- To contact the KanCare Ombudsman
- Role of the Ombudsman
- Resource Information
- Meet the KanCare Ombudsman
To contact the KanCare Ombudsman
Toll Free: (855) 643-8180
Office: (785) 296-6270
Cell: (785) 213-2258
Fax: (785) 296-0256
- KanCare/Medicaid Contact Information
- MCO Contact Information
- Frequently Asked Questions
- Grievance/Complaint Process
- MCO Appeal Process
- State Appeal Process
- Continuation of Services
- MCO Member Resources on-line (including Member Handbooks)
KanCare/Medicaid Contact Information
- To apply for KanCare, call 1-800-792-4884 or your local DCF office; or apply online at https://cssp.kees.ks.gov/apspssp/
- If you didn’t receive an enrollment packet or have questions about enrollment call 1-866-305-5147.
- Medicaid: If you didn’t get a Medicaid ID card call your health care plan; Amerigroup (1-800-600-4441); Sunflower (1-877-644-4623); United Healthcare (877-542-9238)
MCO Contact Information
For general assistance for your managed care companies call these main numbers:
- Amerigroup (1-800-600-4441)
- Sunflower (1-877-644-4623)
- United Healthcare (877-542-9238)
Frequently Asked Questions
- FAQ’s regarding the request for additional services (“underserved”) list process )
- FAQ’s Targeted Cased Managers and Care Coordinators
Members who disagree with decisions made by their MCO regarding services have the right to file a grievance with the MCO.
Members must file a grievance within 180 days of the action taken by the MCO. The MCO must acknowledge in writing the grievance was received within 10 business days; 98% of all grievances must be resolved in 30 busines days. If the MCO believes an additional 30 business days may be needed to resolve the grievance, this request must be made to KDHE/HDCF two business days in advance of the 30 business day deadline. 100% of grievances must be resolved in 60 business days.
For grievance/complaint process for your managed care companies call these main numbers.
- Amerigroup Toll Free:(1-800-600-4441) (TTY 1-800-855-2880); Direct: 913-749-5955 (TTY 1-800-855-2880)
- Mail to: Administrative Review and Grievance Department , Amerigroup Kansas, Inc., 9225 Indian Creek Parkway, Building #32, Overland Park, KS 66210
- Sunflower (1-877-644-4623)
- United Healthcare (877-542-9238) (TTY: 711)
- Mail to: Grievance and Appeals, P.O. Box 31364, Salt Lake City, UT 84131-0364
MCO Appeal Process
- Members who have experienced an adverse action with an MCO may appeal the decision through the MCO defined process within 30, plus 3 calendar days if mailed, of the adverse action. The MCO must inform the member of the action in a notice. This notice is called a “Notice of Action.” The MCO must send a letter to the member within five business days acknowledging receipt of the appeal request. The MCO must resolve the appeal within 30 business days.
- Note: Members may request a State Fair Hearing (SFH) with the Office of Administrative Hearings (OAH) at the same time that they appeal an action taken by their MCO, or wait until after the MCO makes a final decision and then request a SFH if dissatisfied with the MCO’s final decision.
- Expedited Appeal – Members may file an expedited appeal when the member’s health requires a decision made as expeditiously as possible. MCOs must resolve an expedited appeal within three days. If more time is needed to gather additional information the MCO may request the additional time from KDHE/HCF. When an expedited appeal is requested, the member may not file a SFH concurrently.
Members should refer to their MCO’s member handbook for information regarding how to request an appeal with their MCO. MCO member handbooks can be found on the MCO’s website. MCO websites can be reached via the KanCare website at http://www.kancare.ks.gov/.
- Amerigroup appeal process ; Go to Member Handbook – two different Handbooks for Amerigroup; see instructions under MCO Member Resources.
- Sunflower appeal process (http://www.sunflowerstatehealth.com/for-members/member-resources/filing-a-complaint/) Scroll down half a page to where the appeal part starts.
Sunflower State Health Plan
Four Pine Ridge Drive, Suite 200
8325 Lenexa Drive
Lenexa, KS 66214
- Authorized Representative Form (http://www.sunflowerstatehealth.com/files/2012/06/grievance-representative-form.pdf)
- United Healthcare appeal process: Go to the Member handbook, p36; (http://www.uhccommunityplan.com/content/dam/communityplan/plandocuments/handbook/en/KS-MemberHandbook.pdf)
State Appeal Process
State Fair Hearing – Consumers dissatisfied with the MCO decision may make a written request for a Fair Hearing to the OAH. This can be done at the same time the consumer is appealing a decision with the MCO, of after the MCO makes their decision. The request must be in writing within 30 days of the notice of the decision, with three additional days added to allow for delivery via mail (33 days). All hearing dates, resolutions, and notifications follow the timelines prescribed by the Office of Administrative Hearings. If neither the consumer nor the State request that the KDHE State Appeals Committee (SAC) review the decision, the decision becomes final thirty (30) days from the date of the order.
To file a State Fair Hearing, consumers should write a letter within 30 plus 3 calendar days if mailed of the adverse action. The letter should be sent to
1020 S. Kansas Ave.
Topeka, Kansas 66612
- Frequently Asked Questions (http://www.oah.ks.gov/faqs-other.htm)
Continuation of Services: If an MCO’s action reduces, suspends or terminates previously authorized HCBS Program services, those services will continue for 33 days from the mailing date of the Notice of Action to allow you time to file an MCO appeal or ask for a State Fair Hearing. If you ask for an MCO appeal or a State Fair Hearing, your current HCBS Program services will continue for the duration of your MCO appeal or the date of the decision in your State Fair Hearing. If your MCO appeal is denied or the action taken by your MCO is approved by the Office of Administrative Hearings, you will not have to repay your MCO for service(s) provided during your MCO appeal and/or State Fair Hearing, unless fraud has occurred.
MCO Member Resources on-line (including Member Handbooks)
- Amerigroup: (https://www.myamerigroup.com/English/Medicaid/KS/Pages/kansas.aspx) two different handbooks. Choose Medicaid and Chip or SSI, LTC or Waivers, whichever one applies to your services. Then scroll to the bottom of the page to Member Handbook.
- Sunflower (http://www.sunflowerstatehealth.com/for-members/member-resources/)
- United Healthcare: Handbook (http://www.uhccommunityplan.com/content/dam/communityplan/plandocuments/handbook/en/KS-MemberHandbook.pdf)
Meet the KanCare Ombudsman
Dear KanCare Consumer,
I am the new KanCare Ombudsman. My name is Kerrie Bacon and I live in Topeka, Kansas. I have helped people with disabilities for many years. I worked for the Kansas Commission on Disability Concerns for more than 10 years, as Interim Executive Director for eight months at the Kansas Council on Developmental Disabilities and in KDADS’ Money Follows the Person program for nine months.
A great deal of the work I have done in the past has been to help people with resources, answer questions and resolve the issues they have. Those skills will be very helpful when working with consumers in the Ombudsman’s office.
Treating people with respect and dignity is a core value in the Ombudsman’s office. The primary role of the Ombudsman’s office is to help people understand how to navigate the KanCare system and to assist them in solving problems.
Please call me to talk about concerns you may have.