Grievances, Appeals and Fair Hearings

Which Process is Right for You?

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
  • Forms

Eligibility (Clearinghouse)

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).

Grievance


Eligibility grievance is for people in the KanCare/Medicaid eligibility process (new application or renewal process) or have an issue with spenddown or client obligation/patient liability.

Eligibility (Clearinghouse) Grievance Process
Eligibility (Clearinghouse) Grievance Process Large Print

Fair Hearing


The eligibility fair hearing process is for people in the eligibility process (application or renewal process) for receiving KanCare.

Eligibility Fair Hearing Process
Eligibility Fair Hearing Process Large Print

Managed Care Organization (MCO)

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

Grievance


The grievance process is for KanCare members who are currently receiving services from an MCO such as Amerigroup, Sunflower or UnitedHealthcare.

MCO Grievance Process
MCO Grievance Process Large Print

Appeal


The appeal process is for KanCare members who are currently receiving services from a MCO such as Amerigroup, Sunflower or UnitedHealthcare.

MCO Appeal Process
MCO Appeal Process Large Print

Fair Hearing


The fair hearing process is for KanCare members currently receiving services. Must complete appeal process with MCO prior to submitting request for state fair hearing.

MCO Fair Hearing Process
MCO Fair Hearing Process Large Print
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.

Fee for Service

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

Grievance


A grievance is an expression of dissatisfaction.

Fee for Service Grievance Process
Fee for Service Grievance Process Large Print

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

Forms