Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 12/26/2024
01000 >>> 01520
01500
1521 Complaint Procedures - A complaint is a verbal or written grievance concerning an agency action or program policy. Any person who is an applicant, recipient, or is authorized to represent the applicant/recipient per 2010.01, 2010.02, 2010.04, 2011, and 2011.01 may file a complaint with the agency.
1521.01 Complaints Received in the KanCare Clearinghouse - Upon receipt of a complaint, the KanCare Clearinghouse shall:
(1) - Review the situation and determine if corrective action is indicated. The determination should be made by the Eligibility Supervisor or Program Administrator after consulting with the Eligibility Specialist.
(2) - Explain the action or policy to the complainant in writing or verbally. If corrective action is necessary, it should be initiated immediately. If corrective action is not indicated, inform the complainant of his right to request a fair hearing and the request procedure.
1521.02 Complaints Received in KDHE-DHCF Administration - Complaints received in KDHE-DHCF Administration will be referred to Eligibility Policy Section for a response. If the response requires KanCare Clearinghouse input, a telephone call or e-mail message outlining the nature of the complaint will be made to the Eligibility Program Administrator or their designee. This person will review the case and determine the appropriateness of the agency's action. If the agency is in error, the Eligibility Program Administrator or their designee will mandate that corrective action be initiated immediately.
Once the determination is completed, the Eligibility Program Administrator or designee will telephone or e-mail the Eligibility Policy Section and provide details of the agency's actions as well as any corrective measures taken. The Eligibility Policy Section will then answer the verbal or written complaint. If the Eligibility Program Administrator wishes to respond to a telephone complaint directly, the Eligibility Policy Section will notify the complainant to expect a telephone call from the Eligibility Program Administrator or designee within a pre-determined time period.
Complaints filed through the above system shall not include complaints alleging discrimination. Refer to 1530 for discussion of Civil Rights complaints. This system shall also not include complaints that should be pursued through the fair hearing process.