The KanCare Ombudsman’s office has a document that provides medical, pharmacy, vision and dental assistance for those without insurance. The Assistance for Those without Insurance Document is online or can be mailed by calling the KanCare Ombudsman’s office at 855-643-8180.

Call 1-800-792-4884

You have the right to voice concerns about your health care.

You may file a grievance if:

• You are concerned about the type of care you are getting,
• You are concerned about the quality of the care you are getting, or
• You have other concerns about your health plan or your provider.

You may ask for a fair hearing or an appeal if:

• You do not agree with an action such as a denial or limit on services,
• You feel you had to wait too long to get services, or
• Your KanCare plan is not paying for a service you got.

A fair hearing is like a trial in court. The hearing is your chance to tell a third party why you disagree with the agency. You must request a fair hearing within 30 days of when you were told of the decision. For more information on the fair hearing process, please contact Customer Service at 800-766-9012. Your KanCare plan can help you with this process.

Yes. Each KanCare health plan must have a Member Advisory Council made up of people who receive services or their families. People who receive services are also represented on the Governor’s KanCare Advisory Council.

You should call the KanCare health plan’s customer service number, talk to your care manager or file a written grievance. The handbook you received explains how to do that.

You will be able to see special doctors or other providers for treatment or follow-up if you need to.

Managed care is a way of providing health care and long-term services and supports through a health plan. In a health plan, a group of providers offers health care services and community long-term services and supports. Under managed care, your services are coordinated by your primary care doctor and a service coordinator.

Every Medicaid member is in a KanCare health plan.

Children are eligible to receive dental services. Adults are able to receive dental exams and cleanings at least once per year.

You may have a client obligation based on your family’s income. If the service you receive is a covered service, you will not have to pay anything for it. If you have a monthly client obligation to pay or must spend down to continue to receive Medicaid.

This is someone who works for the KanCare health plan. A care manager makes sure you get the medical care and community services you need to stay healthy and take care of any conditions you have, like diabetes or asthma.

You don’t have to use them. If you need community long-term services and supports in the future, contact your health plan and ask to speak to your care manager.

If you are in both programs, you will use Medicare for many of your health care needs and prescription drugs. Medicaid does not replace your Medicare Part D. You will use KanCare for your Medicaid long-term service and support needs. Medicaid may be able to help with your Medicare co-pays and deductible.

Yes. Each KanCare health plan will help you get to your doctor and other health care providers. They will give you a phone number to call to get a ride.

You can choose to go to any doctor on the provider list for the KanCare health plan you’ve chosen. You can change doctors any time, as long as the new doctor is on the health plan’s provider list. Call your health plan if you want to choose a different doctor.

You will be in the health plan you have chosen for one year. You will have a chance to change plans again each year. There are a few reasons that you can change plans in the middle of the year. To change in the middle of the year you need to have what is called a “good cause” reason to change. For more information, you can look at this list of FAQ Good Cause Reasons to Change Your Plan.

They all cover the same basic Medicaid services, but some of the extra services they provide are different. They also have to provide service statewide.

There are three KanCare health plans you can choose from. You are asked to choose a health plan at the time you complete your initial application. If approved, you will have 90 days after approval date to choose or change health plans.

KanCare is the name for the State of Kansas’ Medicaid program. KanCare is managed care that combines health care (like doctor visits) with community long-term services and supports (like help in your home). You choose a KanCare health plan that provides your services.

If you have questions about the KanCare program we want you to get the information you need. See this Contact List for information and phone numbers to call to get your questions answered.

The DD waiver currently provides services to approximately 8,220 people. The waiting list for these services is comprised of approximately 3,762 individuals, and of those, 2,631 are receiving no services and 1,131 are getting some services but waiting for others. As savings from KanCare are generated during its lifespan, the State of Kansas will have the opportunity to direct some of the savings to the DD waiting list.

For the immediate future, before a substantial amount of the savings from KanCare will be actualized, legislators allotted $3.6 million in State General Funds to help reduce the waiting lists.

Additional initiatives have been pursued as well, specifically the recent signing of HB 2453 which will create job opportunities for Kansans with developmental disabilities. HB 2453 not only promotes employment for Kansans with developmental disabilities, it also decreases the individual’s dependency on Medicaid. In turn, this saves the state Medicaid system money and helps address the DD waiver waiting list.

The state has ensured that improved health outcomes are a main focus of the contracts with managed care companies. The performance measures for health outcomes begin in the second year of the KanCare contracts. Contractors will not earn their full payments if they fail to achieve meet performance expectations for Kansans.

The state will require KanCare companies to create “health homes” revolving around our consumers’ core health care providers.

These reforms create the most comprehensive set of goals and targeted results in Kansas Medicaid history. These new standards exceed the federal requirements and set Kansas on a path to historic improvement and efficiency.

Savings will be achieved by reducing the number of people who are being kept in institutional settings unnecessarily, decreasing repeated hospitalizations, better managing chronic conditions and coordinating each individual’s overall care. KanCare contractors will be rewarded for paying for preventative care that keeps people healthy, so they don’t get so ill that they need very expensive services. Over time this will help slow the fast-rising costs of the Medicaid system and ensure it continues to function effectively for those who need it.

The KanCare contracts require that contractors use established community partners to deliver care and services. This includes hospitals, nursing homes, physicians, community mental health centers (CMHCs), primary care and safety net clinics, centers for independent living (CILs), area agencies on aging (AAAs), and community developmental disability organizations (CDDOs). The KanCare program will allow these community partners to do an even better job. The state will continue to use CDDOs and other provider groups in their established roles, which are outlined in Kansas law.

The state is planning an extensive educational campaign prior to implementation for all Kansas Medicaid consumers and their families, legal guardians and caregivers.

Persons with developmental disabilities will continue to work with their current case managers. State law ensures community developmental disability organizations (CDDOs) will conduct – either directly or by subcontract – the waiver eligibility assessments, case management and service.

The contracts stipulate that providers must be paid within 30 days or KanCare companies will face financial penalties. To further encourage timely claims, the contracts also include a pay-for-performance measure which requires contractors to process 100 percent of clean claims within 20 days.

The KanCare Advisory Council was appointed in March of 2012 to provide guidance and feedback to the state regarding the implementation, operation, and policies of KanCare. The appointees on this council represent beneficiaries, providers, and advocates as well as members of the Kansas House of Representatives and Kansas Senate.

Additionally, the KanCare health plan companies will be required to create member advisory boards to receive regular feedback from members enrolled in their health plans.

Two bills introduced during the 2012 legislative session to create a KanCare Legislative Oversight Committee were never passed by state lawmakers. However, the administration has been very vocal and supportive of a legislative committee tasked with KanCare oversight, and will continue to champion this initiative. In the meantime, the administration looks forward to keeping all legislators, and particularly members of the Joint Health Policy Oversight Committee and the House Home and Community Based Services Committee, engaged in an oversight role for KanCare.

Nearly 75 percent of Kansas Medicaid patients already are part of integrated care.. Coordinating all care – including long-term services -- is critical if we are going to improve the health outcomes of all Kansans enrolled in the program.

A 2010 study by Kansas Medicaid and the KU Medical Center found that Medicaid for Kansans with intellectual and developmental disabilities and those with physical disabilities was fragmented and poorly coordinated. It did not consistently provide the recommended health care that most people take for granted, such as screenings for breast, cervical or colorectal cancer. Lack of care coordination -- and therefore lack of access -- led to increased care costs and poor results. The best way to rearrange this system, which has been separating one kind of care from another, is by coordinating all care for the each individual. KanCare also attaches financial incentives to the system, which are designed to encourage contractors to integrate behavioral care, medical care and long-term services and supports in a way that will provide more effective overall care for each individual.

While Kansas has looked at other states and learned from their models, there is no single state that KanCare is modeled after. In Kansas, nearly two years has been dedicated to study, plan and implement KanCare. Currently, approximately 75 percent of Medicaid consumers in Kansas already are part of managed care programs involving their doctors, hospitals, pharmacists and behavioral health providers. Medicaid consumers currently in managed care will move to ‘integrated care,’ something similar to managed care, but with improved health care outcomes. Kansas has implemented policies to avoid the problems that other states have experienced. Kansas is on the leading edge of implementing an integrated system of care that focuses on Medicaid consumers as individuals with individual needs, not numbers.

Yes. KanCare will take more than a year to phase-in and implement. This time period allows for readiness reviews to be conducted on all three KanCare companies. This systematically ensures that consumers will be properly supported and served by this new system. A significant difference between KanCare and any other in the nation lies in Kansas’ focus on accountability. While Kansas has looked at other states and learned from their models, there is no single state that KanCare is modeled after.

The state is leveraging private sector experience and innovation while maintaining policy and hands on oversight of the Kansas Medicaid program to ensure improved outcomes and sustainable growth.

The state has included firm protections to maintain state responsibility for KanCare. These protections include a strong emphasis on data and outcomes. Each contractor is required by the State of Kansas to maintain a Health Information System (HIS) that analyzes and integrates data, and makes that data available to the State of Kansas and Centers for Medicare and Medicaid Services (CMS). These reports will include, but will not be limited to, information on utilization of services, grievances and appeals, and Medicaid trends in enrollment and disenrollment. Further, the usage of an External Quality Review (EQR) of the insurance companies will be conducted annually. This review, consistent with CMS protocols, will study the following:

• The methodology used by the contractor to gather and analyze its data;
• An assessment of quality, timeliness and accessibly to health care services; and
• The extent to which the contractor has made quality improvements based on external recommendations.

The compilation of these reviews will act as a streamlined source of unbiased data which can be acted on by the State of Kansas. The objectivity of the performance measures provided in Attachment J (Appendices 1-11) of the KanCare RFP, coupled with the technical report data, makes it possible to benchmark the performance of KanCare and monitor the performance of the contractors in relationship to the performance goals of the state.

In the event that the State of Kansas determines that a contractor has failed to provide medically necessary services or follow specified procedures, capitation payments may be withheld. Additionally, liquidated damages will be collected by the State of Kansas should the contractor fail to meet performance requirements.

The KanCare contracts ensure that previous levels of services for consumers and reimbursements to providers werel not reduced. At the same time, new services were added into the contracts to bridge the gaps in Medicaid, and improve overall coverage. These new services were incorporated into KanCare based on feedback the state heard from Medicaid providers, stakeholders, and consumers.

New services added through the KanCare program include:

• Heart, lung, and heart/lung combination transplants for adults
  • None of these transplants are currently covered in Medicaid for adults.
• Bariatric surgery
  • The State identified specific requirements that must be met for an individual to receive this previously non-covered service.
• Value-added services
  • Each MCO agreed to provide a set of additional, previously non-covered services to beneficiaries at no cost to the State.
  • All three MCOs are providing an adult preventive dental benefit as part of their value-added services.
  • Other services provided by one or more MCOs include things such as rewards programs for healthy behaviors, additional respite care for certain beneficiaries, and career development services for people with disabilities.

Expectations include:

• The State expects KanCare networks to include all Medicaid providers;
• The State conducted readiness reviews of each contractor prior to implementation;
• Clean claims must be processed within 30 days. A pay for performance measure establishes a standard of 100% of clean claims processed within 20 days;
• Persons with developmental disabilities will continue to work with their current case managers if they choose. The statutory role of Community Developmental Disability Organizations will be maintained;
• Contractors will use established community partners to deliver care and services;
• Health homes will revolve around consumers’ core providers.

The three KanCare contractors were selected in a technical, systematic, four-step process.

KanCare evaluation teams were formed by members of the state agencies currently involved in the Medicaid program – the Department of Health and Environment, Department on Aging, and Department of Social and Rehabilitation Services – and tasked with the review of all submitted technical and cost proposals.

To ensure congruency in the selection process, leaders of the evaluation teams organized to form the evaluation committee. The evaluation committee carefully designed and planned the structure of evaluation sessions to safeguard against bias, and guarantee that each potential bidder would have an equal opportunity to exhibit their approach and experience.

After the evaluation teams determined that the five bidders proposals merited further consideration, the evaluation committee held two rounds of face-to-face negotiations with each bidder. During these negotiations, bidders gave website demonstrations and answered questions, comments, and concerns from the state. Each negotiation was conducted in the same manner to ensure that the evaluation committee could perform the most accurate comparative analysis.

After the two rounds of face-to-face negotiations, the evaluation committee recommended the three contractors that met all technical requisites of KanCare and expectations of the state. These bidders also submitted the lowest-cost proposals.

• Person-centered care coordination
• Clearer accountability
• Agency streamlining and name change
• Financing consolidation

Changes can be reported in the Self-Service Portal. You must be logged in to report a change to your case.

You may also report changes over the phone at 1-800-792-4884. You can submit changes in writing by faxing them to 1-800-498-1255 for Family Medical Programs or 1-844-264-6285 for Elderly & Disabled Programs.

You may also mail them to KanCare Clearinghouse, PO Box 3599, Topeka, KS 66601. Always include your name and case number on documents you send in.

Getting married does not affect current coverage for many of our programs, although changes may occur at your next review. If your coverage is through a program for the elderly or disabled current coverage might be affected, but we would have to look at your individual case to know.

Everyone with an open case should report this change to us.

In some cases, yes, they can. You will need to contact us and make a request to add your spouse to your case. You may be asked to provide your Social Security number, date of birth, income, and resources. You can also report a change and upload documents on the Customer Self Service Portal.

In most cases, yes, they can. You will need to contact us and make a request to add your baby/child to your case. You may be asked to provide your Social Security number, date of birth, and income. You can also report a change and upload documents on the Customer Self Service Portal.

In some cases, premiums can be reduced or even removed. Events such as the loss of a job or the birth of a child can change how your premium is calculated. If you feel that your circumstances have changed since you applied (or since your last review), then you should contact us for more information.

In some cases, yes, you can. If you were the sole source of income for your household and you have no other source of income, then it is likely that you could receive coverage. If you contact us and request coverage for yourself, a new determination can be made to see if you are eligible for coverage.

Getting a job does not affect current coverage for many of our programs, although changes may occur at your next review. If your coverage is through a program for the Elderly or Disabled programs, current coverage might be affected but we would have to look at your individual case to know. Changes should be reported within 10 days of the change.

Income guidelines are higher for pregnant women than for other non-pregnant adults. In order to be considered for coverage you will need to contact us and request coverage.

Health Insurance through an employer will not cause you or your children to lose your current coverage. You do need to let us know about this change. Your insurance through your job will become your primary insurance. Changes do sometimes happen at review.

Please call us at 1-800-792-4884 so that we can assist you.

Please call us at 800-792-4884 so that we can assist you.

If you are logged in to the Customer Self-Service Portal you can upload documents there.

If you do not choose to upload them electronically, you may also fax them to Family Medical programs at 1-800-498-1255 or for Elderly & Disabled programs at 1-844-264-6285

Or mail them to KanCare Clearinghouse, P.O. Box 3599, Topeka, KS 66601. Be sure to include a copy of the notice you received.

The email or text message we sent is only to alert you that a new message has been sent to the message center. You need to be signed on to see your messages, they can be read here.

Click on the 'View notices' link in the Access my benefits section of the home page. The link is only visible if you are signed in. Notices from the last 14 months are available.

If you are on Medicare, you may qualify for help to pay your Medicare premium. If you need nursing home care, you may qualify for Medicaid to help pay for it. We also have a program of in-home care called Home and Community Based Services (HCBS). This may help you remain in your home. Visit Program Fact Sheets to read more about these programs.

If you are not yet age 65, your disability must be determined by Social Security rules. If you are getting Social Security Disability benefits, this was already done. You may qualify for Medicaid if your income is within certain limits. You may also qualify for Home and Community Based Services (HCBS). This program may provide some in-home help to you. If you receive Medicare, you may also qualify for help with your premiums. Visit Program Fact Sheets to read more about this.

While Medicaid and Medicare sound similar, they are in fact, very different programs. One of the biggest differences is Medicaid is a state governed program and Medicare is a federal governed program. Here are some other differences:

Medicaid is for low income:

• Pregnant women
• Children under the age of 19
• People 65 and over
• People who are blind
• People who are disabled
• People who need nursing home care

Application for Medicaid is made at the State's Medicaid agency.

Medicare is for:

• People 65 and over
• People of any age who have kidney failure or long-term kidney disease
• People who are permanently disabled and cannot work

Medicare is applied for at the local Social Security office.

Some people qualify for both Medicaid and Medicare. Medicaid is sometimes used to help pay for Medicare premiums. People who qualify for both programs are called 'dual eligible'.

A facilitator is someone who has very limited access to your case information. They may be able to help you with your application, check on the status of your application, and find out if you are currently receiving coverage.

A medical representative, on the other hand, has more access to your case and may in fact be able to make requests for coverage on your behalf and sign your application for you.

For anyone to be designated as either a medical representative or facilitator, the proper releases and forms must be completed, and copies provided to us.

Additionally, if you are a legally appointed role such as a Guardian or Conservator, you must send proof. This can be uploaded on the Medical Self Service Portal, faxed to 1-800-498-1255 for Family Medical or 1-844-264-6285 for Elderly & Disabled. Documents may also be mailed to KanCare Clearinghouse, PO Box 3599, Topeka, KS 66601.

We also have a submitter role. A submitter is someone with an organization such as a Community Food Bank, Community Health Clinic, or Housing Office. It could also be an assisting friend or family member. These individuals may help consumers apply on the Medical Self Service Portal. They would not receive information about the consumer's case or copies of notices. In these cases, they must print out the signature page of the application, have the consumer sign it, and upload the signature page with the application. If the signature page is not received, it will not be considered a valid application. Consumers may receive a copy of the application to sign and return which would be required to consider it a valid application.

Forms that can be filled out and returned to KanCare to appoint a Medical Representative or a facilitator are available for download.

• Medical Representative Authorization Form
• Formularios de Autorización del Representante Médico
• Facilitator Authorization Form
• Formulario de Autorización del Facilitador

Nursing Home
This category of coverage is for persons residing in a nursing home or similar facility for a long-term stay. Based on income level, some individuals are responsible for a portion of the cost of their care in the facility.

HCBS (Home and Community Based Services)
This program is for persons who have a medical need for services in the community which can keep them out of an institution. There are currently 7 different HCBS programs, each with a different set of rules. Based on income level, some individuals are responsible for a portion of the cost of their care.

PACE (Program of All-Inclusive Care for the Elderly)
This program is for disabled persons (age 55 years or older) and persons age 65 or older residing in selected counties within the state.

• Dickinson
• Douglas
• Ellsworth
• Harvey
• Jackson
• Jefferson
• Leavenworth
• Lincoln
• Lyon
• Marion
• Marshall
• McPherson
• Nemaha
• Osage
• Ottawa
• Reno
• Rice
• Saline
• Sedgwick
• Shawnee
• Pottawatomie
• Wabaunsee
• Wyandotte

Individuals receive long term care coverage through a managed care network. HCBS guidelines apply to individuals living in the community and institutional guidelines apply to those living in a facility. Based on income level, some individuals are responsible for a portion of the cost of their care.

WORK (Work Opportunities Reward Kansans)
This program is for disabled or blind persons between the ages of 16 to 64 who are working. It will provide personal care and other services to help people stay employed. Based on income level, some individuals are responsible for a portion of the cost of their care.

Other Institutional Care
Coverage for other types of Institutional Care is also available. For example:

• State Hospitals
• Psychiatric Residential Treatment Facilities
• Swing Bed Hospitals
• Head Injury/Rehabilitation Facilities
• Intermediate Care Facilities for People with intellectual Disabilities/Mental Retardation

Persons seeking payment for coverage in one of these facilities will need to meet level of care requirements. Based on income level, some individuals are responsible for a portion of the cost of their care.

You can use our self-assessment to see what you might be eligible for. Begin the self-assessment process. We will not be able to give you a final answer until after you apply. If you wish to bypass the self-assessment and apply now, begin your application process.

The self-assessment takes only a few minutes. It will take you about 15 minutes if you want to fill out the online application.

During the application process, you will receive a page that provides information on documents that may be needed. It will also allow you to upload these documents. If you do not choose to upload them electronically during the application process, you may also fax them to 1-800-498-1255 for Family Medical programs or 1-844-264-6285 for Elderly & Disabled programs.

You may also mail them to KanCare Clearinghouse, P.O. Box 3599, Topeka, KS 66601.

Below is a list of items that we might need:

• Employment and Income Information
• Last Year's Tax Return (if self-employed)
• *Medical Expenses
• *Property/Assets
• *Shelter Expenses

Items marked with an asterisk (*) are only needed if you are applying for an individual who is aged, blind, disabled, or receiving Medicare.

Within a few days you may be asked to send documents. The sooner you can provide these, the sooner a decision can be made. If you have not heard from us within 45 days, please call us at 1-800-792-4884.

Applications should not take longer than 45 days to process. In most cases you should hear from us much sooner than that.

You can use the link on the home page that reads 'Check the status of my application'. This link will not be visible until you sign in. If you have not heard from us within 45 days, please call us at 800-792-4884.

In many cases if you contact us and let us know that you feel an error was made, we can review the processing of your application. If any errors are found, they will be corrected. Please call 1-800-792-4884

If you are dissatisfied with experience or outcome of application, you can file a grievance also by calling the number above.

If a re-determination has been done on your case and you continue to think that the outcome should have been something different you can File an Appeal.

You can call 1-800-792-4884 to file an Appeal.

You can submit your request for an appeal in writing and send it to:

Office of Administrative Hearings
1020 S. Kansas Ave.
Topeka, KS 66612.

The fax number is 785-296-4848.

To see online help, you may need to change the pop-up blocker settings on your computer. In some cases, this may be as simple as clicking on a bar near the top of this page that displays a message like "a pop-up was blocked, click here to allow pop-ups." If you don't see a bar like this, you may need to edit the internet settings for your browser under the tool's menu. Many browsers have a help option that will show you step-by-step instructions.

You will need to log into the Customer Self-Service Portal. Once you have done that, click the "Maximize" button on the Message Center. This will be located on the upper left-hand part of your screen.

Locate the link reading 'Click here if you forgot your password'. Once you click on the words 'Click here if you forgot your password,' just follow the on-screen instructions. If you need additional help you can call 1-877-782-7358.

Locate the link reading 'Click here if you forgot your username'. Once you click the words 'Click here if you forgot your username,' just follow the on-screen instructions. If you need additional help you can call 1-877-782-7358.

Having an email address has become a necessity in our society. You will need an email address if you want to create an account for this site. You also need email for using some public library services, purchasing online, and contacting prospective employers. There are many free email services for you to choose from. Your chosen free email service should offer plenty of storage, effective spam filtering, a fast and productive interface, desktop email program as well as mobile access, and more. Each of the services has different strengths and weaknesses. You may find that one serves your needs better than another. In all cases, print out a copy of your information (including password, exactly as entered) and keep it securely with you.

To find free email services, search for "free email" using your computer's web browser. In addition, your local public library can help you set up an email account.

If you already had a case with us when you created your account on the portal you will need to take one more step to link the two together. On the left-hand side of the page, look for the link 'Request Case Access'. Once you click on that link follow the instructions on screen. You will need to know your case number in order to link your case. This can be found in the top right corner on any notice/form sent regarding your case. The linking is currently a manual process and may take some time to be processed.

We are not able to show you the documents you have sent us. We are only able to show you a list of the documents we have received. To see the list, click the link 'View my documents' in the Access my benefits section of the home page. The link is only visible if you are signed in.

Click on the 'View notices' link in the Access my benefits section of the home page. The link is only visible if you are signed in. Notices from the last 14 months are available.

This site can only provide you information about your low or no-cost health insurance. Programs that are handled by the Department for Children and Families (DCF) like food assistance or TANF can be viewed at DCF self-service portal. Please note that a link is always available to their site in the column to the left of the page.