Family Services
DCF Administration Building
555 S. Kansas Ave., 6th Floor
Topeka, KS 66603

Regional Directors
Economic and Employment Services Program Administrators
Economic and Employment Services Staff
KDHE-HCF Staff, including the KanCare Clearinghouse
Prevention and Protection Services Administrators
Other Staff


Summary of Changes for Kansas Economic and Employment Services Manual (KEESM) Revision No. 84 effective Aug. 18, 2017


A brief overview of the major changes is described below. Other clarifications and technical corrections are also included and described in the next section. Additional technical corrections not mentioned here are being incorporated in KEESM, as needed.

These processes are detailed in the KEES user manual and KEES Phase 3 DCF Implementation Guide.

Child Care –The maximum number of hours that can be authorized without supervisory approval is changing to 240 hours per child, except for cases using relative providers.

Child Care and TANF – Recoupment of benefits for TANF and child care programs for all claims will be determined based on the determined benefit amount, not the standard amount.

Food Assistance – Allowable medical expenses are now prorated for households that have excluded members paying or receiving medical bills. The standard medical deduction will now be allowed for one-time allowable medical expenses more than $35, and less than $175.

TANF – TANF payments where the net benefit is less than $10 will not be issued for any month, including initial month payments.


  1. Child Care

    1. Changes

      1. Child Care Plan Hours – Changes are being made in Sections 2835 and 7600 regarding the maximum number of hours that can be authorized on a child care plan. Supervisory approval is required for plans with more than 240 hours per child. This is an increase from the previously-suggested maximum of 215 hours per child.

        Relative providers continue to be limited to 215 hours per child.

    2. Clarifications


  2. Child Care and TANF

    1. Changes

      1. Recoupment – KEESM 11126.1 is being updated to change the manner in which benefits are recouped for child care and TANF. The recoupment amount will now be based on the benefit amount, and not the benefit standard. Language referring to KAECSES is being removed, and references to KEES are being included.

    2. Clarifications


  3. Food Assistance

    1. Changes

      1. Deductible Expense Disregards – An item for allowable medical expenses is being added to the list of expenses in 6520(2)(a) that are paid by or billed to excluded members. These expenses will be divided evenly among the household’s members, including the excluded member(s).

      2. Excess Medical Deduction – Text is being added to 7227.5(7) to indicate households with an allowable one-time expense more than $35, and less than $175, will receive the standard medical deduction for that month.

        Text is being removed as needed from 7223 to reflect policy.

        Other changes to these sections removed KAECSES references.

    2. Clarifications


  4. TANF

    1. Changes

      1. Prohibition of Less than $10 Payments – KEESM 1512.5 is being updated to reflect that no TANF payment less than $10 will be issued for any month, including the initial month of assistance.

      2. Review Periods for Cash – When all adults are receiving, SSI the review is limited to 12 months. KEESM 9371 is being updated to reflect this change.

    2. Clarifications


FORMS (Explanation provided, if not mentioned previously in this summary.)

  1. All Programs

    ES-1600, Civil Rights Complaint. Under review.

    ES-1601, Affidavit of Identity. New form developed from system notice V074.

    ES-1603, Address Change-Vote Registration Information. New form developed from system notice V102.

    ES-3101, Release of Information and Liability. KDHE language removed.

    ES-3106, Notice of Action

    ES-3107, Waiver of Timely Notice of Action

  2. Electronic Benefit Transfer

    ES-3144, Food Assistance Adjustment Notice. New form developed from system notice F850.

    ES-3145, Kansas Benefits Card-Important Notice (FA). New form developed from system notice V107.

    ES-3146, Kansas Benefits Card-Important Notice (Cash). New form developed from system notice V109.

    ES-3147, Restricted Use of TANF Benefits. New form developed from system notice.

    ES-3148, Claim Balance Change-Paid with IPT Benefits. New form developed from system notice V112.

  3. Employment Services

    ES-4303, Sample Month Participant. New form developed from system notice W523.

    ES-4305, TANF Sample Cases Review Guide. Updated with KEES information.

  4. Food Assistance

    ES 1510.1, Computation of Food Assistance Benefit. This is being changed to match the KEES computation method for the period prior to October 2017. For benefits in October 2017 forward, use this link, ES-1510.1.

    ES-3103, Income/Expense Worksheet. The SUA and LUA standards have been added to the worksheet. For benefits in October 2017 forward, use this link, ES-3103.

    ES-3117, Purchase and Prepare Statement. New form developed from system notice V030.

  5. TANF

    ES-3104.1, TANF Benefit Determination. Updated with KEES language.

APPENDIX (Explanation provided, if not mentioned previously in this summary.)

A-12, Citizenship and Identity Verification. Updated for EES Non-medical

MISCELLANEOUS FORMS (Explanation provided, if not mentioned previously in this summary.)


All changes are effective Aug. 18, 2017, unless specified otherwise in the implementation memo.

EFFECT ON LOCAL STAFF (No significant effect, if not explained below.)


These items are being removed because of the change to KEES or because KDHE has developed a separate Medical KEESM.


C-25, Child Care Checklist

C-26, Referral for Child Care Provider Enrollment Application

C-27, EHS/Child Care Partnership Checklist

E-23, Diversion Payment Option Decision Tree

E-24, Diversion Payment Option Process Flow

M-2 thru M-7: All Medical related

P-2, Statement of Medically Necessity

P-6, Landlord Letter

P-11, Authorization for Release of PHI

R-1, Medical Subrogation Referral - Adoption

R-2, Medical Subrogation Referral - Injury


T-13, Under development: Review Type Matrix

W-12, Fair Labor Standard Act (FLSA) Calculation Table

W-13, Child Care Plan Hours Worksheet

W-14, MediKan Eligibility Worksheet

W-15, VA Potential Benefits Checklist

W-16, Patient Liability Worksheet

W-17, Reasonable Compatibility Tool

W-18, Under development: Review Reactivation Tool

X-5, Back of Notices of Action

X-8, ICT Checklist

X-9, Concerns About A Case Received in Transfer from XX County


Child Care Forms Explanations

CC-1626A, Child Care Provider Denial Notice

CC-1630, Legally Exempt Release of Information Child Abuse/Neglect Registry Check

ES-1100, Request for Administrative Hearing

ES-1602, Child Care Provider Rate Modification

ES-1604, Daily Attendance Record (Sample Form)

ES-1606, Request for Supervisory Approval - Child Care Exceeding 215 Per Month

ES-1627a, Request for Enhanced Rate for Special Care

ES-1640, Statement of Understanding - Employed Income Eligible Child Care Assistance

ES-3100.3, Certification of Need for Hospital Tuberculosis Treatment

ES-3100.7, Application for Medical Coverage - Breast and Cervical Cancer

ES 3104.5, Determination of Need (Medical Assistance)

ES-3104.6, Determination Worksheet for PICKLE Eligibles and Other Protected Medical Groups

ES-3105.1, Request for Information

ES-3108, Appointment of Authorized Medical Agent for a Minor

ES-3110, Negative Drug test

ES-3152, Medical Assistance Lien Physician Verification

ES-3153, Statement of Continuing Eligibility (Working Healthy)

ES-3160, Notification of Medicaid/HCBS Services Referral/Initial Eligibility/Assessment/ Services Information

ES-3161, Notification of Medicaid/HCBS/Working Healthy Services

ES-3162, Resource Assessment and Allowance Determination Form

ES-3163, Income Allowance Determination Form

ES-3165, Working Healthy and Premium Information

ES-3166, Notification of PACE Information

ES-3167, Annuities and the Kansas Medical Assistance Program Information for Medicaid Applicants and Recipients

ES-3167A, Annuity Information Request

ES-3168, Prepaid Funeral Agreement

ES-3169, Irrevocable Assignment of Benefits of Life Insurance/Annuity Policy

ES-3170, Beneficiary/Patient Spenddown Billed Form

ES-3171, Irrevocable Collateral Assignment of Life Insurance Proceeds

ES-3178, Authorization Form for the Release of Information

ES-3820, Notice of Eligibility Review

ES-3822, Notice of Review - Medical Assistance - BCC Program

ES-3822A, Statement of Continuing Cancer Treatment Medical Assistance - BCC Program

ES-3901, Presumptive Medical Disability Team Referral

ES-3903, KDHE Presumptive Medical Disability Determination Questionnaire

ES-3904, HIPAA Compliant Authorization to Release Information to KDHE

ES-3906, Presumptive Medicaid Disability Determination Notification of Changes and Final Decision Form

ES-3907, Disability Review Team Referral

ES-3909, Applicant Instructions for The Presumptive Medical Disability Process

ES-4103, School Enrollment Verification

ES-4109, Referral for Non-Cooperation with a Fraud Investigation

ES-4306, Employer Contact Record

ES-4306F, Food Assistance Employer Contact Record (For Food Assistance Potential Employment Violation Only)

ES-4307, Penalty Tracking Sheet

ES-4312, ABAWD Eligibility Tracking Form

IM-3105.5, Request for Medical Expense Information

IM-3121, VA-DCF Information System

PA-3103.5, MAcrSSI Disregard Worksheet (Independent Living and HCBS Only)


Disability Determination forms DD-1103, DD-1104, DD-1105, DD-1106

Authorization for Release of Protected Health Information, English and Spanish

Protected Health Information Disclosure Tracking Log

MS-2504, Health Insurance Premium Payment Information Form

MS-2504.1, HIPPS Change Report Form

MS-2156, Medical Review of Emergency Services for Establishing SOBRA Eligibility


This change was coordinated with staff in Economic and Employment Services, Executive leadership, and the EES Program Administrators.

Sandra Kimmons, EES Director
Economic and Employment Services

Page Last Updated: September 1, 2017 8:49 AM