Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 4/18/2024
07000 >>> 07300
07200
7330 Reviews - All categories of assistance require periodic review. At the expiration of the review period, entitlement of benefits ends. Further eligibility must be determined through the review process. Depending on the type of assistance received and the circumstances of the case, the review may be either passive or non-passive. A non-passive review is based on a new application or review form and verification is required.
The purpose of the review is to give the client an opportunity to bring to the attention of the agency his or her needs and to give the agency an opportunity to re-examine all factors of eligibility in order to ensure coverage and eligibility levels continue to be correct. In the process, the appropriate review form shall be used along with the rest of the agency record.
The following review types apply:
7330.01 Super Passive Review - A super passive review is one in which the medical program is automatically re-evaluated by the KEES system based on program type, income, and resources to determine continued eligibility using the information already known or obtained by the agency. If eligible based on the review criteria, a new 12-month review period is established with notification issued to the beneficiary.
The program types potentially subject to super passive reviews are the Deemed Newborns, Aged Out Foster Care, and Poverty Level Pregnant Woman.
7330.02 Passive Review - A Passive Review is a review where information known to the agency is used to make a new eligibility determination. Eligibility is redetermined and reauthorized without worker involvement. The member receives notification outlining the information used for the redetermination. The member is required to inform the agency of any changes or incorrect information used in the determination. If the recipient has no changes to report, the review process is complete. If the recipient contacts the agency (either orally or in writing) with updated information based on receipt of the review notification, action is taken to update the case.
In order to qualify for a passive review, when earned income exists it must meet reasonable compatibility under the automated RC test completed by KEES. When unearned, countable income from Social Security (SSA) exists, it must be within $5.00 of the amount found on the SSA data source. In addition, each of the following program types may be subject to a passive review when specific criteria are met:
- Medically Needy (MDN) – There is no earned income, countable resources are less than 85% of the limit, there is no trust and there are no due and owing medical expenses, and the status of the Spenddown is ‘met.’
- Caretaker Medical (CTM), TransMed (TMD) and Extended Medical (EXT) – Earned income is reasonably compatible, there is no self-employment, no individuals outside the home are claimed as tax dependents, there is no discrepancy in the tax information for the household member(s) due for review, and individuals do not move to a Protected Medical Group, Working Healthy, Medically Needy, or MSP program.
- Poverty Level Pregnant Woman (PLN/PW) – Fails the super passive criteria, passes the income test, and passes reasonable compatibility.
- Poverty Level Pregnant Woman Under 19 (PLT or CHIP) – Income does not exceed 200% of the FPL, income is reasonably compatible, and does not contain self-employment income.
- Poverty Level Newborns and Children (Medicaid and CHIP) – Income does not exceed 200% of the FPL, income is reasonably compatible, and does not contain self-employment income.
7330.03 Pre-Populated Review - A pre-populated review is required for all other situations where a passive or super passive review isn’t sent. A notice of expiration of the review period is sent along with a generated pre-populated review form for completion and return. The forms are generated based on information that is contained within KEES.
Recipients are required to update the form with new or changed information and return to the agency. Failure to return the review form will result in discontinuance of coverage.
7331 Notice of Expiration - A notice of expiration of the review period shall be sent to each household subject to a pre-populated review as described in 7330.03. A notice of expiration of review is not required for passively (7330.02) or super-passively (7330.01) reviewed households. The agency shall provide a pre-populated review form with the notice of expiration. When a review is required and it is known that the recipient is temporarily visiting away from his or her residence, the notice of expiration and review form should be mailed to the temporary address.
The notice of expiration and pre-populated review form shall be mailed to the household on or about the 15th of the next to last month of the review period. This gives the household approximately 30 days to complete and return the review form to the agency (see 7410).
NOTE: The notice of expiration provides timely notice of the ending of benefits; therefore, further timely notice is not required to affect benefits for the start of the new review period.