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