Kansas Department of Health & Environment

Kansas Family Medical Assistance

Manual (KFMAM)

Eligibility Policy - 10/16/2021

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1601 Case Records - Case records are required for all assistance cases and are to be separate from social service records. The eligibility record shall include required forms to establish eligibility for assistance and additional information and decisions reached regarding eligibility, the type of assistance, notices to the client, and authorization forms.

The case record includes all information about all individuals on a case. The case record is comprised of three (3) main components: 1) All information input into KEES, 2) The eligibility record held on KEES, and 3) information and documentation in the case file.

The eligibility record is the output of KEES which is transferred to the MMIS for claims payment and MCO assignment. All data input is a part of the eligibility and case record.

The case file is the collection of documents that support the information contained in the state eligibility system as well as all other documentation that relates to the case. Any information received, in any format, in relation to a case must be in the case file. The case file contains all documentation supporting the case processing activities, such as application forms, income verification and worksheets, correspondence, legal documents, requests for case maintenance, a log of case actions and customer contacts, and previous eligibility information for the household.

1601.01 Correspondence - Notices affecting the eligibility shall become a permanent part of the agency's record. Notices sent through KEES are maintained in KEES. Off-system notices are imaged to the case file.

(1) - Content of Notices - All notices should contain sufficient information to make clear their purpose, the information desired, and how the information is to be used. The wording should be clear, direct, and adequate to cover the subject. Care should be taken to avoid misunderstanding or misinterpretation.

(2) - Filing - Letters from clients are to be retained if they contain significant material.

(3) - Letters, newspaper clippings, and other material, should be dated and properly identified.

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