Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 11/21/2024
7431
7432 Agency Failure to Act Timely - If the agency fails to timely process a timely received review form, an administrative processing error may have occurred. Eligibility will continue with coverage at the current level while the review is pending. This may result in one or more months of coverage past the end of the review period before the review is processed [extended month(s)]. Once the review is processed, the extended months of coverage resulting from the delay shall be reevaluated as follows:
1. If the new level of coverage determined by the untimely agency review is the same as the previous coverage, no adjustment to the extended month(s) is required. No administrative error, other than delayed processing, has occurred.
2. If the new level of coverage determined by the untimely agency review is greater than the previous coverage, the extended month(s) must be adjusted accordingly. Coverage for those extended month(s) shall be enhanced to match the newly determined coverage. The agency shall promptly update the coverage and notify the recipient(s) of the change.
3. If the new level of coverage determined by the untimely agency review is less than the previous coverage, including discontinuance of coverage, an agency error overstated eligibility has occurred for the extended month(s). Agency action must be taken to determine the amount of the overstated eligibility and establish a claim according to 8300 and subsections.