1400 Application Process, Case Disposition, and Written Notice of Case Action

1410 Application Process

1411 Application Process, Case Disposition, and Written Notice of Case Action - Submittal of a signed paper application, an on-line application, or a telephonic application shall be considered a request for assistance.  See 1411.5 for signature requirements.

Based on the provisions of 4000, an application shall include all persons who are required to be in the assistance plan. A new application is not required to add additional household members to existing programs.

Intake may be limited to providing the application form unless the applicant makes an additional request. If there is an intake interview, it must provide the applicant an opportunity to state his request and explain his situation and enable the agency to provide the applicant with needed information or to refer him to other staff members or other agencies for the help requested.

The application form together with the eligibility worker's records (if any), the necessary forms (budgets, notices of action, narratives, etc.), and any required verification must substantiate eligibility or ineligibility.

At the time of application processing, each month shall be viewed separately in determining eligibility or ineligibility. For example, if an application is filed in July but processed in August, ineligibility in August shall not affect the eligibility determination for the month of July.

•KC1500 – E&D Medical Application

•KC1100 – Family Medical Application

•KC1105 – E&D Supplement to KC1100

Note: Online applications are received through the KDHE-DHCF Customer Self-Service Portal (CSSP).

When an application is requested, the agency shall help the household identify their medical needs and assure that the individual receives the appropriate application.  The individual shall be encouraged to file the application the same day – in person, by fax, or electronically online. See 1411.2 below for the application date of an online application. An application shall be mailed to the household the same day the request is received.

If the applicant household is homeless and they have no physical street address to list, the application shall be so noted and accepted by the agency.

 For ongoing recipients who have completed an application form and who subsequently request additional assistance and for situations in which an additional program is added to a pending application based on a client's request, the following provisions shall apply:

1. If the new program is requested within the month following the month of application or in the first month of the new review period, a new application, signature, or interview is not required. The date of application for the new program shall be the date the additional request is first received – either orally or in writing, by the agency.

2. Reserved

3. If a request is made for a new medical program on an open medical assistance case within an existing review period, additional information may be requested, but a new application is not required unless the medical program has remained active beyond the review period due to timeliness factors.  If the medical program has remained active past the required review period, only submittal of a signed application form will constitute a request for coverage.

4. Reserved

5. No new application is required if the agency initiates the new program, such as, adding QMB coverage to an open Medically Needy (MN) case.

1.  Paper Applications – The date a paper application is received by the agency shall be considered the application date.  All signed paper applications shall be date-stamped the date physically received at the KanCare Clearinghouse, an Outstation Worker site, or other location designated by the agency.

A paper application that is received through the mail or physically delivered to agency personnel on agency premises shall be considered received that date.  An application that is received through a drop box, mail slot, or other such manner at the opening of the business day shall be considered that day, even if the application was deposited prior to that date.

An application received by the agency via email or fax is deemed an original application and is considered received on the date on the time stamp if received by 5:00pm on a business day.  If the application is received after 5:00pm on a business day or on the weekend or a holiday, the application is the next following business day.

When an applicant files an application form that is not intended for the medical coverage requested, additional information may be requested, but the application date is the date the application is received by the agency.  Completion of the appropriate form is not required to establish the application date for the coverage requested.

Note: Date-stamping of a paper application by someone other than agency of agency contracted personnel does not constitute a date of receipt for application purposes.

2. Online Applications – The date an electronically signed online application is received by the agency shall be considered the application date if received by 5:00pm on a business day.  If the application is received after 5:00pm on a business day or on the weekend or holiday, the application date is the next following business day.

3.  Other Electronic applications– The application date for other electronic applications received by the agency are described below.  MIPPA and FFM applications both have two (2) applications dates – one for processing purposes, and one for eligibility purposes.

a. MIPPA applications – The date the electronic data file is received by the agency from social security is the application date for processing purposes and establishes the 45-day processing timeline.  The date the original Low-Income Subsidy (LIS) application was filed with Social Security is considered the date of request for MSP and therefore is the start date for eligibility purposes.  Note:  Since the original LIS applications on which these applications are based do not include a request for prior medical assistance, there is no MSP eligibility for months prior to the request month of these applications.

b.  FFM Applications – The date the electronic data file is received by the agency from the federally facilitated health insurance marketplace exchange is the application date for processing purposes and establishes the 45-day processing timeline.  The date the original health insurance exchange subsidy application was filed with the Federally Facilitated Marketplace (FFM) is considered the date of request for medical assistance and therefore is the start date for eligibility purposes.

4. Telephonic applications – The application date for a telephonic application is the date the applicant answers all the questions and telephonically signs the application by certifying, under penalty of perjury, that they understand the questions and statements read to them and his/her answers are correct and complete to the best of their knowledge.

5.   Unsigned applications – An unsigned application received by the agency is not considered an application for processing purposes.  All unsigned applications shall be promptly returned to the applicant for signature.

The entire application shall be returned to allow the applicant to review his/her answers prior to certifying under penalty of perjury that all answers are correct and complete to the best of their knowledge.  A cover letter must be attached to the returned application explaining the need to sign the application and return to the agency for processing.

If the originally unsigned application is returned with a valid signature, the application date for processing purposes is the date the returned application is received by the agency if received on a business day.  If the application is received on the weekend or a holiday, the application date is the next following business day.

Note:  Neither an online nor telephonic application may be submitted without a signature.  Therefore, there should never be an online or telephonic application received without a signature.  The signature may be invalid (see subsection (6) below), but there should always be a signature.  

6.  Invalid Signature - An application received by the agency with an invalid signature is considered an application for processing purposes.  An invalid signature is one in which the person who signed the application has no authority to act on behalf of the applicant (see 2110 and subsections).  This includes verifiably forged signatures where the person signing the application is attempting to portray themselves as some else.  

When an application with an invalid signature has been received by the agency, the application (or a copy of the application for online applications) shall be returned to the applicant with instructions to either verify the authority of the person who signed the application or to sign the application in their own name (if legally competent to do so).

If verification of authority to sign the application or if the application with the applicant’s own signature is timely received by the agency per 1321 (3), the application date for this application is determined by the following:

a.  If verification is provided documenting that the person who signed the application was authorized to apply on behalf of the applicant at the time the application was received by the agency, the application date is the date the application was originally received by the agency. 

Note: If the application indicates that the person signing the application has authority to apply on behalf of the applicant (such as a person holding a Durable Power of Attorney or is a guardian or conservator of the applicant), but no verification has been provided at the time of application, the process described in this section does not apply.  In that instance, the signature is initially considered valid and the agency shall send a request for information to provide verification of the authority.

b.  If the applicant responds by formally designating the person who signed the application as his/her medical representative according to 2111 (2)(b), the application date is the date documentation of the medical representative authorization is received by the agency if received on a business day.  If the medical representative authorization is received on the weekend or a holiday, the application date is the next following business day.

c.  If the application is returned with the applicant’s own signature, and the applicant is legally competent to apply on their own behalf, the application date is the date the returned application with the valid signature is received by the agency if received on a business day.  If the returned application is received on the weekend or a holiday, the application date is the next following business day.

This provision also applies where someone other than the applicant, who is verified to act on behalf of the applicant according to 2111 (2)(a), signs and timely returns the application to the agency.

If verification of authority to sign the application or if the application with the applicant’s own signature (or of someone who can act on behalf of the applicant) is not timely received, the application shall be denied due to an invalid signature based on the date the application was originally received.     

7. No program request – The application date for an application received with no program request is the date the application is physically received at the KanCare Clearinghouse, an Outstation Worker site, or other location designated by the agency.   Immediate contact with the applicant shall be made to determine which programs are being requested.

The program(s) requested shall be registered using the date of receipt of the application as the application date for those programs only.  Any subsequent request for other programs by the applicant shall be registered with an application date based on the date of request for the additional program(s).

Note: An online application may not be submitted without a program request.  Therefore, there should never be an online application received without a program request.    

1411.3 Who May File - An application for assistance shall be made by the individual in need or by another person able to act in the individual's behalf. See 2110. If the applicant or his representative signs by mark, the names and addresses of two witnesses are required. Obtaining the signatures of all persons in the family group who are requesting assistance and able to act in their own behalf per 2110 is encouraged, but cannot be required. 

1. Filing on Behalf of a Deceased Person - For medical, an application may be made on behalf of a deceased person by any responsible person. Application must be made in the month of death or within the three following months.

2. Filing for Institutionalized Individuals (Not applicable to the MediKan Reintegration Program) - When possible, all necessary information and signed forms will be obtained by institutional personnel. Parents, spouses, guardians/conservators and others who may apply on behalf of the individual per 2110 must always be given the opportunity to apply on behalf of an institutionalized person not able to act in his own behalf. If institutional personnel are unable to obtain an application from the patient or any of the above individuals, the administrator of a licensed facility may apply on behalf of the patient. For minor children, if the length of stay will not exceed 30 days so that parental income and assets are considered, hospital staff are not allowed to complete the application process.

General hospitals are generally not regarded as a licensed facility for this purpose unless approved.  However, KDHE policy may approve exceptions on a case by case basis.

Complete applications will be forwarded to the Clearinghouse for processing.  All information pertinent to eligibility and known by institutional staff will be communicated to the Clearinghouse. When the institution acts as an employer to the patient, institutional personnel will be responsible for reporting all earnings to the Clearinghouse. 

3. Filing for Individuals Requesting Tuberculosis Coverage - For persons KDHE determines to be in need of treatment for TB (per 2692) who are not eligible for regular medical coverage, the Certification of Need for TB Treatment (ES-3100.3) is normally used for application.

The form must include an authorization for care from KDHE as well as an effective date for care.

4. Filing for Individuals Qualifying for the MediKan Reintegration Program - Discharged staff have the responsibility for initiating a discharge plan for persons being discharged from Medicaid approved psychiatric hospitals, the Larned State Security Program, and the Larned Correctional Mental Health Facility (Central Unit). For MediKan Reintegration program purposes, an approved discharge or release plan shall include: 

All documents are located on the KDHE Eligibility Policy website.   

In addition, the plan will also include the anticipated date of discharge, documentation that the individual has been referred to Social Security to make application for SSI or SSDI benefits, the individual's address and living arrangement following discharge, and an ongoing treatment plan. 

The assigned worker shall have at least five working days advance notice to carry out the eligibility functions. Upon receipt of the approved discharge plan, the worker will need to ascertain the current eligibility status of the individual. 

5. Filing for Individuals Being Released from State Correctional Institutions - Discharge staff at the 9 State Correctional Facilities may begin the application process for potentially eligible inmates a maximum of 90 days prior to their release. The correctional facilities are El Dorado (Central, North, and Toronto Unit), Ellsworth, Hutchinson (Central, East, and South Units), Lansing (Central and East Units), Larned (Central and West Units), Norton, Topeka, Wichita Work Release Facility, and Winfield.

In such instances, the inmate can sign the application as of the date of completion and the application can be filed with the Clearinghouse where the facility is located. The application must be part of the approved discharge plan for the inmate. Designated Clearinghouse staff shall be responsible for coordinating submission and processing of these applications. Discharge planning staff at each correctional facility are responsible for initiating a release plan which incorporates a completed and signed application for benefits, if appropriate, as well as all supporting documentation for the application. If application is made for medical assistance benefits, the guidelines provided for MediKan Reintegration cases in item (4) above are applicable. This includes completion of the ES-3903 and completion of necessary forms and referrals as well as all medical records obtained by the facility regarding the person's disability.

The application shall be registered in KEES at the time of receipt. However, the application is not valid until the release date. As such, the application registration date shall be changed to reflect the release date at the time of release and application processing time frames (including expedited benefits) will be based on that date.

The agency shall make an eligibility determination and issue benefits within 30 days following the date of the applicant's release from the institution. If, for any reason, the agency is not notified on a timely basis of the applicant's release date, the agency shall determine benefits based on the date of release.

Assistance shall be determined based on the living arrangement the person is residing in upon release.  Assistance for the individual shall be prorated for the first month of assistance based on the date of application/discharge.

6. Filing for Individuals through the Health Insurance Marketplace – Individuals may apply for medical assistance through the Health Insurance Marketplace. The Marketplace application allows any adult member of the tax household to apply for any and all other members of the tax household. Should the agency receive an application via account transfer from the Marketplace, it shall be accepted and processed even if the individual filing the application does not meet the requirements of 2110 and subsections.

1411.4 Withdrawing the Application - The household may voluntarily withdraw its application at any time. The agency shall document in the case file the reason for withdrawal, if any was stated by the household, and that contact was made with the household to confirm the withdrawal. The household shall be advised of its right to reapply at any time subsequent to withdrawal.

1411.5 Signature Requirement – As noted in 1411, an application must be signed to be considered a valid request for assistance.  The signature must be both valid (see 1411.2 (6)) and acceptable.  An acceptable signature is one which meets the following requirements.     

1. Paper Applications – Any mark or sign made by the person signing the application with the intent to represent the identity of that person is acceptable.  This includes hand written (wet), typed (mechanical), stamped, and scanned signatures.  A handwritten signature does not have to be legible to be acceptable. If the person is marking the application with an “X” (or other symbol) because they are unable to sign their name due to illiteracy or disability, the signature of two (2) witnesses to validate the identity of the person making the mark is required.

2. Online Applications – In general the applicant (or applicant’s representative authorized to act on behalf of the applicant) should type his/her full name on the application, which constitutes a valid and acceptable signature.  However, when less than the applicant’s (or authorized representative’s) full name appears, the following provisions apply.

a. Acceptable – Using the prudent person concept described in 1310, if the signature submitted on the application provides enough evidence to reasonably identify the signer as the applicant (or authorized representative), the signature is considered acceptable.  Examples of acceptable signatures include (but are not limited to) the use of initials, nicknames, or partial names associated with that person instead of his/her legal name, as long as the identity of the signer can reasonably be discerned from the signature.

b. Not Acceptable –– If the signature provided on the application does not provide enough evidence to reasonably identify the signer as the applicant (or authorized representative), the signature is considered unacceptable. Examples of unacceptable signatures include (but are not limited to) partial names or nicknames not normally associated with the person’s formal name, an indecipherable combination of letters and/or numbers, or a name totally disassociated from the applicant.

When the signature has been determined to be unacceptable, an attempt to contact the applicant should be made to confirm the identity of the person who signed the application.  If it is confirmed that the applicant (or authorized representative) signed the application, the signature shall be considered acceptable.

3. Telephonic Applications – A person applying telephonically shall be required to verbally certify, under penalty of perjury, that they understand the questions and statements read to them, and that the answers are correct and complete to the best of their knowledge.  To complete the telephonic signature, the applicant will be required to state their full legal name.  That statement will be recorded and attached to the case as a permanent record.

Based on this process, the verbal signature shall always be deemed to be acceptable.  However, if it is later verified that the person who provided the verbal signature was not the applicant (or authorized representative), the signature is considered to be a forgery, and thus an invalid signature, see 1411.2 (6).

If the application does not contain an acceptable signature, follow the process described in 1411.2 (6) for invalid signatures.

Note:  While the applicant (or authorized representative) is directed to both sign and date the application, failure to date the application (or provide an incorrect date) does not invalid the signature or the application.  As long as an acceptable signature has been provided, the signature requirement has been met.  See 1411.2.