State Fair Hearing Request Form for a Member regarding Eligibility or Fee for Service Decision:
Eligibility or FFS Beneficiary Request for Medicaid Fair Hearing
State Fair Hearing Request Form for a Member regarding a Healthcare Service Decision by a MCO:
KanCare Member Request for Medicaid Fair Hearing
Withdrawal of State Fair Hearing Request
State Fair Hearing Request Form for a Provider regarding a Payment Decision by an MCO or KMAP, or a Healthcare Service Decision by a MCO:
Providers Request for Medicaid Fair Hearing
Withdrawal of State Fair Hearing Request