Kansas Department of Health & Environment

Kansas Family Medical Assistance

Manual (KFMAM)

Eligibility Policy - 12/9/2022

02000 >>> 02020

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02020 Cooperation - The client must cooperate with all program requirements. In addition, the client (including an ineligible caretaker) shall cooperate with the agency in the establishment of eligibility including providing necessary information, reporting changes as required, cooperating in the application process, and cooperating in obtaining resources.

2020.01 Supplying Information - The client (or ineligible caretaker) shall supply information essential to the establishment of eligibility; give written permission on prescribed forms for release of information regarding resources when needed; and report changes in circumstances in accordance with 7100 as appropriate.

Failure to provide information necessary to determine eligibility shall result in ineligibility. A case which has been closed for failure to provide information is to be reinstated when the required information is provided by the end of the month following the effective date of closure and all other eligibility requirements are met.

2020.02 Application and Review Process - To determine eligibility, the application form must be completed and signed; certain information on the application must be verified. If denied or terminated for refusal to cooperate, the client may reapply but shall not be determined eligible until he or she cooperates.

The client shall also be determined ineligible if he or she refuses to cooperate in any subsequent review of its eligibility, including reviews generated by reported changes and recertification. For medical, the formal review requirement does not apply to individuals under the SI program or pregnant women and children under the age of 1 who have continuous eligibility under the Medicaid program.

2020.03 Potential Resources - For medical purposes, a client shall cooperate with the agency to obtain potential resources. The client is required to take action to:

(1) identify and provide information to assist the agency in pursuing any third party who may be liable to pay for medical services under the medical programs.

2021 Reserved -

2022 Requirements - The client is required to take any necessary action to acquire potential resources. In many instances, legal action may be necessary. In general, any source must be considered. It is the responsibility of the client to demonstrate all required actions have been taken to make the resource available. The special situations listed below are applicable:

2022.01 - The client must cooperate with the Medical Subrogation Unit as well as cooperate with the requirements of the Health Insurance Premium Payment System (HIPPS) including enrollment in the employer health insurance plan if cost effective. (See 2540.)

2022.02 - Persons may not be rendered ineligible for failure to apply for or receive SSI benefits.

2023 Failure to Comply - Failure to meet these requirements without good cause shall: For medical assistance, render the client ineligible for assistance. However, minor children will not be impacted by a caretaker's failure to meet these requirements on behalf of himself or the minor. If the client is cooperating in obtaining the identified potential resource, assistance shall continue.

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