Lane Williams and James Jordan, attorneys with Disability Rights Center of Kansas talk about how to file an appeal with a Managed Care Organization or request a State Fair Hearing for Medicaid patients whose care or services have been denied or reduced. (Link to training video will appear here when video is available)
Eric Carlson with the national Justice in Aging non-profit advocacy organization talks about Trends and Emerging Issues in Managed Long Term Services & Supports (MLTSS) (Link to Eric talking will appear here when video is available). View Carlson’s presentation/slideshow here.
If you submit a request for an appeal to your KanCare managed care organization (MCO), the MCO will conduct an internal review your record and their action/decision. When their review is completed the MCO will provide you with a written response of the review and the action they will take. Your request is submitted in writing and their reply is given in writing. There is no hearing.
If you submit a request for a State Fair Hearing, an administrative law judge will set a date for a hearing. The MCO and/or the state of Kansas will present information/evidence to the judge about why the MCO or State took the action or made the determination on your case that it took or made. You will have the opportunity to present information/evidence to the judge as well. Because the hearing is more formal than a conversation, it is helpful to find out ahead of the hearing how it will proceed and who can assist you in preparing your information/evidence and presenting your side. The Disability Rights Center of Kansas may be able to help you. You can contact them at Topeka by voice phone: 785-273-9661 • Toll free voice outside of Topeka: 1-877-776-1541 and by TDD: 1-877-335-3725. Otherwise you may designate someone to speak for/represent you or hire an attorney.
Resources and Examples of Letters and Forms
• KanCare and Your Plan of Care: Know Your Rights – a guide for persons using KanCare. To request print copies contact us at firstname.lastname@example.org or call toll free 1-800-525-1782
• Examples of Letters and Forms:
Denial of Eligibility Letter and notice of right to a hearing
KDADS Denial of Eligibility: Crisis Exception Request
Notice of Action (which reduces personal care service hours) Sunflower Managed Care Organization (MCO)
Denial of Requested Service, United Healthcare MCO
Amerigroup MCO Appeal Response
Request for Administrative Hearing
• EPSDT: Early and Periodic Screening, Diagnostic, and Treatment – Getting Services and Filing Appeals
• Helping Medicaid patients receive medically necessary services – a doctor’s perspective