In July, LeadingAge Kansas convened a stakeholder meeting at the request of Representatives Buehler and Helwig with representatives from KDADS, KDHE, Sunflower, HealthyBlue, United Healthcare, Office of Inspector General, Office of Attorney General, Long Term Care Ombudsman, k4ad, Kansas Healthcare Association and provider Comfort Care Homes of Pittsburg to discuss concerns regarding the Medicaid eligibility, and specifically the Home and Community Based Services (HCBS) eligibility process. The purpose of the meeting was to clarify the current process, identify where delays occur, and explore opportunities to improve communication and coordination across agencies.

Here’s some additional details that may be relevant and helpful for providers:

HCBS Eligibility Timeline

1. Referral & Options Counseling (Liberty Healthcare)

  • Individuals enter the HCBS process through the KanCare Clearinghouse, provider referral, MCO referral, self-referral, or other entry points.
  • Liberty Healthcare completes Options Counseling within 2 business days and initiates the referral for assessment.

2. Functional Assessment (Maximus)

  • Maximus has 5 days following Options Counseling to complete the functional eligibility assessment and submit documentation to KDADS.

3. Functional Eligibility Review (KDADS)

  • KDADS reviews the assessment and determines program eligibility.
  • Staff reported that current processing generally takes 15–30 days, following improvements made after CMS-required eligibility changes implemented in 2025.

4. Financial Eligibility (KDHE)

  • Financial eligibility can begin concurrently with the HCBS eligibility process, but cannot be finalized without KDADS approval on functional eligibility.
  • KDHE reported a federal processing timeframe of up to 45 days, although most applications are currently completed within that timeframe.
  • Some applications can take up to 90 days if additional determinations or documentation are needed.

5. Managed Care Organization (MCO)
 Once eligibility is established and transmitted to the assigned MCO:

  • The MCO has 14 days to complete:
    • Health Risk Assessment
    • Needs Assessment
    • Person-Centered Service Plan
  • The MCO then has 7 additional days to enter service authorizations.
  • Providers cannot begin to bill until the MCO has completed the needed assessments.
  • MCOs can authorize billing to the date of the signed person-centered service plan.

Managed Care Organization (MCO) Discussion

MCO representatives responded to provider questions regarding assessments, service planning, claims processing, and provider enrollment.

  • MCOs stated that HCBS assessments are completed in person and used to develop an individualized, person-centered service plan. The state assessment required under the KanCare contracts serves as the foundation for service planning, and provider input is considered when determining service needs and authorized units.
  • MCOs confirmed they do not use artificial intelligence or automated tools to determine service units or authorizations. Technology is used only for administrative functions, such as converting approved units for payment. Providers were encouraged to report concerns regarding automated or non-individualized determinations to the MCO and KDHE.
  • MCOs reviewed claims processing and appeal timelines, including 180 days to submit a new claim, 120 days for reconsideration, 365 days to submit a corrected claim, 60 days to file an appeal, and 120 days to request a State Fair Hearing following completion of the MCO appeal process. MCOs also noted that clean claims are contractually required to be processed within 30 days, though average processing time is currently about 9 days. Providers have 45 days to respond to a recoupment notice, and MCOs generally have up to 24 months to recover overpayments, subject to contract terms.
  • Sunflower Health Plan shared that it is working to better align provider enrollment and revalidation timelines with KMAP.

Additional Resources Shared:

NF Inquiry SpreadsheetDownload

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Kylee Childs
Kylee Childs
Kylee Childs, MSW, is the Director of Government Affairs.Since joining the association in 2023, she continues to be a fierce and resourceful advocate for aging services in Kansas. Her professional focus has always been service to others through advocacy. Kylee has a master’s degree in social work from the University of Missouri-Columbia, a bachelor's degree in criminology with a minor in Conflict Analysis and Trauma studies from Kansas State University, and a certificate in Grant Proposal Writing from Fort Hays State University. With a professional background in law enforcement and child welfare, and a successful 2023 legislative practicum with the Children's Alliance of Kansas, she brings rich professional experience to her role as Director of Government Affairs, and a front-line perspective on the needs of health and human services providers in our state. When not working, she's spending time with her two daughters. You can reach Kylee directly at 785.670.8051.

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