Kansas Department of Health & Environment

Kansas Family Medical Assistance

Manual (KFMAM)


Eligibility Policy - 10/25/2021

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01210 Rights of Applicant/Recipient -

1210.01 Right to Make Application - An individual shall have the right to make application regardless of any question of eligibility or agency responsibility. The right of an individual to make application may not be abridged.

1210.02 Right to Information - A client has the right to be provided with information concerning the types of assistance, which are provided by the agency. Upon request, the agency shall furnish the client with informational pamphlets and will explain to him/her the categories of assistance for which he/she may be eligible and the eligibility factors for each.

1210.03 Right to a Private Interview - A client has the right to a private interview whenever he/she is discussing his/her individual situation with the agency.

1210.04 Right to Receive a Prompt Decision - A client has the right to have a timely decision rendered on his/her application. See 1405. A recipient has the right to a decision rendered on any other formal request (such as a request for information) within 30 days of its receipt by the agency.

1210.05 Right to Restored Benefits - If the client has been wrongfully delayed, denied, or terminated, he/she is due restored benefits.

1210.06 Right to Correct Amount of Assistance - The client, if eligible, shall be entitled to the correct determination of benefits based upon budgetary standards or allowances in accordance with agency policies.

1210.07 Right to Equal Treatment - All clients have a right to equal treatment in similar circumstances and no person shall be denied benefits or be subject to discrimination on the basis of race, color, or national origin, gender, religion, age, disability, political beliefs, sexual orientation, or marital or family status.

The client has the right to file a discrimination complaint with either the Federal or the State agency.

1210.08 Right to A Fair Hearing - A client has the right to request a fair hearing on any agency decision or lack of action in regard to his application for or receipt of assistance.

1210.09 Right to Withdraw from the Program - An applicant has the right to withdraw his application at any time between the date the application is signed and the date the notice of the agency decision is mailed. A recipient may withdraw from a program at any time.

1210.10 Right to an Individual Determination of Eligibility for Assistance - A client shall be given an opportunity to present his request and to explain his situation.

1210.11 Right to Written Notification of Action - A client has the right to a written notification of agency action concerning his eligibility for assistance.

1211 Responsibilities of Applicant/Recipient -

1211.01 Responsibility to Submit Identifiable Application - The applicant shall submit an application containing a legible name and address (unless homeless), and which has been signed.

1211.02 Responsibility to Supply Information - A client has the responsibility to supply, insofar as able, information essential to the establishment of eligibility.

Information which is "time-sensitive" and received in the office through a drop box, mail slot or other such manner at the opening of the business day shall be considered as received during the previous work day. Information which is received as a fax or copy, but is required in original form, shall be considered as received when the fax/copy arrives in the office provided the original document arrives in a timely manner as determined at the local level. In general, a fax or copy of a document shall be acceptable without requiring an original (including an application form or monthly report form). However, an original document shall be required for establishing age, identity and citizenship and alienage status, and when determined to be necessary based on prudent person judgment.

1211.03 Responsibility to Provide Verification - The client has primary responsibility for providing verification (certain exceptions to these requirements are specified in the verification section). See 1330.

1211.04 Responsibility to Authorize Release of Information - A client has the responsibility to give written permission for release of information when needed.

1212 Responsibilities of the Agency - Upon request, the agency must explain the rights and responsibilities of clients and the following requirements placed on the agency.

1212.01 Periodic Reviews - The agency is required to make periodic reviews of eligibility if the application is approved.

When a formal review is required, the agency shall notify the client of the expiration of the review period and shall send the client a new application prior to the last month of the review period.

When the family qualifies for a Passive Review, a new application is not required and therefore not mailed to the client.

1212.02 Fraud - The agency is required to investigate and refer for legal action any alleged fraud related to the receipt of assistance.

1212.03 Responsibility to Accept an Identifiable Application - The agency shall accept an application containing a legible name and address (unless homeless) and which has been signed. See 1401.

1212.04 Responsibility to Review Recipients Timely - The agency has the responsibility to process all subsequent applications timely so there will be no break in the benefits the client is eligible to receive.

1212.05 Responsibility to Establish Claims of Overpayment - The agency is responsible for establishing claims for overpayment (either fraud, client, or agency error).

1212.06 Responsibility to Restore Lost Benefits - The agency shall restore benefits to the client if benefits were wrongfully denied, delayed, or terminated.

1212.07 Responsibility for Giving Notice of Action - The agency is responsible for giving adequate and/or timely notice of action when appropriate.

1212.08 Case File Documentation - The agency has the responsibility to insure that case file documentation supports the decision to provide, deny or change eligibility, benefits, or services.

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