Adult Day Care

Companionship is important. Adult day care provides care and companionship for frail elderly waiver members who need extra help during the day. Caregivers also benefit, knowing their loved one is well cared for and safe during the day.

Adult day care can provide:

• Social connections and friendship.
• Bathing and personal care.
• Meals.

Asthma and COPD Support

Do you or a family member have trouble managing asthma or COPD symptoms? A nurse who specializes in breathing issues can really help. You will get a customized treatment plan and medicine to:

• Manage flare-ups.
• Reduce symptoms.
• Help you stay active.

Attendant Care Services

If you live with a disability or chronic health condition, you may need extra help to stay in your own home. Our plan gives members who qualify the services needed to be safe and comfortable. An attendant can provide:

• Companionship.
• Homemaking services.
• Personal care.

You and your caregiver can decide which chores you want your care attendant to do in your home.

Behavioral Health

Behavioral health is as important as physical health. That's why we have coverage for both.

Required care is 100% covered with no copay. This includes:

• Behavioral therapy.
• Substance abuse treatment.
• Medications.
• Peer Coaching program.

Care Coordinator

The daily care and safety of our members is important. That’s why we conduct home visits for eligible waiver members who need extra help staying at home. 

During this visit we:

• Understand your personal needs.
• See if your home needs minor modifications, such as ramps and bathroom safety devices.
• Set up emergency monitoring.
• Arrange for personal care attendants.

Care Management

Do you have a disability or a serious health problem? If your health needs qualify then our care coordinators are in your corner. They will:

• Explain medical terms in plain language.
• Coordinate your doctor appointments.
• Provide your care team with your medical records.

Your care coordinator will stay with you throughout the medical journey. He or she will:

• Think beyond your immediate medical needs.
• Make sure you have support at home.

Choice of Birth Center

Where you have your baby is an important choice. That's why you can pick from hospitals across Kansas and surrounding states.

We also encourage you to tour the hospital's birthing center. This way you will be familiar with it. And be more relaxed when you have your baby.

Cell Phone Program

Contact Member Services for help applying for a cell phone plan.

Choice of Doctors

You get a primary care physician (PCP) who is your main doctor. Use the Doctor Lookup tool to see if your doctor is in our network.

If you don't have a doctor or if your doctor is not in our network, we can help you find a new one close to you.

Your PCP is your main doctor for:

• Preventive care.
• Treatment if you are sick or injured.
• Referrals to specialists for certain conditions.

Dental Care

Child members up to age 20 receive Preventative exams and cleaning 2 times a year. This helps keep teeth and gums strong and healthy.

Adults over 20 can visit participating dental provider for exams, x-rays, cleanings and fillings. Covers up to $500 per year*.

*The $500 coverage that includes fillings begins in 2019

Diabetic Support

If you have diabetes, we'll help make life a little easier for you. You'll get medicine, supplies and education to help you reach and stay your best.

Our diabetes program also includes self-care training and classes focused on:

• Planning healthy meals.
• Managing stress.
• Living a healthy lifestyle.
• Wellness Rewards for getting needed exams.

Disease Management

If you have chronic or high-risk illnesses, our disease management services may help you. We provide support for:

• Congestive heart failure.
• Asthma.
• HIV.
• Chronic obstructive pulmonary disease (COPD).
• Coronary artery disease.

Emergency Response System

If you are on one of the waiver programs and at risk for a fall or sudden illness, an emergency call system can really help. It sends an urgent request for someone to check on you and help you.

Equipment and Medical Supplies

Your health and safety at home are important.

Our plan covers medical equipment ordered by your doctor. This might include supplies like:

• Oxygen tanks.
• Hospital beds.
• Wheelchairs or walkers.

Foot Care

Children can get the exams needed to help keep your feet in great shape. And if you have diabetes, good foot care can help prevent much more serious problems.

Our podiatry coverage includes:

• Routine foot exams.
• Tips about foot care and choosing the right shoes.
• Information about nerve damage warning signs.

Healthy First Steps®

Build a healthy future for you and your baby and earn great rewards with Healthy First Steps. Our program will help you take the right steps to keep you and your baby healthy. Plus you can earn $20 just for signing up. 

We will help you:

• Choose a pregnancy provider and a pediatrician (child’s doctor).
• Schedule visits and exams and arrange rides to your visits.
• Earn rewards for going to visits throughout your pregnancy and baby’s first 15 months of life.
• Get supplies, including breast pumps for nursing moms.
• Connect with community resources such as Women, Infants and Children (WIC) services.

Hearing Care

Trouble hearing can affect your everyday life in many ways. Our plan includes services and support to help protect your hearing.

We cover:

• Exams, therapy and tests.
• Hearing aids when ordered by your doctor.

Home Meal Delivery

If you are on the PD or TBI waiver and live with a disability or chronic health condition, we may be able to arrange home meal deliver. You will not be eligible if you are getting home meals through different program.

Hospitalization

This plan pays for all expenses related to a hospital stay, so you can rest and heal.

Hospitalization coverage includes:

• Nursing care.
• Room and board.
• Supplies and equipment.
• Treatment and therapies.
• Diagnostic tests and exams.

And after you leave the hospital, you are not alone. We make sure you get follow-up care to continue healing at home.

In-Home Care / Skilled Home Health Care Services

If you have health or mobility challenges, you may need extra help with day-to-day tasks. You may even need an in-home medical visit to check on how well you are healing. If ordered by a doctor for medical reasons, our Plan covers: 

• In-home medical visits.
• Medical equipment like hospital beds, walkers or wheelchairs.
• Disposable medical supplies.
• Help with personal care or housekeeping.

Interpreters

Your doctor and you need to understand each other. Not speaking English well makes this difficult. We can arrange for a medical interpreter to be available for you over the telephone at your appointments.

We also have people in member services who speak more than one language. Chances are, we have someone who speaks your language.

Kidney Disease Care

Kidney disease is a serious medical condition. After the kidneys stop working, regular treatments (called renal dialysis) or an organ transplant are necessary. Dialysis uses a machine to clean the blood, just like healthy kidneys do. Our plan includes:

• Dialysis.
• Medications.
• Health education and support.
• Organ transplant if needed.

Lab and X-rays

Knowing what's wrong and finding it early can make all the difference. Our plan covers:

• Labs and testing.
• X-rays, scans and other imaging.

We'll help you get the information needed to improve your health or be at your best.

Medicines

There are no copays for covered drugs. You can fill your prescriptions at local pharmacies. 

The medical card will cover many services and items. In order for a service to be covered, you must use a Kansas Medicaid provider. The type of coverage you have will determine how you receive coverage.

Specific limits and guidelines apply to all services, and these change often. Before getting any service or item, contact KMAP/MCO Customer Service. A general list of KMAP/MCO covered services is included on our website at https://www.kmap-state-ks.us/Public/Beneficiary/default.asp.

Medicaid requires some services to be approved before you get them. Your provider knows which services need prior authorization and is responsible for obtaining it for you. Medicaid will send you and your provider a letter approving or denying the prior authorization request.

Member Advocates

We're looking out for you. Member advocates can help solve problems, provide training and education, and work on issues that concern members.

They can:

• Provide information about your plan.
• Teach you how to get the care you need.
• Help with doctor issues or complaints.
• Call Member Services and ask for a Member Advocate to help you.

Member Services

Sometimes you might need a little help understanding your health care options. With us, you have someone you can call Monday-Friday 8 am - 6 pm at 1-877-542-9238. We'll answer your questions simply and completely.

We can also help you find:

• Doctors.
• Pharmacies.
• Hospitals or other health facilities.
• Local resources.

NurseLine℠

Medical questions and situations sometimes happen at inconvenient times. When you have questions about your health, you can call a nurse 24 hours a day, 7 days a week. Call 1-855-575-0136.

Our nurses will:

• Listen to symptoms.
• Help with self-care.
• Advise you about getting care at a doctor visit or an urgent care center.
• Help you know when to go to the emergency room.

Prenatal Visits

Your pregnancy is a journey and you will need help along the way. You can visit a family doctor or pregnancy doctor (OB-GYN) to get the care you need.  

All recommended prenatal clinical visits and tests are covered by our plan.

At these visits, the clinic will:

• Make sure both you and your baby are healthy.
• Explain what to expect at each stage of your pregnancy.
• Answer your questions.

Programs for Kids and Teens

Positive role models can make a big difference in a child's life. That's why we provide one free activity each year at local youth organizations, like:

• YMCA.
• Boys & Girls Clubs.
• 4-H.
• Select Kansas Park and Recreation Departments.

Quitting Tobacco

You know the bad health effects of smoking. You know you need to quit. We support you while you quit with coaches and supplies. The only thing you won't get from us is a lecture.

You can also call the KanQuit smoking line at 1-800-784-8669 for support. 

Respite Care

Are you a waiver member who has family members or friends who care for you in your home? If so, we want to support their hard work too. That's why we provide respite care to give your caregivers a rest. Respite care offers caregivers time away from their loved one who is ill or has special care needs. Some members can get extra respite care. Ask your Care Coordinator if you qualify.

Shots and Vaccines

Routine shots help protect you from illness. So, our plan covers:

• Pneumonia, influenza and shingles shots.
• Tetanus, diphtheria, pertussis.
• HPV.

Therapy Services

Physical, occupational and speech therapy can help you recover from a serious injury or illness, or simply reach your full potential.

When approved by a doctor, covered therapies include:

• Occupational therapy.
• Physical therapy.
• Speech therapy.

Transportation

Our plan provides needed rides to and from health care locations for medical appointments. That includes trips to:

• Doctor or therapy visits.
• Health departments.
• Vision clinics.
• Rides to job activities for members who qualify.

Call 1-877-524-9238.

Vision Care

You'll get the care, eyeglasses and treatment that let you see life more clearly. Coverage includes:

• Annual eye exams.
• Prescription lenses.

This benefit is offered by OptiCare.

Well Visits

Well visits with your doctor can help keep you healthy. These visits can catch health problems early, so they can be treated. Preventive services include:

• Checkups for adults and children.
• Routine shots and tests.
• Mammograms.

There are no copayments for preventive care. Earn Community Rewards points for getting exams.