Kansas Department of Health & Environment

Kansas Family Medical Assistance

Manual (KFMAM)

Eligibility Policy - 8/16/2022

01000 >>> 01500 >>> 1503

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1503 Continuation of Benefits - - If a written or oral request for a fair hearing is received on a Medicaid only program (excludes CHIP) prior to the effective date of action, the notice of adverse action is mailed, and the review period has not expired, assistance shall not be suspended, discontinued, or terminated until a decision is rendered after a hearing, unless:

1503.01 - A determination is made at the hearing by the hearing officer that the sole issue is one of state or federal law or regulation, or change in state or federal law and not one of incorrect application of a policy (when appropriate KanCare Clearinghouse staff should raise this issue in the hearing in order for the referee to render a decision).

1503.02 - A change (except the matter under appeal) affecting the recipient's assistance occurs while the fair hearing decision is pending and the recipient fails to request a hearing after notice of the change.

1503.03 - The request for a fair hearing concerns a discontinued program or service.

1503.04 - The review period expires. The household may reapply and may be determined eligible for a new review period with assistance as determined by the agency.

1503.05 - A mass change affecting the household's eligibility or level of coverage or share of cost occurs while the hearing decision is pending.

Assistance shall also be continued at its prior level if the client or agency submits a timely request for review by the State Appeals Committee. See 1507.

NOTE: In any case where action was taken without timely notice, if the recipient requests a hearing within 10 days of the mailing of the notice of action, and the agency determines that the action resulted from other than the application of state or federal law or policy or a change in state or federal law, assistance shall be reinstated and continued until a decision is rendered in the matter as set forth above.

The agency shall promptly inform the household in writing if assistance is reduced or terminated pending the hearing decision. See 1505.05.

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