On May 1, 2018, the new MS-2126 form was posted on the Policy Forms page of the KanCare website and on the Forms page of the Kansas Medical Assistance Program (KMAP) website under the Beneficiary Information heading. It is available for immediate use by providers.   

In order to allow facilities adequate time to transition to the new form, the Kansas Department of Health and Environment (KDHE) will continue to accept the old version of the form through July 31, 2018. Previous versions of the form will no longer be accepted after that date.

Read the revised form.