Kansas Department of Health & Environment

Kansas Family Medical Assistance

Manual (KFMAM)


Eligibility Policy - 8/21/2019

07000 >>> 07100

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07100 Household Responsibility to Report - Households receiving medical assistance are required to report changes. The specific reporting requirement is determined by the program and the circumstances of the household. There are no additional reporting requirements other than those listed in this section.

7110 Household Responsibility to Report Changes Prior to Approval - Applicants (includes new applications and applications filed after a break of one or more months of assistance) must report all changes of circumstances prior to case approval. The change must be reported within 10 calendar days from the date the change is known. The eligibility worker is responsible for requesting or otherwise obtaining other information or verifications necessary to determine the individual's eligibility for any month.

7120 Household Responsibility to Report Changes After Approval - Medical assistance households are required to report certain changes in circumstances as discussed in this section.
All households are to be notified of the appropriate reporting requirements upon approval for assistance.

7130 Reporting Requirements - Medical assistance households are required to report certain changes in circumstances within 10 days from the date the change becomes known to the household. See subsection 7130.02 below for the definition of "becomes known to the household."

7130.01 Change Reporting Requirements - The change reporting requirements for the Family Medical assistance programs are listed below:

(1) - Changes in the source of earned and/or unearned income.

(2) - Any change in the amount of earned and/or unearned income.

(3) - Changes in household composition, including marriage, separation, or divorce, as well as people moving into or out of the household.

(4) - Changes in residence, including moving into or from an institution or hospital.

(5) - Entitlement to or termination of Medicare coverage or a change in any third party insurance plan.

Households may report a change in their circumstances by telephone, in person, or in writing. Changes in circumstances other than those listed above are not required to be reported until review.

7130.02 Becomes Known to the Household - As indicated in section 7130 above, the household must report changes within 10 days of the date the change becomes known to the household. For purposes of this provision, "becomes known to the household" is defined as:

(1) Change in Source of Earned Income - The change is known to the household upon receipt of the first pay check.

(2) Change in Earned Income Amount - The change is known to the household on the last day of the month of the change.

(3) Change in Source of Unearned Income - The change is known to the household upon receipt of the first payment.

(4) Change in Unearned Income Amount - The change is known to the household when the payment is received.

(5) Change in Household Composition - The change is known to the household the day the individual enters or leaves the household, the date of marriage, separation, or divorce.

(6) Change in Residence - The change is known to the household the day the individual moves.

(7) Entitlement to or Termination of Medicare Coverage or a change in a Third Party Insurance plan - The change is known to the household on the effective date of the change.

7140 Processing Reported Changes - When the agency receives information that a change has occurred, the eligibility worker shall act on the change within 10 days after the date the change is reported by taking the following actions:

(1) Document in the case file the reported change, the date the change occurred, and the date the change was reported;

(2) Determine if verification or additional information is required;

(3) Contact the household to request needed information or verification as soon as possible;

(4) Changes are effective the month following the month of the change, given timely and adequate notice requirements, with the exception of income changes that are reported at the time of a request to add a new individual.

(a) Households reporting changes which would result in a change in benefits must provide any required verification within 12 days of the date of agency request. No change in benefits shall be granted if the household does not provide the required verification. If no verification is required or if the verification required is received within 12 days from the date of verification request, the change in benefits are to be granted effective the month following the month the change is reported. If the verification is received after 12 days from the date the verification was requested, the change benefits would be effective the first month following the month the verification is received.

(b) Changes resulting in ineligibility or a decrease in benefits shall effect eligibility the first month possible considering timely notice requirements.

(c) When processing an income change along with a request to add coverage for a new individual, the new income must be verified and used in the month of request. This allows the income to be used in the determination for the new person and is also applicable to the rest of the household members in that month. This could result in a change in coverage or the reduction or removal of a premium obligation in the month of report when applicable.

(5) If an automated system action occurred on the case prior to a worker becoming aware of the change, the worker must evaluate the effect of the change to determine if any incorrect payment occurred as result.

7150 Notices to Households - The agency shall provide the household with the following notice based on the change in assistance:
(1) Timely and Adequate Notice - The agency shall provide the household with a notice of action that meets the definition of timely and adequate notice (as defined in 1422.01) if the household's benefits are being reduced or terminated.

(2) Adequate Notice - The agency shall provide the household with a notice of action that meets the definition of adequate notice (as defined in 1422) if benefits are being increased.

7160 Failure to Report - If the agency discovers that the household has failed to report a change, as required in 7100 and, as a result, received benefits to which it was not entitled, a claim shall be filed against the household. The household is entitled to a timely and adequate notice of adverse action if the household's benefits are reduced or terminated.

A household shall not be held liable for a claim because of a change in household circumstances which it is not required to report in accordance with 7100. Individuals shall not be disqualified for failing to report a change unless disqualified in accordance with fraud disqualification procedures.

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