Kansas Department of Health & Environment

Kansas Family Medical Assistance

Manual (KFMAM)

Eligibility Policy - 5/16/2022

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1410.02 Denial - A denial shall be processed to assure that the applicant is provided with his/her denial notice in a timely manner. A notice of denial shall be sent at the time of denial, clearly explaining the reason for the denial.

(1) - Found Ineligible - A denied application may be reinstated without a new application at any time within the original 45 day processing timeline. In no case does the denial of the application abridge that individual's right to reapply at any time.

(2) - Failure to Provide Required Information/Cooperation - An application shall be denied after a period of 12 days from the date of a written request for information, but no later than 45 days from the date of application when the applicant has failed to provide required information or cooperate with eligibility requirements. The applicant must be informed in writing of the 12-day standard and the date by which the verification /cooperation must be received.

If the information is subsequently received or the household cooperates within the 45 day application processing time period, the application shall be reactivated and, if eligible, benefits prorated from the date of application. If the information/ cooperation are not received within the above time frames, then the client must re-apply.

(3) - Spenddown - When a spenddown is established for a minor who would otherwise be eligible for CHIP coverage, eligibility staff must ascertain the likelihood that the spenddown will be met. In order to make this determination and prevent delaying CHIP approval, contact with the applicant must be made as quickly as possible. The applicant must be informed of the spenddown amount and given a 12 day notice to respond to the likelihood that the spenddown will be met within the 6 month eligibility base period. If the applicant fails to respond or it does not appear that the spenddown will be met, the application will be denied (or case closed for failure to meet the spenddown) and CHIP coverage will be authorized. In spenddown cases where there is no possibility of CHIP eligibility, the spenddown is established, and the case remains open throughout the base period. At the end of the base period, staff determines if there is a need for further spenddown coverage.

(4) - Another Agency Assumes Responsibility - The agency may dispose of the application if another agency assumes complete responsibility for meeting the applicant's need.

(5) - Cannot be Located - The agency may dispose of the application if the applicant has moved and cannot be located. The agency shall not send a notice of decision.

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