding and is afraid that there could be information disclosed that could reveal his/her whereabouts and where the Eligibility Staff do not doubt the veracity of the individual's statement, a written statement from the victim signed under penalty of perjury shall meet the burden of proof.
In most instances a good cause determination should be made within 60 days following the receipt of such claim. Exceptions to this would include such situations as when the evidence is extremely difficult to obtain.
The Eligibility Staff are responsible for notifying CSS of good cause determinations. A referral shall not be sent to CSS while a good cause claim is pending. Once a claim of good cause has been substantiated, a referral shall be sent to CSS with the good cause indicated. A good cause claim shall be reviewed as often as necessary and at each pre-populated review.
The Eligibility Staff shall not deny, delay, or discontinue assistance pending a good cause determination as long as the caretaker has complied or is in the process of complying with the requirement of providing evidence or other necessary information. If assistance is granted pending a determination of good cause and it is subsequently determined that the claim is invalid, the assistance granted shall not be considered an overpayment. A referral to CSS will be sent at the time the claim is determined to be invalid.
NOTE: Do not confuse cases that involve good cause with routine cases of noncooperation. A client's claim of good cause does not negate the requirement for the assignment of support rights.
2064 Failure to Cooperate - If the caretaker refuses to cooperate with CSS, Eligibility Staff will be notified by CSS via either a task in KEES or an email from the CSS staff. A penalty for failure to meet CSS requirements can be imposed only when the caretaker is referred to CSS and CSS determines the person has not cooperated.
Eligibility staff will discontinue medical assistance for the non-pregnant adult caretaker for failure to cooperate with CSS. However, medical coverage under all other categories shall be considered for such a caretaker at the time the penalty is applied. There is no penalty for other household members.
Pregnant caretakers or caretakers under the age of 19 will not be discontinued for failure to cooperate. Their cooperation status will be evaluated once they’ve reached the age of 19 or the end of the postpartum period.
Because penalties only affect coverage under the Caretaker Medical program, persons currently serving a penalty who later meet categorical requirements under another program shall have eligibility determined under the new medical program without regard to the penalty. Because penalties can result in a temporary hardship, penalties must be applied with much care and consideration. To ensure that penalties are applied uniformly and appropriately, the following guidelines must be applied in all instances of noncooperation:
2064.01 - There is documented evidence that the person was made aware of the cooperation requirement. Information provided in the approval notice fulfills this requirement.
2064.02 - There is documented evidence that the person was informed of the consequences for failing to cooperate. Information provided in the approval notice fulfills this requirement.
2065 Evaluating Cooperation of an Applicant - Previous non-cooperation does not impact future assistance. When processing a new request for medical assistance, and a caretaker is determined eligible for the Caretaker Medical program, it is assumed that the Caretaker will cooperate with CSS. In situations where the Caretaker was penalized for failing to cooperate with CSS in the six months prior to the month of application, the Caretaker must self-attest to cooperation prior to approval of Caretaker Medical coverage. Self-attestation of the agreement to cooperate with CSS in order to receive Caretaker Medical assistance may be provided verbally or in writing.
2066 Reestablishing Coverage Following Cooperation - After a non-cooperation penalty occurs, if the caretaker cooperates with CSS, Eligibility Staff will be notified by CSS via a task in KEES.
If cooperation occurs in the month of discontinuance or the month following, eligibility shall be reinstated without requiring a new application or request for coverage. Coverage shall be reinstated effective the first day of the month in which cooperation is established.
If more than a one-month break in assistance has occurred, a new application or request for coverage is required according to the policies outlined in 1402.
2067 Special Case Situations -
2067.01 Legal vs. Biological (Alleged) Father - In situations where the mother is currently or was married to a different person at the time, she was pregnant or during the child's birth, this establishes a legal father contrary to claims that the real (biological) father is in the home. When these circumstances are identified, both the mother and alleged father may volunteer for referral to CSS. CSS will be able to do a more in-depth analysis of the circumstances at the time of the child's birth and advise the clients of legal aspects of the situation. If CSS responds that a voluntary order is obtained, the Eligibility Staff will process the case considering paternity established with the father in the home. However, in most instances CSS's response may be that a legal father exists and a voluntary order is not possible. When this occurs, the alleged father is to be treated as a nonrelative to the child in question and the case is to be processed in that manner. In such instances, the non-custodial page should list the legal father as the absent parent. A penalty is applicable if she fails to cooperate with any CSS requirements following case approval.
2068 Voluntary Referral - All households which include a child whose parent(s) is absent may voluntarily request to be referred to CSS. CSS will help with establishing paternity if not already established and obtaining support. Clients requesting CSS services shall be given the name and phone number of the appropriate contact person in the local CSS office. No automated process is in place for referring voluntary CSS participants.
There is no penalty for failing to cooperate with CSS on a voluntary referral.
A previous finding of noncooperation by a voluntary household shall not impact future assistance under any program.