Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 11/22/2024
2445
2446 Premium Refunds and Adjustments -
Overstated Premiums - When the agency determines a premium has been overstated for a prior period, immediate action to correct future premiums shall be taken. In addition, a premium is adjusted for a prior period in the following situations:
- An agency error resulted in the incorrect premium; or
- A timely reported change was not acted upon timely and resulted in the incorrect premium.
Failure on the part of the client to report a change timely shall not result in an adjusted premium for a prior period.
To adjust the premium amount for the prior period, the Eligibility Specialist must reprocess eligibility in KEES for each month affected.
Understated Premiums - When the agency determines a premium has been understated for a current or prior period, immediate action to correct future premiums shall be taken. Only adequate notice is required when notifying of the new premium amount. If the client was initially given notice of the correct premium amount, a retroactive adjustment shall be made in KEES. If the client did not initially receive the correct notification, an overpayment shall be established for the prior period.