Kansas Department of Health & Environment

Kansas Family Medical Assistance

Manual (KFMAM)

Eligibility Policy - 5/16/2022

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1505.01 Standard Procedures - The procedures set forth below shall be followed whenever a client makes an inquiry concerning a fair hearing, asks for fair hearing forms, or files a request for a fair hearing.

(1) The eligibility staff or supervisor should find out why the client is questioning the agency action.

(2) If the client is only disagreeing with a federal or state law or policy, the reason for such policy should be discussed with the client.

(3) If a client appears to be questioning the application of a federal or state law or policy to his individual situation (incorrect eligibility determination or use of incorrect facts), an administrative review shall be conducted to determine if the agency action was correct. Upon reconsideration, the agency may amend or change its decision at any time before or during the hearing. The hearing shall not be delayed or canceled because of this preliminary review.

If a satisfactory adjustment is reached prior to the hearing, the agency shall submit a written report to the hearing officer but the appeal shall remain pending until the client submits a signed written statement withdrawing the request for a fair hearing.

(4) If the client is questioning the decision regarding disability and the decision was made related to an SSI or SSA application for benefits, the client is to be referred to the SSA office to file an appeal. See Medical-KEESM 2636.

(5) If the client is questioning the decision regarding disability and the decision was made by Disability Determination Services (DDS) based on an SRS request via the DD-1104 and DD-1105, the appeal will be processed through DDS as specified in Medical-KEESM 1614.6(1).

(6) When a household member or representative makes an oral request for a fair hearing to the KanCare Clearinghouse or to the Office of Administrative Hearings by telephone or in person, the agency shall document the request by using the Request for Administrative Hearing form. The date of the request shall be the date the oral communication was made to the agency and that date shall appear on the form. Lack of signature by the household member on the form used to document an oral request shall not invalidate the request.

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