Am I currently covered by a medical program?
You can check to see if you are currently eligible through these methods:
- From your 'My Home' page of Member Web Services, click 'Check my Eligibility' and then select the member from the 'Member List'.
- Use ROSIE, the automated attendant. Call 1-800-766-9012 and select Option #1.
- Contact KMAP Customer Service 1-800-766-9012.
Is this service covered?
To verify if a service is covered, you must contact your doctor to obtain the procedure code and diagnosis code. If you are assigned to a KanCare plan, you need to call the number on your KanCare medical card. If you are not assigned to a KanCare plan, call KMAP Customer Service at 1-800-766-9012.
Why do I not have coverage?
To find out why you don't have coverage, you should talk to an eligibility expert about your specific case. If you had coverage under a family program, such as for children, families, or pregnant woman coverage, contact the KanCare Clearinghouse (toll free 1-800-792-4884). Otherwise, contact your DCF Case Worker (toll free 1-888-369-4777).
What type of coverage do I have?
From your 'My Home' page of Member Web Services, click 'Check my Eligibility' and then select the member from the 'Member List' to find the type of coverage you have.
Click here for a description of the your coverage type.
I have a KanCare plan assignment. What does that mean?
You will be assigned to a KanCare plan. Aetna, Sunflower, or UHC will be responsible for providing your KanCare benefits. When you are assigned to a KanCare plan, you will receive two packets in the mail. The first will be an enrollment packet explaining your assigned KanCare plan and your KanCare options. You have 90 days after approval to ask for a different plan. To change your plan, call the Enrollment Center at 1-866-305-5147. The second will be a welcome packet from your KanCare health plan. This packet will include your medical card. Your plan will assign you to a primary care provider (PCP). If you want to change your PCP, contact your KanCare plan.
What is a Spenddown?
A spenddown is like an insurance deductible, where you must incur medical expenses before you qualify for full medical benefits. For more details about spenddown, click here.
I am covered under Hospice. What does that mean?
Hospice services are provided for members who are terminally ill. These services must be ordered by a medical provider. The goals of Hospice services are to:
- Ease and prevent a member's pain
- Provide comfort for a member
- Improve a member's overall quality of life
I am on Lock-In. What does that mean?
A member is placed on Lock-In status when they have abused their medical card benefits. Medical card benefits can be abused by:
- Allowing another individual to use your medical card
- Going to the emergency room when there is no medical emergency
- Using several medical providers to obtain the same kind of drug
- Writing a fake prescription
- Trading your Medicaid number for money or other things
You will be on Lock-In for at least two years. When you are on Lock-In, you can only go to one medical provider, one pharmacy, and one hospital. If you go to other providers while on Lock-In, you might have to pay the bill. The name of this provider is listed for you in your Member Web Services page. From your 'My Home' page, click on 'View Lock-In/Hospice Designation'.
What does it mean to have a Living Arrangement/Level of Care?
These special codes show that you have been approved for long term care services. In order to qualify for long term care, you must have a medical need. Because specialized treatment is needed for some conditions and because services are offered in a variety of settings, it is important that your record show the type of care you are eligible to get. Only people with these special codes are eligible for payment of long term care expenses.
What is a Living Arrangement and a Level of Care?
The Living Arrangement is the place or location where you receive personal services. This also specifies where you live.
The Level of Care is the type of personal services you have been approved to receive on a regular basis.
What types of Long Term Care services are offered?
We offer many types of long term care services. From your 'My Home' page, click on 'View Living Arrangement/Level of Care Details' to find the type of care you are approved for.
Click here for a description of each type of care.
What is KAN Be Healthy?
KAN Be Healthy or KBH is a program that is designed to:
- Prevent illness - with regular check-ups and immunization shots.
- Find health problems early - by seeing a medical provider on a regular basis. Finding a health problem early makes it easier to treat.
Who is eligible for the KAN Be Healthy program?
Children from birth to age 20 who receive Medicaid.
What services are covered by KAN Be Healthy?
- Immunization shots
- Dental services
- Vision services
- Hearing services
- Some over-the-counter medicines (a prescription is needed; check with a pharmacist for more information)
- Rides to a medical provider
- School readiness
- Lead testing
- Diet and nutrition appointments
When should my child see a medical provider for KAN Be Healthy services/screenings?
- At birth
- At months 1, 2, 4, 6, 9, 12, 15, 18, and 24
- At ages 3, 4, 5, 6, 8, 10, and 11-20
- Any time your child is due for a Kan Be Healthy appointment
When should my child see a dentist for KAN Be Healthy services/screenings?
Every year for cleanings, fluoride treatments, fillings, and pulling teeth.
When should my child see a vision specialist for KAN Be Healthy services/screenings?
- At age 3
- Every 2 years after age 3
When should my child see a hearing specialist for KAN Be Healthy services/screenings?
At least every 3 years.
How do I know when my last screening was and when the next one is due?
From your 'My Home' page, click 'Kan Be Healthy' to view information about your last and next screenings.
What if I cannot show up for my doctor's appointment?
Call your doctor as soon as you know you will not be able to make the appointment (at least 24 hours in advance, if possible).
When should I go to the emergency room?
You should go to the emergency room only when you believe you have a true emergency. If you believe there is a true emergency, you do not need to call your doctor before you go to the emergency room. A true emergency is a problem that is life threatening or may cause you to lose your arm, leg, or any other part of your body.
I think I am pregnant. What do I do?
Your medical card will pay for medically necessary pregnancy care. Schedule an appointment to begin prenatal care. Contact your eligibility worker to notify them of your pregnancy. You may be eligible for extra services.
If you have coverage under a family program, contact your eligibility worker at the KanCare Clearinghouse (toll free 1-800-792-4884). Otherwise, contact your DCF Case Worker (toll free 1-888-369-4777).
You should report the birth of your baby right after he or she is born.
- As soon as you have your baby, call the KanCare Clearinghouse at 1-800-972-4884 to request coverage. A medical card can be issued in your baby's name.
- Call your managed care organization.
Are vision services covered?
Coverage for vision services depends on the program you have. If you are assigned to a KanCare plan, you need to call the number on your KanCare medical card. If you are not assigned to a KanCare plan, call KMAP Customer Service at 1-800-766-9012.
Can I receive payment for travel to medical services?
Nonemergent medical transportation (NEMT) services depend on your plan. If you are assigned to a KanCare plan, you need to call the number on your KanCare medical card. If you are not assigned to a KanCare plan, see the guidelines below or call KMAP Customer Service at 1-800-766-9012.
- Transportation can only be approved for services covered by Medicaid.
- NEMT services are covered if no other ride is available only for the following people:
- Kan Be Healthy participants
- Pregnant women (for pregnancy-related services only)
- People going for renal dialysis, psychiatric medicine checks, or cancer therapy
- People receiving medical treatment more than 50 miles one way or 100 miles round-trip with documentation from your doctor stating medical necessity
- To get transportation, you should:
- Get approval before the trip from KMAP Customer Service.
- Go to the nearest facility to receive the needed service/treatment.
- Keep track of mileage (for noncommerical provders).
- Log mileage ONLYwhen the member is in the vehicle.
- Return paperwork to the Medicaid program for payment.
- Contact a local commercial NEMT provider for transportation.
NOTE: The commercial NEMT provider must follow Medicaid's policies and rules as outlined in their provider manual.
Are there times Medicaid will not pay for NEMT services?
Transportation services Medicaid will never pay for includes:
- Adult and child day care, day camp, or school.
- Trips to pick up anything (including medications, prosthetics, medical equipment, eye glasses, hearing aids, etc.)
- Trips to attend nutrition, diabetes, or any other kind of educational or informational class.
- Trips to water therapy or other noncovered therapies.
- Trips to WIC clinics.
- Trips to the chiropractor, acupuncture clinic, biofeedback, relaxation therapy, or hypnosis.
- Trips for personal errands/shopping.
- Trips for residents of nursing facilities or adult care homes.
- Waiting time by the provider.
- Local Education Agency (LEA) providers.
- Attendants to assist drivers.
- Trips for recreation or activity type trips.
- If you are enrolled in managed care, your MCO may cover services that Medicaid does not. You should call your MCO to find when they will pay for transportation.
What if I am not happy with services?
If you are assigned to a KanCare plan, you need to call the number on your KanCare medical card. If you are not assigned to a KanCare plan, call KMAP Customer Service at 1-800-766-9012.