Skip to Main Content

KMAP BULLETIN: Eligibility Reinstatement

Date: 10/26/23

KMAP GENERAL BULLETIN 23279 (PDF)

The Centers for Medicare and Medicaid Services (CMS) mandated Kansas to reinstate eligibility for individuals who met the ex parte (passive renewal) criteria at the individual level at renewal but were instead discontinued. This reinstatement will be retroactive back to the date of termination without a gap in coverage.

Impacted groups include both Medicaid and Children’s Health Insurance Program (CHIP) members:

  • If the member is Medicaid eligible, based on eligibility award date, a Managed Care Organization (MCO) may be assigned. Any months of eligibility not assigned to an MCO will be considered fee-for-service (FFS) and claims will need to be billed to the Kansas Medical Assistance Program (KMAP).
  • If the member is CHIP eligible, an MCO will be assigned retroactively back to the last day of coverage.

CHIP members will not be assigned monthly premiums retroactively.

The Kansas Department of Health and Environment (KDHE) will send letters to notify impacted members of eligibility reinstatement. The letters sent to impacted members will inform the member of the approved eligibility at renewal and include the following language:

Provide your Medicaid ID Number located on the back of your medical ID card to all the doctors, hospitals, pharmacies, or dentists who gave you medical care during this time frame. Have them bill KanCare. KanCare will only pay for covered services. You can call your health plan to find out if the services are covered.

Providers should confirm member eligibility for past dates of service if members ask for rebilling of claims. If providers need assistance, please contact MCO Customer Service or KMAP Customer Service as appropriate per eligibility assignment.

Providers will need to follow retroactive eligibility procedures and bill the proper MCO/KMAP for services. Members should be refunded any money that is not patient responsibility on the explanation of benefits.

Timely filing must be waived for claims billed due to retroactive eligibility.

Contacts:

For eligibility reinstatement verification, please call:

KMAP Managed Care Enrollment Center 866-305-5147

For claim questions, please call:

KMAP Customer Service 800-766-9012

For Managed Care Organization (MCO) questions, please call:

Aetna Customer Service 855-221-5656

Sunflower Customer Service 877-644-4623

UnitedHealthcare Customer Service 877-542-9238