State Fair Hearings

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Eligibility State Fair Hearings

The eligibility state fair hearing is processed by the Office of Administrative Hearings (OAH). It is an opportunity for the applicant/member to speak about the eligibility decision made by the Medicaid agency. Eligibility state fair hearings include the opportunity to speak about the HCBS waiver eligibility decision made by the Department on Aging and Disability (KDADS). The member and either the Medicaid agency or KDADS meet before an impartial administrative law judge. He or she will issue an initial order based upon what is presented by you and the Medicaid agency or by you and KDADS at the hearing. An eligibility state fair hearing can be requested regarding any negative eligibility decision or if the application process is delayed.

What is an eligibility state fair hearing?

An eligibility state fair hearing can be requested regarding any eligibility decision made by the Medicaid agency or if the application process is delayed. The eligibility state fair hearing is processed by the Office of Administrative Hearings (OAH) with the State of Kansas. It is similar to a trial in court with witnesses and exhibits. It is an opportunity for the applicant/member and the Medicaid agency to speak to an impartial Administrative Law Judge about the eligibility decision made by the Medicaid agency. The OAH judge conducts the hearing. The judge does not represent you or the Medicaid agency. He or she will make a decision based upon what is presented by you and the Medicaid agency at the hearing. OAH will send a notice of hearing with the date and time of the hearing at least 10 days before the hearing. The hearing is recorded. The recording will become part of the official record of your case. Hearings are conducted by telephone and also at OAH.

May I review the information relied upon by the Medicaid agency in making the decision about my eligibility?

How do I submit a state fair hearing request regarding an eligibility decision?

The applicant, member or their authorized representative’s state fair hearing request may be submitted by telephone or in writing.

Eligibility State Fair Hearing Request Form

To submit an eligibility state fair hearing request by telephone call:

Call Center Phone Number: 1-800-792-4884
TDD/TTY Phone Number: 1-800-792-4292
The call center staff will complete the state fair hearing request form for you if your request is made by telephone.

To submit an eligibility state fair hearing request by fax send to:

(785) 296-4848 (Requests greater than 20 pages cannot be faxed).

To submit an eligibility state fair hearing request by mail send to:

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

To submit a withdrawal go to:

Withdrawal of State Fair Hearing Request

Is there a deadline for filing an eligibility state fair hearing?

Can my coverage be continued until the hearing decision?

What is the process once an eligibility state fair hearing request has been submitted?

The Medicaid agency or KDADS will submit documents related to the eligibility decision to OAH prior to the state fair hearing. You may also submit documents to OAH prior to the state fair hearing. OAH will schedule a state fair hearing about your eligibility decision within one or two months of the date of your state fair hearing request. OAH must reach its decision usually within 30 calendar days of the state fair hearing date.

If you ask for an expedited (fast) state fair hearing due to an urgent medical need, you must submit medical documents at the same time that you ask for a fast state fair hearing. The Medicaid Agency or KDADS will review medical documents and approve or deny your request. If approved, the hearing will be scheduled as soon as possible. If denied, your hearing request will be processed in the usual amount of time.

What documents do I need to submit with my request for a fair hearing?

What will I need for my eligibility state fair hearing?

May I bring an attorney or other representative to the hearing?

You may have an attorney represent you at the hearing. The attorney will be at your expense. If you hire an attorney, he or she must be licensed in Kansas. You may have a non-attorney represent you at the hearing. If you want someone to represent you, you will need to fill out the medical representative authorization form. That form may be found at the link below under Release of Information. You will need to submit it with your state fair hearing request.

Policy Appendix Page

Two legal assistance organizations that may provide help with a state fair hearing at no or low cost are:

Kansas Legal Services
Toll Free Phone: 1-800-723-6953 (application line)

Kansas Disability Rights Center
Toll Free Phone: 1-877-776-1541

May I have witnesses at the hearing?

Yes. You may have witnesses testify on your behalf at the hearing. If you need a subpoena issued that requires the subpoenaed person to participate in the hearing, you must ask the judge in writing to issue a subpoena for that person. You must ask the judge at least seven days before the hearing. You will be responsible for giving the subpoena to the witness. You will also be responsible for paying for any costs associated with the witness participating in the hearing.

If I don't like the judge's decision, what is the next step?

You may ask the State Appeals Committee to review the judge's decision. You must send your request in writing addressed to the State Appeals Committee. Your request should be mailed to the address in the judge's decision. You must ask for the review by the State Appeals Committee within 18 days of the judge's decision of the judge mailed the decision to you. You must ask for the review within 15 days if the judge sent the decision to you electronically. There will not be another hearing. The State Appeals Committee will review the judge's decision and issue a decision.

If I don't like the State Appeal Committee's decision, what is the next step?

How do I withdraw my request for a state fair hearing?

Other eligibility state fair hearing information

KanCare State Fair Hearings

The KanCare state fair hearing is processed by the Office of Administrative Hearings (OAH). It is an opportunity for the member to speak about the healthcare service decision made by one of the Medicaid agency's managed care organizations (MCO), Aetna, Sunflower, or United Healthcare. The member, representatives from Aetna, Sunflower or United Healthcare, and a representative from the Medicaid agency or KDADS meet before an impartial administrative law judge. He or she will issue an initial order based upon what is presented by you and the Medicaid agency or by you and KDADS at the hearing. This process is for KanCare members who have already completed the appeal process with Aetna, Sunflower, or United Healthcare.

What is a managed care state fair hearing?

How do I submit a managed care state fair hearing request regarding a managed care decision?

The member or member's authorized representative's state fair hearing request must be submitted in writing.

To submit a managed care state fair hearing by fax send to:

(785) 296-4848 (Requests greater than 20 pages cannot be faxed)

To submit a managed care state fair hearing by mail send to:

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

A managed care state fair hearing request form:

KanCare Member Request for Medicaid Fair Hearing

Notice of Withdrawal of Appeal

Is there a deadline for filing a managed care state fair hearing?

Yes, the member or member's representative must submit a request for a state fair hearing within 123 calendar days from the date of the notice of the appeal resolution determination.

The member has another opportunity to submit a request for a state fair hearing if the healthcare service decision was reviewed by the External Independent Third-Party Reviewer. The member must submit the request for a state fair hearing within 33 calendar days of the date of the notice containing the decision by the external independent third-party reviewer.

What happens once a managed care state fair hearing request has been submitted?

The MCO will submit documents related to the decision about your services to OAH prior to the state fair hearing. You may also submit documents to OAH prior to the state fair hearing. OAH will schedule a state fair hearing about the MCO's decision within one or two months of the date of your state fair hearing request. OAH must reach its decision usually within 30 calendar days of the state fair hearing date.

If you asked for an expedited (fast) appeal with the MCO, and the MCO approved the request and made a decision about your appeal within 72 hours, then you may ask for a fast state fair hearing due to an urgent medical need. OAH will schedule a state fair hearing and make a decision within 3 business days following receipt of your request for a fast state fair hearing.

What documents do I need to submit for my managed care state fair hearing?

Send in your state fair hearing request form as soon as possible saying you want a hearing. Provide an explanation of why you believe the MCO's decision is wrong. Include a copy of the notice and include an explanation of:

the change that has been determined by the managed care organization
why this should not be done and the problem it will cause
the effect it will have short and long-term on the physical, mental and emotional well-being of the member.
For HCBS members, include a copy of the current Integrated Service Plan (ISP) (plan of care) and the new plan.

What happens to my services during the managed care state fair hearing process?

Non-HCBS Services

If the MCO did not change their decision when you appealed you may ask for a state fair hearing. You must ask for the state fair hearing within 123 calendar days from the date of the appeal resolution notice.

If you want your services to continue during the state fair hearing process, you must ask the MCO within 10 calendar days from the mailing date of the appeal resolution notice.

If the state fair hearing officer changes the MCO's decision, and the Member received the services while the state fair hearing was pending, the MCO must pay for those services.

Please keep in mind that you may have to pay for the continued services if you lose the state fair hearing.

Home and Community Based Services (HCBS)

If the MCO did not change their decision when you appealed, you may ask for a state fair hearing. The MCO will automatically continue your current HCBS services for 123 calendar days from the date of the appeal resolution notice to allow you time to ask for a state fair hearing. If you do not ask for a state fair hearing, the current level of HCBS services will change.

If you ask for a state fair hearing within 123 calendar days from the date of the appeal resolution notice, the MCO will continue your current level of HCBS services until the hearing decision.

If the state fair hearing officer changes the MCO's decision, and the Member received the HCBS services while the state fair hearing was pending, the MCO must pay for those services.

You will not have to pay for the continued services if the state fair hearing decision is not in your favor unless fraud is present.

Other managed care state fair hearing information

You may have an attorney represent you at the hearing. The attorney will be at your expense. If you hire an attorney, he or she must be licensed in Kansas.

The most frequent mistake made by individuals during the process of preparing is failing to read the notices and documents issued as part of the state fair hearing process. The notices and documents will have deadlines. Read everything you receive very carefully.

How do I withdraw my request for a state fair hearing?

May I bring an attorney or other representative to the hearing?

Two legal assistance organizations that may provide help with a state fair hearing at no or low cost are:

Kansas Legal Services
Toll Free Phone: 1-800-723-6953 (application line)

Kansas Disability Rights Center
Toll Free Phone: 1-877-776-1541

FFS State Fair Hearings

The FFS state fair hearing is processed by the Office of Administrative Hearings (OAH). It is an opportunity for the FFS member to speak about the healthcare service decision made by the Medicaid agency. 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 you and the Medicaid agency at the hearing. The fair hearing process is for members currently receiving services.

What is a FFS state fair hearing?

How do I submit a state fair hearing request regarding a FFS decision?

The member or member's authorized representative's state fair hearing request may be submitted verbally or in writing.

FFS Beneficiary - Request for Medicaid Fair Hearing

To submit a FFS state fair hearing request verbally:

1-800-766-9012

To submit a FFS state fair hearing request by fax send to:

(785) 296-4848 (Requests greater than 20 pages cannot be faxed).

To submit a FFS state fair hearing request by mail send to:

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

Is there a deadline for filing a FFS state fair hearing?

What is the process once a FFS state fair hearing request has been submitted?

The Medicaid Agency will submit documents related to the decision about your services to OAH prior to the state fair hearing. You may also submit documents to OAH prior to the state fair hearing. OAH will schedule a state fair hearing about the Medicaid Agency's decision within one or two months of the date of your state fair hearing request. OAH must reach its decision usually within 30 calendar days of the state fair hearing date.

If you ask for an expedited (fast) state fair hearing due to an urgent medical need, you must submit medical documents at the same time that you ask for a fast state fair hearing. The Medicaid Agency will review medical documents and approve or deny your request. If approved, the hearing will be scheduled as soon as possible. If denied, your hearing request will be processed in the usual amount of time.

What documents do I need to submit for my FFS state fair hearing?

Full name, address, telephone number, a copy of the notice about which you are appealing. If your address changes during the state fair hearing process it is your responsibility to give that address change to OAH.

In the FFS state fair hearing process, you may provide information that shows why you believe that the Medicaid Agency did not follow the rules in processing your request for services.

Other FFS state fair hearing information

You may have an attorney represent you at the hearing. The attorney will be at your expense. If you hire an attorney, he or she must be licensed in Kansas.

May I bring an attorney or other representative to the hearing?