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hello my name is Aaron and my name is.Russell today we've made this video to.help nursing facilities understand the.can care application for the elderly and.people with disabilities we know that.nursing facility staff are often the.ones helping individuals and families.fill out the Medicaid application.throughout this presentation we will.provide information about the KC 1500.application for medical assistance for.the elderly and persons with.disabilities not to be confused with the.KC 1100 which is the application for.families with children make sure the.consumer is filling out the KC 1500 our.learning objectives for today are to.summarize the important sections of the.application what to document who to.document information for and what kind.of information is needed recognize the.importance of completing the application.in its entirety and to demonstrate the.ability to complete the application for.medical assistance for the elderly and.persons with disabilities the.application number and revision date are.located in the top right corner the most.up-to-date revision of the application.is from January 2016 applications prior.to that date may not have the most.current information and could cause.processing delays this is an.informational page and it describes the.different Medicaid programs you can.apply for with this application I would.imagine that you will be using it for.nursing home coverage so that's what.we're going to focus on you can also.apply online by visiting the website.ww-why for KanCare KS gov the types of.assistance and descriptions shown above.will correspond to those listed on page.3 so page to section a tell us why you.are applying if there are services.needed for a specific reason you are.applying tell us about it in this.section it could be as easy as.writing in I'm needing help paying for.nursing home expenses when assisting a.nursing facility resident the home.address entered should be the facility.where the individual resides a correct.phone number is important email and text.are not important as at this time KDHE.does not use these forms of.communication on page three section c.applicants are asked to tell us about.yourself and the people in your home.this section can be confusing.many who assist nursing home residents.may think they should enter information.about themselves we have seen adult.children who are durable power of.attorney enter their information.this section is truly for those who are.needing nursing home coverage the.resident who needs assistance should be.entered in the first column under person.one yourself if the resident has a.spouse please enter the spouse's.information in column two under person.two we need to have the spouse's.information even if they are do not need.assistance in the next section.applicants are asked to identify who is.applying for medical assistance as well.as the types of assistance the person.needs applicants can check the boxes for.all programs that apply it is important.to check the correct type of assistance.to speed up processing here is an easy.way to determine what program since this.is a presentation for nursing homes the.box you will select is nursing home if.your facility has assisted living and.skilled nursing it is important to know.which section of the facility the.individual is in if a resident is.residing in the assisted living section.you will need to mark HCBS so this is an.error-prone place on the application so.please make sure that the consumer and.his or her family knows what to apply.for many families are not familiar with.the difference between assisted living.in nursing home.HCBS or community home and.community-based services if the.applicant is residing an assisted living.facility.you must mark this box it is very.important for the facility to indicate.if the resident is in the skilled.nursing or the assisted living section.of the facility we have seen multiple.applications where the facility did not.indicate which section and added to the.application processing time nursing home.select this box if the applicant is.residing in a nursing home as a special.note a 2126 form must be completed and.submitted for all admission and.discharges we must have this form to.process the application also the.facility must have a care assessment.which indicates the resident meets the.level of care to be in the facility.Medicare cost select this box if the.applicant has Medicare please note we do.a review of the applicants eligibility.for help with Medicare premiums.co-payments and deductibles when.determining eligibility for nursing.facility medically needy working healthy.HCBS nursing home and pace.section C continues on page four where.applicants are asked to continue.answering questions about themselves.Social Security number it is important.to enter the resident social security.number and also their spouses social.security number if we do not have this.information it may cause a delay does.this person need help paying medical.bills from the past three months.including Medicare premiums it is.important to mark this question yes if.the applicant has been a resident in.your facility months prior to the.completion and submission of this.application if the resident was admitted.to your facility say on January the 10th.and the application was submitted on.February the 9th you must mark this.question yes to allow us to review.eligibility for January.on page five applicants are asked to.answer questions about their current and.previous living arrangements if they.have ever been in a long-term care.facility is this person living outside.the home if the applicant is residing in.the nursing home.please mark this question yes what is.the date expected to return if the.nursing home stay is temporary please.indicate the date of potential return to.home if the nursing home stay is.permanent please indicate permanent stay.if in a hospital nursing facility or.other institution what is the name of.the facility it is very important to.list the name if this is a swingbed.please list the hospital name and.indicate swingbed facility afterwards.date omitted and date of discharge it is.important to enter the date and include.the MS 2126 form to verify the dates to.determine eligibility and payment.approval has this person ever been in a.hospital or nursing facility for more.than 30 days in a row if yes when please.list a month day year to month day year.when answering this question this.question is specific to an applicant who.has a spouse and the applicant is.requesting nursing home pace or HCBS.coverage we need to know the applicants.first 30 days stay in a hospital or.nursing home as this will determine the.month and year we request resources to.determine how much a spouse can protect.of the couple's resources has this.person ever been in the military if an.applicant residing in your facility.served in the military there is the.potential for cash benefits from the.Veterans Administration it is a.requirement if you are a veteran to.apply for VA benefits we must have.verification the applicant has applied.with the VA to apply the family can.contact the Veterans Administration at.zero zero for their local VFW is this.person the spouse or widow of someone.who served in the military if the.applicant residing in your facility is a.spouse or a current widow of a veteran.they must also apply for a potential.cash benefit from the VA does this.person pay for medical expenses many.will enter their insurance premiums for.private Medicare supplement here or if.they have an ongoing medical expense.that they pay out-of-pocket for you may.want to list this here this section asks.for additional information about the.people in your household to help us.process eligibility for medical.assistance in prior months if you have.requested help with paying medical bills.in the past three months please answer.these questions have there been any.changes in the household during the last.three months.please mark no or yes if yes tell us.about the household changes it's.important to know if the nursing home.residence was in another living.arrangement during the three months.prior to the application being submitted.were they in another facility hospital.assisted living or in their own home we.may determine eligibility for a.different medical program in the prior.medical month based on their living.arrangement have there been any changes.in a household income during the last.three months.please mark no or yes if yes tell us.about the income changes in some cases.applicants have worked in Prior months.and due to a serious medical condition.are now unable to work and are in need.of skilled nursing it is important to.list any wages and provide copies of pay.stubs for each of the prior medical.month have there been any changes in the.household assets during the last three.months.once again mark yes or no if yes tell us.about the asset changes if you made a.request for prior medical determination.please indicate any resources.changed for example did the residents.close a savings account and use the.funds to set up a funeral arrangement if.this occurred we would need verification.that the savings account had been closed.and copy of the funeral arrangements on.page six applicants are asked to answer.questions about their federal income tax.information and tell us if you are.disabled for federal income tax.information please complete this section.for the primary applicant in Section D.we need to know if any person in your.household has a disability this section.will need to be completed if an.individual is under the age of 65 and.has not been determined disabled by the.Social Security Administration on page 7.section e asks applicants to tell us.about resources let's talk about some of.the resources listed on the application.checking account if you have more than.one checking account please use the.extra lines in this section or add.another page we will need copies of your.checking account statement with a full.month of activity provide statement for.each month you are requesting coverage.retirement plan this could be an IRA a.401k or other account or funds set up.for retirement we will require a.statement which reflects the owner and.the balance nursing facility account.resident trust fund or resident care.home account these are the same as a.checking account please provide a full.month of activity provide statements for.each month you are requesting coverage.stocks and bonds it's important to.indicate the type of stock in a.statement showing the current value for.bonds please provide a copy of your bond.funeral or burial plans it is a.requirement to verify if a funeral.arrangement will be considered a.resource to an applicant please provide.a copy of the funeral arrangements these.arrangements need to contain an.itemized statement of goods and services.a statement signed indicating the.arrangements are irrevocable and how the.arrangements were funded funeral homes.are familiar with these types of.requests when an individual applies for.Medicaid burial plots just indicate if.they have one question three asks if.anyone in your household has life.insurance it is very common for most.applicants to have a life insurance.policy to verify a policy we ask the.applicant to request a letter from the.insurance company which will contain the.policy number call us the owner type of.policy whole life or term face value.cash value and any loans which have been.taken against the policy Aaron would you.agree that we pinned a lot of.applications and wait for information.based on verification of life insurance.policies I gave a grain on page eight of.the application it continues to ask.about the application resources question.four asks does anyone in your household.own a home it is important to list the.information about the residence home.does their spouse continue to live in.the home does the resident intern to.return home all of these things make a.difference in the eligibility.determination being made when answering.the question if the owner does not live.there does the owner intend to return.home think about if the consumer.miraculously gets better would they.return to this home if they would return.to it answer this question yes Russell.do you mean if my great aunt wanted to.go home.even if it wasn't very likely answering.yes to this question would be.appropriate that is correct.question number five ask does anyone in.your household own other real estate.this question does not include the land.that the consumers primary house sits on.if they own other land or buildings.please document that here question.number 6 asks does anyone in your.household have a life estate or life.interest in any property rule of thumb.here.if the consumer has no idea what this is.most likely they do not have one so.Aaron what is electricity a life estate.is a form of joint ownership that allows.one person to remain in a home until his.or her death then the home passes to.another owner question number seven asks.does anyone in your household have a.trust if the resident owns a trust.documented here but it is also important.to document all the assets that are part.of the trust on page 7 of the.application as well.if marked yes KDHE will need a full copy.of the entire trust along with all of.the schedules for question number 8 this.section describes any annuities the.applicant or their spouse owns if the.consumer owns an annuity the state of.Kansas must be named as the beneficiary.of any annuity which they own that was.purchased on or after February 8 2006.the consumer agrees to make this.assignment when they sign the.application question number nine asked.does anybody owe you money through a.promissory note or other loan this is.not about credit cards but it's about if.somebody owes the person money such as.did the consumer loan someone eight.thousand dollars six months ago question.number ten does anyone in your household.have other assets this would also.include motorcycles tractors or farm.equipment on question 11 do you or your.spouse taken out a loan against any.property in the past five years.including a second mortgage or reverse.mortgage a reverse mortgage is a loan.available to homeowners 62 years or.older that allow them to convert part of.the equity in their home into cash if.the consumer has one we will need the.contract from the reverse mortgage that.shows the gross amount of money they get.from it question number 13 have you or.your spouse ever worked within a.journey or other professional for estate.planning purposes estate planning is the.process of arranging during a person's.life for the disposal of their estate if.the applicant has paid for someone to.help them manage assets list them here.question number 14 have you or your.spouse sold traded gave away or changed.ownership of any properties such as a.house or money or property within the.last five years please document any.change in ownership of any property.within the last five years in this.section sale of vehicles homes or.transferring resources to a trust fund.are examples of what should be.documented in this section.this would include giving assets to.family members section F tell us about.your earned income by earned income we.mean wages from a job we will need to.last 30 days of pay stubs and if asking.for medical for prior months we will.need to pay stubs for those three months.prior to the month of application for.example if I am applying in April and.asked for prior medical help the person.will need to send in the pay stubs for.January February March and the pace.temps they have for April if the person.does not have their pay stubs they need.to ask for a printout of their gross.wages and the date received for these.months from the employer a w-2 will not.be accepted page ten ask about.self-employment income is anyone in your.household self-employed there are.several types of self-employment income.that may be received by the individual.residing in a nursing facility or their.spouse a few examples include income.from farming income received from.leasing or renting farmland or income.received from renting a home or other.property if a consumer is self-employed.we will be asking for their last tax.return this will need to be the entire.return not just certain scheduled.Section G on page 11.applicants to tell us about other income.this section is used to document income.that is unearned not received from a job.or self-employment list the gross amount.received before taxes or other.deductions it is important to list the.income of the applicant and the.applicant spouse we require this when.determining allocation of income to the.community spouse providing the spouses.income and verification will help speed.up the determination process Social.Security benefits and Supplemental.Security income or SSI please list the.amounts we are able to obtain Social.Security income amounts directly from.the Social Security Administration.veterans benefits please provide a.letter from the VA which lists the type.of veterans benefit and the current.amount it is important that it lists.what type of benefit it is railroad.retirement please provide a letter from.the Railroad Retirement Board which.lists the current amount trust payments.verification of payments received from a.trust must be provided oil royalties or.mineral rights please provide a tax.return to verify any income earned from.oil royalties or mineral oil life.contract sale a contract sale is a.contract in which a property title is.transferred only after the buyer makes a.certain number of monthly payments if an.applicant is receiving payments this is.considered income and we must have.verification of the contract sale and.the income being received rental income.if an applicant or spouse owns property.or a home and it is being rented we need.verification of the amount of income.received from the rental page 12 as.applicants to tell us about medical.insurance this page is asking about.Medicare and any private insurance that.the consumer may have answer the.questions to the best that you.and the consumer can we have connections.with Medicare and can find out most of.the Medicare effective dates ourselves.with private insurance such as Blue.Cross and Blue Shield use the bottom.section to document any private health.insurance policies the consumer may have.this may include Medicare supplemental.health insurance policies or health.insurance through an employer or.long-term care insurance we would like a.copy of the front and back of the.insurance card and proof of the monthly.premium they pay by providing us with.the health insurance premium we can.lower a person's patient liability.section I complete this section if the.applicant resides in a nursing facility.or an assisted living facility and has.dependent family members a dependent.family member could include a spouse.minor child or other family member.dependency may be of any kind for.example legal financial or medical.verification of reported shelter.expenses must be provided also don't.forget to choose a health plan of course.make sure it is a health plan at your.facility except if this is left blank a.health plan will be chosen for the.consumer Section J if you are completing.this application on behalf of someone.for whom you are the social security.payee please complete this section and.submit proof medical representatives.KDHE highly recommends that everyone in.a nursing home have a medical.representative listed on the application.this is a person that can sign the.application and answer the questions for.the consumer this person will get a copy.of all the letters sent to the consumer.the medical rep can be a relative.neighbor friend or other person that the.consumer trust you may not name someone.who is trying to collect a medical debt.against the consumer employees of.nursing facilities cannot serve as.medical Rep.medical reps get copies of the person's.yearly review form which can be very.important in keeping a person's case.over a facilitator is someone granted.limited authority to assist the.applicant they cannot complete an.application or request services on.behalf of an applicant but they do.receive copies of all notices and forms.sent to the applicant regarding their.case an employee of the nursing facility.can act as a facilitator without signing.a release of information form by.completing this page of the application.the facilitator appointment will last.through the end of the application.period after the application has been.processed and the facilitator.appointment has expired it is not.required that the nursing facility.submit a new release of information form.the nursing facility will still be able.to call the kan care Clearing House and.receive information about the status of.the application dates of eligibility.decisions and coverage effective dates.patient liability amounts and name and.contact information of the MCO.additionally the nursing facility will.also receive notices to inform them of.changes in the individual patient.liability page 15 this is the signature.page and it's important for the consumer.and/or the Guardian and/or the.conservator to sign this page it is also.important to read the fine print as it.provides important information such as.estate recovery and the consumers rights.and responsibilities the last page of.the application is another checklist.that provides you reminders of what you.need to send in with the application it.also reminds you to have the person sign.and date the application on page 15 I.think you would be surprised the number.of unsigned applications that can care.receives so again please send the bank.statements from the most recent month.life insurance verification and funeral.and or burial plans for the consumer.other things that can care would need.we're from the nursing home instead of.the consumer would be the 21:26 form and.the care score the 21:26 form is a.bureaucratic form that tells KDHE when a.person moves into a nursing facility or.moves out it's not something that the.consumer fills out or is responsible for.a care score is provided as part of the.level of care assessment that is.completed by the ADRC when an individual.is admitted to the nursing facility it.is important that the nursing facility.ensure the care assessment is sent to.Kate ad to avoid processing delays and.ensure the facility is paid for all days.the individual was there thank you for.joining us today as we walk through the.can Care application for the elderly and.people with disabilities we appreciate.the help you provide consumers as they.complete these applications as well as.obtaining and providing a requested.verification if you have further.questions please reach out to the kan.care clearinghouse at one eight hundred.seven nine two four eight eight four and.they have staff that can answer your.questions.

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Kancare Application Form FAQs

Here are the answers to some common inquiries regarding Kancare Application Form . Let us know if you have any other confusion.

Need help? Contact support

How do I fill out an application form to open a bank account?

It is very simple and easy to fill up this form. If you are in a difficult situation ,get the help of related Bank officials and they will help you to submit the application form.

What is the procedure for filling out the CPT registration form online?

You are asking for cpt examination or cpt registration If for registration then sorry but now you can only register for CA foundation If you have registered yourself for cpt before then for filling exam form go to icaiexam.icai.org and you will find all details there. Best of luck

How do I fill out the CAT 2018 application form?

There is a detailed instruction on how to fill up the form on the CAT website. Both written and a video format. The instructions are easy to follow. If you still find it difficult talk to a faculty if you are taking coaching in any institute or anyone known to you who has already filled the form.

How do I fill out the IIFT 2018 application form?

The IIFT application form process is in online mode only while to make the payment, candidates can opt for the online as well as offline mode. The end date to submit the IIFT application form has also been extended till September 15, 2017. Check the steps to register for IIFT Application Form 2018 .

How do I apply for Medicaid in Kansas?

Not complicated. Google “Medicaid in Michigan” - (or whatever state you live in). Go to the website, fill out the paperwork, call the phone number on the website if you need assistance.

How do I fill the JEE (Main) application form?

Hi Folks. Since NTA is about to release the application forms for JEE Main exam to be conducted in the month of January 2019, many of you must be wondering how can you fill the application form for the exam. As the application process is going to be online, it is advisable to all the aspirants to fill in your details and make the payment carefully. Keep your documents and required details beforehand so as to avoid any kind of delay later. Also, keep your scanned images of photograph and signature ready. All the best!!

Who is eligible for Medicaid in Kansas?

Medicare Eligibility Arkansas – Who Qualifies for Medicare? There are three groups of people who may have Medicare eligibility in Arkansas, including: People aged 65 or older People who are disabled and under the age of 65 People with kidney failure at any age The group you fall into will affect your Medicare eligibility. If you are 65 or older and getting a Social Security check, you will be automatically enrolled into what is known as "original" Medicare, which includes Part A hospital insurance that covers hospital stays and Part B medical insurance that covers visits to your doctor, lab work, outpatient care, and other covered services. Medicare Eligibility in Arkansas Here’s another resource. Medicare in Arkansas - Find AR Medicare Insurance Options I hope this helps.

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