Member Appeals, Hearings & Grievances

Eligibility

The grievance process is for people who are applying for, renewing Medicaid eligibility, or who have a complaint about some part eligibility of the eligibility process.

The state fair hearing is done through the Office of Administrative Hearings (OAH) with the State of Kansas. It is an opportunity for the member to speak about the decision made by the Medicaid Agency about your eligibility. The applicant/member and the Medicaid Agency meet before an impartial administrative law judge. He or she will issue an initial order based upon what is presented by the agency and by you at the hearing. You may ask for a state fair hearing if you disagree with an eligibility decision about your eligibility, client obligation, patient liability, spenddown, or eligibility for home and community based (HCBS) services.

 

KanCare Managed Care Organization (MCO)

If you are a KanCare member currently receiving services and have a managed care organization (MCO) such as Aetna, Sunflower or UnitedHealthcare, this applies to you.

Grievance


A managed care grievance is an expression of dissatisfaction about any matter other than an adverse decision.The grievance process is for KanCare members who are currently receiving services from an MCO.

Appeal


An appeal is your request for a review by your MCO of an adverse decision about your services. The appeal process is for KanCare members currently receiving services from a MCO.

State Fair Hearing


The state fair hearing is done through the Office of Administrative Hearings (OAH) with the State of Kansas. It is an opportunity for the member to speak about the decision made by the MCO about your services. The member, MCO and the Medicaid agency meet before an impartial administrative law judge. He or she will issue an initial order based upon what is presented by the agency and by you at the hearing. Members must complete the appeal process with their MCO prior to submitting a request for a state fair hearing.

Fee for Service (FFS)

If you receive Medicaid and do not have a managed care organization (MCO) such as Aetna, Sunflower or UnitedHealthcare, this applies to you (e.g., MediKan, QMB, SOBRA, Early Detection Works, PACE, etc.)

Grievance

A grievance is defined as an expression of dissatisfaction about any Fee For Service matter including an adverse decision. 

State Fair Hearing

The state fair hearing is done through the Office of Administrative Hearings (OAH) with the State of Kansas. It is an opportunity for the member to speak about the decision made by the Medicaid agency about your services. The member and the Medicaid agency meet before an impartial administrative law judge. He or she will issue an initial order based upon what is presented by the agency and by you at the hearing.