Kansas Department of Health & Environment

Kansas Family Medical Assistance

Manual (KFMAM)


Eligibility Policy - 8/21/2019

07000 >>> 07400 >>> 7410 >>> 7410.02

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7410.02 Continuation of Coverage Pending Completion of Review - When a review form is timely received (see 7331) and registered before the change processing deadline, eligibility at current levels will continue automatically until the review process is completed. If the review is timely received, but not registered before the change processing deadline, coverage will be automatically discontinued. In that instance, the discontinuance shall be rescinded and coverage reinstated while the review is pending. Note that if an untimely review is received during the review reconsideration period (see 7431), the discontinuance shall be rescinded but coverage shall not be reinstated pending the completion of the review.

Due to this process, if a timely received review is not timely processed by the agency, as defined in 7420, the current level of coverage for the household may continue past the end of the review period for one or more months [extended month(s)]. The date the timely review is received will determine if those months are subject to correction.

1. If the review is received before the 1st day of the last month of the review period, it is anticipated
that the review will be completed prior to the change processing deadline in the last month of the
review period (see 7420). Therefore, there should be no extended months of coverage. However,
if the review is not processed timely, resulting in extended coverage month(s), those months are
subject to correction, if necessary. Understated eligibility shall be restored, and an agency error
claim shall be created for any overstated eligibility (see 8312) for those month(s).

2. If the review is received on or after the 1st day of the last month of the review period, correction is
required beginning with the second extended month. The first extended month is only subject to
correction when the new benefit level is greater than the previous coverage. In that instance, the
extended month shall be corrected to reflect the new benefit level for that month. If the new
benefit level is less than the previous coverage, no correction of the extended month is required.


Correction is required for all months beginning with the second extended month.

Note: If the review is not timely processed, as noted above, eligibility will continue at the current level until some intervening action, automated or manual, is taken to either change or discontinue coverage. If the ultimate action taken on the case is adverse, timely and adequate notice of the action is required (see 1422).

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