If you have questions after reviewing this information, please contact the KanCare Ombudsman office at
855-643-8180 or
email us.
Information you will find on this page includes:
- Eligibility Grievance and Fair Hearing
- Managed Care Organization (MCO) Grievance, Appeal and Fair Hearing
- Fee for Service Grievance and Fair Hearing
- Agency Fair Hearing
- Forms
If you have a concern with the Clearinghouse, this may apply to you (e.g., application process, eligibility, renewal, client obligation, spenddown or Home- and Community-Based (HCBS) coding issues).
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.
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; a member may file for a fair hearing.
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.).
Fair Hearing
A fair hearing is an administrative hearing involving the presentation of evidence and argument before a presiding officer from the Kansas Office of Administrative Hearings (OAH) concerning an adverse benefit determination. The eligibility fair hearing process is for people in the eligibility process (application or renewal process) for receiving KanCare.
Fee for Service Fair Hearing Process
Fee for Service Fair Hearing Process Large Print