Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 7/27/2024
07000 >>> 07300
07200
7330 Reviews - All categories of assistance require periodic review. At the expiration of the review period, entitlement of benefits ends. Further eligibility must be determined through the review process. Depending on the type of assistance received and the circumstances of the case, the review may be either passive or non-passive. A non-passive review is based on a new application or review form and verification is required.
The purpose of the review is to give the client an opportunity to bring to the attention of the agency his or her needs and to give the agency an opportunity to re-examine all factors of eligibility in order to ensure coverage and eligibility levels continue to be correct. In the process, the appropriate review form shall be used along with the rest of the agency record.
The following review types apply:
7330.01 Passive Review - Passive Review - A Passive Review is a review where information known to the agency is used to make a new eligibility determination for an individual due for review. Eligibility is redetermined and reauthorized without worker involvement. The member receives notification outlining the information used for the redetermination. The member is required to inform the agency of any changes or incorrect information used in the determination. If the recipient has no changes to report, the review process is complete. If the recipient contacts the agency (either orally or in writing) with updated information based on receipt of the review notification, action is taken to update the case. See 7421 regarding passive review responses.
If a person qualifies for a passive review but is in the same household with members with a pre-populated review type, or if the data used at passive review will result in coverage on a lesser program, or a change between CHIP and PLN, a pre-populated form will be sent to give them the opportunity to report changes. If the form is not returned, the members with the passive type will be approved using the information in the system.
If a person over the age of one receives a pre-populated review due only to a missing SSN, and the SSN is provided, the person may be administratively (manually) reviewed using the rest of the information on file in absence of a review form. Likewise, if it is identified that a person received a pre-populated in error due to a citizenship record changing to an unverified status when it had already been verified, the pre-populated form is not required. They may be reinstated if necessary and administratively reviewed and approved using the information on file.
1. The following programs are eligible for a passive review due to the program type without any other qualifications:
- Deemed Newborns.
- Aged Out Foster Care.
2. All other programs must meet the following qualifications, as indicated, to be eligible for a passive review:
In order to qualify for a passive review, when earned income exists it must meet reasonable compatibility under the automated RC test completed by KEES. When unearned, countable income from Social Security (SSA) exists, it must be within $5.00 of the amount found on the SSA data source. In addition, each of the following program types may be subject to a passive review when specific criteria are met:
- Medically Needy (MDN) – There is no self-employment or earned income, countable resources are less than 85% of the limit, and the status of the Spenddown is ‘met.’
- Caretaker Medical (CTM), TransMed (TMD) and Extended Medical (EXT) – Earned income is reasonably compatible, there is no self-employment, there is no discrepancy in the tax information for the household member(s) due for review, and individuals do not move to a Protected Medical Group, Working Healthy, Medically Needy, or MSP program.
- Poverty Level Pregnant Woman (PLN/PW) – Passes the income test and passes reasonable compatibility.
- Poverty Level Pregnant Woman Under 19 (PLT or CHIP) – Income is reasonably compatible and does not contain self-employment income.
- Poverty Level Newborns and Children (Medicaid and CHIP) – Income is reasonably compatible and does not contain self-employment income.
7330.02 Pre-Populated Review - A pre-populated review is required for all other situations where a passive review isn’t sent. A notice of expiration of the review period is sent along with a generated pre-populated review form for completion and return. The forms are generated based on information that is contained within KEES.
Recipients are required to update the form with new or changed information and return to the agency. Failure to return the review form will result in discontinuance of coverage for all members with an individual pre-populated review type. Any members who qualify for an individual passive review may not be discontinued for failure to return the review form but will instead be passively reviewed by the system when a pre-populated review is not returned.
7330.02 Passive Review - A Passive Review is a review where information known to the agency is used to make a new eligibility determination. Eligibility is redetermined and reauthorized without worker involvement. The member receives notification outlining the information used for the redetermination. The member is required to inform the agency of any changes or incorrect information used in the determination. If the recipient has no changes to report, the review process is complete. If the recipient contacts the agency (either orally or in writing) with updated information based on receipt of the review notification, action is taken to update the case.
In order to qualify for a passive review, when earned income exists it must meet reasonable compatibility under the automated RC test completed by KEES. When unearned, countable income from Social Security (SSA) exists, it must be within $5.00 of the amount found on the SSA data source. In addition, each of the following program types may be subject to a passive review when specific criteria are met:
- Medically Needy (MDN) – There is no earned income, countable resources are less than 85% of the limit, there is no trust and there are no due and owing medical expenses, and the status of the Spenddown is ‘met.’
- Caretaker Medical (CTM), TransMed (TMD) and Extended Medical (EXT) – Earned income is reasonably compatible, there is no self-employment, no individuals outside the home are claimed as tax dependents, there is no discrepancy in the tax information for the household member(s) due for review, and individuals do not move to a Protected Medical Group, Working Healthy, Medically Needy, or MSP program.
- Poverty Level Pregnant Woman (PLN/PW) – Fails the super passive criteria, passes the income test, and passes reasonable compatibility.
- Poverty Level Pregnant Woman Under 19 (PLT or CHIP) – Income does not exceed 200% of the FPL, income is reasonably compatible, and does not contain self-employment income.
- Poverty Level Newborns and Children (Medicaid and CHIP) – Income does not exceed 200% of the FPL, income is reasonably compatible, and does not contain self-employment income.
7331 Notice of Expiration - A notice of expiration of the review period shall be sent to each household subject to a pre-populated review as described in INVALID LINK - Please ensure that there is a "^" after the section number and the section number you are trying to link to is currently active.. A notice of expiration of review is not required for passively (7330.02) or super-passively (7330.01) reviewed households. The agency shall provide a pre-populated review form with the notice of expiration. When a review is required and it is known that the recipient is temporarily visiting away from his or her residence, the notice of expiration and review form should be mailed to the temporary address.
The notice of expiration and pre-populated review form shall be mailed to the household on or about the 15th of the next to last month of the review period. This gives the household approximately 30 days to complete and return the review form to the agency (see 7410).
NOTE: The notice of expiration provides timely notice of the ending of benefits; therefore, further timely notice is not required to affect benefits for the start of the new review period.