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This document is a form used to request prior authorization for the medication Maraviroc (Selzentry®) for beneficiaries enrolled in the Kansas Medical Assistance Program, requiring specific information
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How to fill out kansas medical assistance program

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How to fill out Kansas Medical Assistance Program

01
Gather necessary personal identification documents such as Social Security number, proof of income, and residency information.
02
Complete the application form, which can be accessed online or at local offices.
03
Provide detailed information about your household composition, including family members and their income.
04
Include any additional required documentation, such as medical expenses or disability information.
05
Review the application for accuracy before submission.
06
Submit the application online, by mail, or in person at a designated location.
07
Follow up with the Kansas Department of Health and Environment to check on the status of your application.

Who needs Kansas Medical Assistance Program?

01
Low-income individuals and families who require financial assistance for medical services.
02
Children in need of healthcare coverage, including preventative services.
03
Pregnant women seeking medical care during and after pregnancy.
04
Individuals with disabilities who require specialized healthcare services.
05
Seniors who need support for healthcare costs associated with aging.
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Medicare Savings Plans A single person must have assets below $9,430 and a couple must have assets below $14,130 for QMB and LMB. There are two different programs: Qualified Medicare Beneficiary (QMB): Single persons must have a monthly income below $1,255. Couples must have a monthly income below $1,704.
UnitedHealthcare Community Plan is one of three managed care organizations (MCOs) that coordinate care for KanCare members. UnitedHealthcare Community Plan is the top-rated Medicaid Health Plan in Kansas, with a rating of 4 out of 5 in NCQA's Medicaid Health Plan Ratings in 2021, 2022, and 2023.
Unlike Medicaid, CHIP is not open-ended; states are awarded yearly allotments. Kansas provides low-cost health insurance coverage to children who are under the age of 19, do not qualify for Medicaid, have family incomes under 232% of the federal poverty level, and are not covered by private health insurance.
Income & Asset Limits for Eligibility 2025 Kansas Medicaid Long-Term Care Eligibility for Seniors Type of MedicaidSingle Institutional / Nursing Home Medicaid No set income limit* $2,000 Medicaid Waivers / Home and Community Based Services No set income limit† $2,000 Regular Medicaid / Aged Blind and Disabled $967 / month $2,0001 more row • Jun 4, 2025
The Medically Needy program offers coverage to people who have income over the maximum allowable income standard. The spenddown amount is like an insurance deductible. If you have a spenddown amount (deductible), you are responsible for that amount.
Frequently Asked Questions Household SizeGross monthly income (130 percent of poverty)Net monthly income (100 percent of poverty) 1 $1,632 $1,255 2 $2,215 $1,704 3 $2,798 $2,152 4 $3,380 $2,6005 more rows
To qualify for health insurance subsidies, you'll typically need to earn between $15,060 and $60,240 as a single person or between $31,200 and $124,800 as a family of four. But the income limits are not exact, and you can still qualify with a higher income if your costs for health insurance are very high.
Annual Household Income Limits (before taxes) Household Size*Maximum Income Level (Per Year) 1 $31,814 2 $43,028 3 $54,242 4 $65,4564 more rows

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The Kansas Medical Assistance Program (KMAP) is a state-run program that provides health coverage and benefits to eligible low-income individuals and families in Kansas.
Individuals and families who meet the income and eligibility requirements for low-income health coverage in Kansas are required to file for the Kansas Medical Assistance Program.
To fill out the Kansas Medical Assistance Program application, applicants must complete the appropriate application form, which can be submitted online or in person at local offices, providing necessary documentation to verify income and residency.
The purpose of the Kansas Medical Assistance Program is to provide medical coverage and health services to low-income residents, ensuring access to necessary healthcare for those who may not afford it.
When applying for the Kansas Medical Assistance Program, applicants must report information about their household size, income, expenses, and any existing health insurance coverage.
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