Kansas Department of Health & Environment

Kansas Family Medical Assistance

Manual (KFMAM)

Eligibility Policy - 6/29/2022

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2010.03 Facilitators - An individual may grant limited authority to a person who is assisting in the medical application process. This individual would not be a medical representative and may not apply on behalf, sign an application for the adult, nor request a fair hearing on behalf of the individual. They may share and receive information concerning the case depending on the scope of authority granted. This individual would not be responsible for completing review forms or reporting changes. Their role would be confined to helping the individual with the application process.

A signed written authorization from the person for whom they are assisting must be obtained. The KC6200 Facilitator Authorization Form or Facilitator authorization section on the paper application form may be used for this purpose and must be signed by the adult. Two witness signatures are required if the applicant/recipient signs with a mark.

For Facilitators, the length of appointment is dependent on the form used to appoint. The appointment of a community organization, medical provider or staff cannot exceed 12 months.

a. KC6200 form – Six months from date of signature or through the application period, whichever is later, unless a specific date of expiration is provided by the individual. If a specific date of expiration is listed which exceeds six months, the appointment shall last through the date specified or twelve months from the date the form is signed, whichever is shorter.

b. Facilitator form within the KanCare paper application – Through the end of the application period.

Note: The application period is the month following the month of eligibility determination.

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