Understanding the intricacies of Kancare, the Medicaid program in Kansas, for your long-term service and support needs is an important step in planning for your future. Working with a knowledgeable attorney throughout the application process can prevent costly mistakes and ease your state of mind regarding finances. Below are some Frequently Asked Question (FAQ’s) regarding KanCare.
What is KanCare?
KanCare is the name for the State of Kansas’ Medicaid program. KanCare is managed care that combines health care (like doctor visits) with community long-term services and supports (like help in your home). You choose a KanCare health plan that provides your services.
How do I choose a KanCare health plan?
There are three KanCare health plans you can choose from- Sunflower Health Plan, Amerigroup and UnitedHealthcare. You are asked to choose a health plan at the time you complete your initial application. If approved, you will have 90 days after approval date to choose or change health plans.
Are all three KanCare health plans the same?
They all cover the same basic Medicaid services, but some of the extra services they provide are different. They also have to provide service statewide.
Can I change my health plan after the enrollment period ends?
You will be in the health plan you have chosen for one year. You will have a chance to change plans again each year. There are a few reasons that you can change plans in the middle of the year. To change in the middle of the year you need to have what is called a “good cause” reason to change. For more information, you can look at this list of common questions about this topic.
Can I change doctors?
You can choose to go to any doctor on the provider list for the KanCare health plan you’ve chosen. You can change doctors any time, as long as the new doctor is on the health plan’s provider list. Call your health plan if you want to choose a different doctor.
Does KanCare offer rides to see my doctor?
Yes. Each KanCare health plan will help you get to your doctor and other health care providers. They will give you a phone number to call to get a ride.
What if I have Medicare and Medicaid?
If you are in both programs, you will use Medicare for many of your health care needs and prescription drugs. You will use KanCare for your Medicaid long-term service and support needs.
What if I don’t need community long-term services and supports?
You don’t have to use them. If you need community long-term services and supports in the future –contact your health plan and ask to speak to your care manager.
What is a care manager?
This is someone who works for the KanCare health plan. A care manager makes sure you get the medical care and community services you need to stay healthy and take care of any conditions you have, like diabetes or asthma.
Will I have to pay anything for services?
You may have a client obligation based on your family’s income. If the service you receive is a covered service, you will not have to pay anything for it. If you have a monthly client obligation to pay or must spend down to continue to receive Medicaid.
Will I be able to get dental services in KanCare?
Children are eligible to receive dental services. Adults are able to receive dental exams and cleanings at least once per year.
What is managed care?
Managed care is a way of providing health care and long-term services and supports through a health plan. In a health plan, a group of providers offers health care services and community long-term services and supports. Under managed care, your services are coordinated by your primary care doctor and a service coordinator.
What if I don’t want to be in a KanCare health plan?
Every Medicaid member is in a KanCare health plan.
Will I be able to see special doctors?
You will be able to see special doctors or other providers for treatment or follow-up if you need to.
What if I have a complaint?
You should call the KanCare health plan’s customer service number, talk to your care manager or file a written grievance. The handbook you received explains how to do that.
Will consumers have any say in how KanCare operates?
Yes. Each KanCare health plan must have a Member Advisory Council, made up of people who receive services or their families. People who receive services are also represented on the Governor’s KanCare Advisory Council.
What If I Don’t Agree With a Decision About My Health Care?
You have the right to voice concerns about your health care.
You may file a grievance if:
- You are concerned about the type of care you are getting,
- You are concerned about the quality of the care you are getting, or
- You have other concerns about your health plan or your provider.
You may ask for a fair hearing or an appeal if:
- You do not agree with an action such as a denial or limit on services,
- You feel you had to wait too long to get services, or
- Your KanCare plan is not paying for a service you got.
A fair hearing is like a trial in court. The hearing is your chance to tell a third party why you disagree with the agency.
You must request a fair hearing within 30 days of when you were told of the decision.
SOURCE: http://www.kancare.ks.gov/consumer_faqs.htm as of 08/09/2016
A cautionary tale of family drama, failure to plan, and taking the wrong advice
The Smith family is in the middle of quite a feud over some valuable rings, owned by the late Mrs. Mary Smith. The eldest sibling, Abby, came over to our office the day after Mrs. Smith’s funeral quite upset because she and her siblings have been disagreeing over who should receive two diamond rings. The diamond rings are valued at $5,000 each, but hold greater sentimental value because of how long they have been in the Smith Family. Mrs. Smith had little personal property; other than the diamond rings, she had: a revocable living trust set up twenty years ago, a stock broker account valued at $20,000, and $150,000 in a bank savings account. At the funeral emotions ran high causing serious arguments, frustration, and hurt feelings between the four Smith siblings. The youngest sibling, Diane, left town abruptly with no question as to her distrust of Abby’s ability to resolve the dispute.
Following the death of her husband five years ago, Mrs. Smith moved to a continuing care retirement community where, for the past two years, she received skilled nursing care. At this point Abby took Mrs. Smith to the bank to have Abby’s name added to her mother’s account so she could write checks for her mother. An innocent enough gesture speaking to Abby’s efforts to care for her aging mother. The bank teller recommended that the account be removed from the trust, and made into a joint account into Mrs. Smith and Abby’s names. Thinking this was a good way to achieve the reason for their visit, Abby and Mrs. Smith took the bank teller’s advice and did just so.
The trust from twenty years ago was amended following Mrs. Smith’s death, by a family friend attorney, to make Abby the Successor Trustee and Executor, replacing the second oldest sibling Ben. For the past five years Abby has been the Successor Trustee of the trust and Executor of the will, and had been her mother’s Durable Power of Attorney for Medical and Financial decisions prior to Mrs. Smith’s death.
In the days since Mrs. Smith’s death the four siblings, Abby, Ben, Colin, (a bachelor with no real interest in what happens) and Diane have been feuding with each other over the fate of the diamond rings. Abby claims that Mrs. Smith gave her the two rings for her own daughters (Mrs. Smith’s granddaughters) while she was in the skilled nursing facility. Both of Abby’s daughters have plans to get married, which include the two heirloom diamond rings. However, Ben does not believe Abby’s story about the rings being gifts for the granddaughters. He wants at least one of the rings.
All four siblings assumed everything will be divided equally among them, which is what Mrs. Smith’s trust dictates. The trouble is that the stock broker account is in the trust, but the bank account is not! Not since the bank teller advised Mrs. Smith and Abby to change it to a joint account outside the trust. Legally, this means that at the time of Mrs. Smith’s death, the $150,000 bank account became exclusive property of Abby (the joint account holder).
Now, Abby can choose to gift ¾ of the $150,000 bank account to her siblings, but legally she doesn’t have to do so. In fact, if Abby did gift a quarter of the account at $37,500 for each sibling she would be making taxable gifts because it would exceed her $14,000 per person annual gift tax exclusion amount. This puts Abby in a tough situation with her siblings: keep all the money, or split it with her siblings but pay the gift tax?
Now, on top of the drama with the diamond rings, Abby is in an awkward situation with her siblings over her decisions regarding the savings account.
Unfortunately for Abby and her siblings, this situation was very preventable. Whatever the bank teller’s intentions, creating a joint account for Mrs. Smith and Abby failed to consider the many other related difficult issues. Joint bank accounts are a good arrangement for married couples, but in very few other situations. Bank tellers seem to like them because they are easy to setup. This is why you bank teller is in fact not your estate planner.
Mr. and Mrs. Smith took an excellent first step twenty years ago in establishing and funding their revocable living trust. But, they did not take the subsequent steps needed to protect their investment. Frequently wives let their husbands handle the financial affairs and do not educate themselves sufficiently to carry on after their spouse dies. This is particularly true for the elderly. At that point, it is critical to involve a trusted child, and better yet more than one child, in understanding the estate plan and related processes.
Remember the Smith family had a family friend attorney change the estate plan making Abby Successor Trustee, Executor of the Will and Power of Attorney for Health Care and Financial decisions, removing Ben (the previous Successor Trustee and Executor of the Will). This type of situation is common; often parents name their eldest son or the eldest child as Successor Trustee and Executor of the Will for no other reasons than tradition and sibling seniority. For the Smith Family, naming Abby as Successor and Executor rather than Ben may have been a good idea at the time, however naming the pair as Successor and Executor jointly and severally allows more than one child the responsibilities thereof. This may have taken some of the pressure off of Abby, and reduced some tension after the death of Mrs. Smith. The decision of whom to name as Successor and/or Executor is an important one. For the Smith Family naming an adult child (or children) who are involved (unlike the third sibling, Colin the bachelor) or who live close (unlike the youngest sibling, Diane who lives in another state) was a wise choice.
A regular review of Mr. Smith’s estate plan, with a knowledgeable estate planning attorney, would have uncovered the problems with the joint bank account. Several methods were available that would have worked more effectively than a joint bank account. The account could have been left in the trust, with Abby as Co-Trustee. Abby could have been made an authorized signer on the account, with the account designated as payable-on-death (POD) to the trust. This means that Abby could have written checks for her mother (which was the original intention), and after Mrs. Smith’s death the content of the bank account would be paid to the trust…which would have been dispersed equally among the siblings as originally intended by Mr. and Mrs. Smith twenty years ago. The durable power of attorney document authorized Abby to make these arrangements, even if Mrs. Smith could not physically make it to the bank. A smaller account could have been setup outside the trust, payable-on-death (POD) to the trust, with Abby as the authorized signer. This would have eliminated the exposure of the bank account to Abby’s potential legal problems and creditors.
As for the diamond rings…Mrs. Smith could have eliminated the misunderstanding by simply writing a note specifying who she wishes to receive them. This could have been done in her own handwriting, at any time before her death; no legal formality required. In some cases when older adults are unable to write or type out their wishes using a video camera to record the person speaking in their own words about their wishes, is an alternative; extra care needs to be taken to record the date and a physical copy of the recording (like a DVD or thumb drive) with the will.
Ben, Diane (and to a lesser extent Colin the Bachelor) had to go off of Abby’s word that Mrs. Smith meant the diamond rings to be gifts for the granddaughters. When people are grieving and upset it is difficult to take for fact things of which they don’t agree. This is why Ben was so upset at the funeral, and probably contributed to Diane’s leaving town angry with Abby.
A regular review of all aspects of an estate plan, including a review of account ownership and beneficiary designations, is far less expensive that litigation that results from a situation like the Smith family faced. This is to say nothing about the family dispute, dissolving sibling relationships, and heartbreak that could have been prevented.