Appeals, Hearings & Grievances

If you have questions after reviewing this information, please call our office at 855-643-8180.

What is a Grievance and Which Process is Right for You?

A grievance is an expression of dissatisfaction. There are three types of grievance processes. For more information about each one, see the description and documents below.
  • This process is for KanCare members who are currently receiving services. This grievance will be filed with the member’s managed care organization.
  • This process is for people who are in the eligibility process(new application or renewal process) for receiving KanCare. This grievance will be filed with the Kansas Department of Health and Environment.
  • This process is for current KanCare members or applicants who (1) have already submitted an Eligibility Grievance with the Clearinghouse, but that grievance has not been resolved in a timely manner, or (2) for individuals in the eligibilty process that have an official complaint with one of the state agency departments. This grievance will be filed with the Kansas Department of Health and Environment.

What is an Appeal and State Fair Hearing and Which Process is Right for You?

An appeal is a request to your managed care organization for a review of an adverse action or a notice of action letter.

A hearing is done through the Office of Administrative Hearings (OAH) with the State of Kansas. It is an opportunity for the applicant/member to speak about his/her issue. The member and the state agency/MCO meet before a Presiding Office that is an administrative law judge, who is an impartial individual. He or she will enter an initial order based upon what is presented by the agency and by you at the hearing. For more information, see the file above, KanCare Appeal and State Fair Hearing Process or Eligibility and Renewal Hearing Process.
  • This process is for KanCare members who are currently receiving services. The appeal is filed with the member's managed care organization. The hearing is filed with the Office of Administrative Hearings. KanCare members must complete the appeal process with their managed care organization (MCO) prior to submitting a request for a state fair hearing.
  • The Eligibility Hearing Process is for people who are in the eligibility process (application or renewal process) for receiving KanCare. The hearing is filed with the Office of Administrative Hearings.
NEW – If the MCO fails to issue service authorization decisions or meet grievance and appeal resolution timeframes for standard and expedited service authorizations, grievances and appeals, such untimely authorizations or resolutions constitute a denial and are adverse actions. For more information see the file above, KanCare Appeal and State Fair Hearing Process.

Forms