Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 7/5/2025
07000 >>> 07400
07300
07400 Client Requirements for Timeliness - Reviews -
7410 Review Form - As indicated in 7331, households subject to a pre-populated review shall be given a minimum of 60 days to return a required review form. The review form shall be mailed to the individual on or about the 15th two months prior to the end of the review period. To be considered timely received, the signed review form (see 1409.01) must be returned to the agency by the last day of the last month of the review period. Reviews received outside this period will be considered late. If the review form is not received by the time the discontinuance batch runs (around the 15th of the last month of the review period), coverage will be automatically discontinued with an effective date of the last day of the last month of the review period, see 7431.
7410.01 Using an Application Form as a Review - An application form shall be used as the review in the following circumstances:
- Received within two months prior to the Review Due month.
- Received any month after the Review Due month through the current month when the Review Discontinuance Batch has not been run.
The application is used to complete the review when all members of the household are listed on the application. The application must be reviewed for consistency with the known case information. If additional information is needed to process the review, it shall be requested from the consumer, but another application form or review form is not required.
It is not necessary for the applicant to have requested coverage for all household members on the application. If individuals who are due for review, are listed on the application form, it is assumed that they wish for coverage to continue, and the form shall be used as a review for them. If the form does not include all household members, it shall be used to determine eligibility for the newly requested individual. If the Review Due date is in the past, manual action shall be taken to discontinue the remaining household members for failing to return their review.
7410.02 Continuation of Coverage Pending Completion of Review - When a review form is received on or around the 15th of the last month of the review period (or the date the review discontinuance batch runs), eligibility at current levels will continue automatically until the review process is completed. For reviews received during the reconsideration period, coverage will not be rescinded, and the effective date will follow application policies (see 7431).
Note that if a review received after the review discontinuance batch runs but before the last day of the review month, the discontinuance shall be rescinded but coverage shall not be reinstated pending the completion of the review.
Due to this process, if a review received on or before the 15th of the last month of the review period is not timely processed by the agency, as defined in 7420, the current level of coverage for the individual(s) due for review may continue past the end of the review period for one or more months [extended month(s)]. The date the timely review is received, and new program eligibility will determine if those months are subject to correction, see 7432.
7411 Information/Verification - All information and/or verification shall be provided by the requested date. Clients must submit any required verification or additional information within 12 days from the date of the initial request in order to ensure the rights to uninterrupted benefits.
For requested information received during the review reconsideration period, see 7431.
Follow the verification requirements at initial application, except that non-citizen status, providing an SSN, residency, and identity, do not have to be reverified unless a change has been reported or it is questionable.
7420 Agency Action on Timely Review - If the review form is timely filed and all review requirements have been met, the agency shall promptly process the review to ensure correct and timely coverage is provided. Timely processing shall be defined as follows:
1. A review form received at least 30 calendar days before the end of the review period shall be processed by the end of the review period.
2. A review form received with less than 30 days remaining before the end of the review period shall be processed no later than the last day of the following month. This includes reviews received after the discontinuance batch has run but before the last day of the review period.
NOTE: This process may result in an extended month of coverage. Any extended month of coverage provided under this process is subject to adjustment as indicated in 7410.02(2) if understated eligibility has occurred. However, in no instance shall a claim subject to recovery be created for the extended month (see 8321.02)).
3. Due to the nature of the program, all Medically Needy (MDN) reviews, regardless of when received, shall be processed by the change processing deadline in the last month of the review period. This will ensure that a new 6-month eligibility base period is properly established beginning with the month after the month the review period ends. See also 1410.01(2).
All households shall be notified of the appropriate reporting requirements upon review approval. See 7120.
7421 Passive Review Responses - After being passively reviewed, the consumer is required to contact the agency (either orally or in writing) if any of the information on file needs to be updated. Reaction to this change is based on when the change was reported and the type of eligibility resulting due to the change.
- If the change was reported by the last day of the old review period, the change is processed as a Passive Review Response.
- If the change was reported after the last day of the old review period, the change is not considered a passive review response. It is treated like any other change that is reported outside of the review process. Anyone already passively reviewed and continuously eligible will not be negatively impacted.
To process the Passive Review Response, staff update the case with the changes and redetermine eligibility for the next review period. If eligibility will be the same or better than the previous review period, the change is effective with the first month of the next review period. If the result is adverse, such as a premium increase or a change to a lower hierarchy program such as CTM to TMD, the change will be effective in the next unpaid month allowing for timely notice.
For passive review responses reported by the end of the old review period, the reported change can result in a change in coverage and/or premium even if coverage has already been approved. If the passive review response includes a request for medical assistance for a new individual, the change to add the individual is processed for the month of request but coverage for existing members is protected for any paid months by continuous eligibility rules. When a premium is involved, if a positive change, the change is made for the month after the month of report.
7431 Review Reconsideration Period - If the review form is not returned by the end of the current review period, the individual has a three-month reconsideration period to return the review form through all existing modalities (mail, fax, phone, in-person, and online). Individuals will have until the end of the third month from the date of discontinuance to return the form for processing. After that, they may still return the review form by mail or fax, but the online portal will no longer allow them to submit an online review. Reviews received during the reconsideration period are processed as an application, meaning the effective date of coverage will follow application effective date policies (i.e., first day of the month of application or prior medical period for Medicaid and the date of approval for CHIP).
The reconsideration period also applies to information requested in order to process the review. When an individual is discontinued at review due to failure to provide requested information, they have three months to return the information without having to submit a new application. When requested information is received during the reconsideration period, it is also treated as a new application for effective-dating purposes. This means that while the information may be used to complete the determination for the review, the start date of coverage will be based on when the information was received (i.e., first day of the month received for Medicaid and date of approval for CHIP). If prior medical is needed to fill any gap months, the consumer has 60 days from the date the information was received to make the request.
A review reconsideration period is not applicable to an individual who is approved at review or is denied at review for not meeting eligibility criteria. Any review not submitted in a timely manner shall be treated as an initial application. The timeliness provisions of 1407 and subsections apply.
Note: An individual who timely submits a review form but submits all verification in an untimely manner shall lose the right to a prompt review of eligibility (see 7420).
7432 Agency Failure to Act Timely - If the agency fails to timely process a timely received review form, an administrative processing error may have occurred. For reviews received before the discontinuance batch runs (around the 15th), eligibility will continue with coverage at the current level while the review is awaiting processing. This may result in one or more months of coverage past the end of the review period before the review is processed [extended month(s)]. Once the review is processed, the extended months of coverage resulting from the delay shall be reevaluated as follows:
1. If the new level of coverage determined by the untimely agency review is the same as the previous coverage, no adjustment to the extended month(s) is required. No administrative error, other than delayed processing, has occurred.
2. If the new level of coverage determined by the untimely agency review is greater (more beneficial) than the previous coverage, the extended month(s) must be adjusted accordingly. Coverage for those extended month(s) shall be enhanced to match the newly determined coverage. The agency shall promptly update the coverage and notify the recipient(s) of the change.
3. If the new level of coverage determined by the untimely agency review is less than the previous coverage, including discontinuance of coverage, an agency error overstated eligibility has occurred for the extended month(s). Timely notice is required, and the new coverage period will begin with the next unpaid month allowing timely notice.
For the definition of a timely received review, see 7410. For definition of timely processing of reviews, see 7420.
7441 Frequency of Reviews - All MAGI-based medical program recipients shall be reviewed once every 12 months and no more frequently than once every 12 months.