KanCare, the Kansas Medicaid program, covers a broad slate of health services with no member copays: primary and specialist care, hospital stays, emergency room visits, prescription drugs, dental, vision, hearing, mental health and addiction treatment, pregnancy and newborn care, therapy, medical equipment, hospice, telehealth, long-term supports at home, and rides to medical appointments.1KanCare. Benefits and Services2KMAP. Pharmacy Fee-for-Service Provider Manual Some benefits are richer for children than for adults, and a short list of services, mostly cosmetic, is excluded.
Doctor, Hospital, and Prescription Coverage
The everyday core of KanCare looks like most health insurance. Office visits with primary care doctors and specialists are covered, along with vaccines, physicals, blood work, labs, and X-rays. Inpatient and outpatient hospital care are covered. So are emergency room visits, and you can use any ER regardless of whether it is in your health plan’s network.1KanCare. Benefits and Services
Prescription drugs are covered through the KanCare Preferred Drug List, which sorts medications as preferred or non-preferred. Non-preferred drugs require prior authorization from your health plan. Generics are required when available unless your doctor gets approval for the brand-name version.3Kansas Department of Health and Environment. KanCare Preferred Drug List There are no copays on either fee-for-service or managed care plans.2KMAP. Pharmacy Fee-for-Service Provider Manual
Dental, Vision, and Hearing
Dental benefits differ sharply by age. Children get comprehensive care: exams, X-rays, sealants, cleanings, fluoride treatments, crowns, and root canals.4KMAP. Additional Benefits Adult dental expanded in 2022 well past the old extraction-only coverage. Adults now get exams, X-rays, cleanings, fillings, crowns, silver diamine fluoride, periodontal care, and dentures, with no annual benefit maximum. Dentures and partials are on a five-year replacement cycle.5Pathways to Oral Health. The Role of KanCare in Improving Access to Dental Care
For vision, adults get one complete eye exam and one pair of eyeglasses per year. Children under 21 can get exams as needed and up to three pairs of eyeglasses a year.6Sunflower Health Plan. Benefits Overview Contact lenses need prior authorization and are only covered for specific medical conditions such as keratoconus or corneal transplant. LASIK and vision therapy are not covered.7KMAP. Vision Fee-for-Service Provider Manual
Hearing exams and hearing aids are covered. First-time hearing aids don’t require prior authorization, but replacements do, and are generally limited to once every four years. Batteries come monthly. Cochlear implant devices, accessories, and repairs are covered for members under 21 through the EPSDT benefit.8KMAP. Audiology Fee-for-Service Provider Manual
Mental Health and Substance Use Treatment
Behavioral health is built into the KanCare managed care benefit. Covered mental health services include diagnostic evaluations, psychotherapy and counseling, psychiatric medication management, inpatient mental health care, applied behavioral analysis, psychosocial rehabilitation, and community psychiatric support. You don’t need a referral from a primary care doctor to see an in-network behavioral health provider.9Healthy Blue Kansas. Behavioral Health
Substance use disorder treatment covers the full continuum: outpatient and intensive outpatient, residential treatment, withdrawal management, medication-assisted treatment including methadone, partial hospitalization, peer recovery support, and case management.10Medicaid.gov. KanCare SUD Interim Evaluation Report
Crisis help is available 24/7. For members under 21, Mobile Response and Stabilization Services send trained professionals to respond face-to-face within 60 minutes during a behavioral crisis.9Healthy Blue Kansas. Behavioral Health A separate Family Mobile Crisis Helpline serves Kansans aged 20 or younger with assessment, screening, up to eight weeks of stabilization services, and referrals, at 833-441-2240.1KanCare. Benefits and Services
Pregnancy and Children’s Benefits
Pregnancy care covers prenatal visits, labor and delivery, and postpartum care. Postpartum coverage extends for a full 12 months after birth, a change effective April 2022.11KMAP. Pregnant Woman Postpartum Extension Coverage Bulletin Family planning is covered, and pregnant women qualify for KanCare at higher income levels than other adults.12Kansas Advocates for Better Care. What Is KanCare
Children on KanCare receive broader benefits than adults through the Early and Periodic Screening, Diagnostic, and Treatment program, known in Kansas as Kan Be Healthy. Federal law requires states to provide every Medicaid-coverable service that is medically necessary for a child, even when that service isn’t in the standard adult benefit.13KMAP. Kan Be Healthy EPSDT Provider Manual Kan Be Healthy covers comprehensive physical exams, developmental screenings, immunizations following the ACIP schedule, blood lead tests at 12 and 24 months, vision screening with eyeglasses, hearing screening with hearing aids, and dental screening at every well-child visit. When a screening identifies a problem, diagnostic follow-up and whatever treatment is necessary to correct or improve the condition must be provided.14Medicaid.gov. Early and Periodic Screening, Diagnostic, and Treatment
Children in households that earn too much for Medicaid may still qualify through the Children’s Health Insurance Program, which is integrated into KanCare and serves kids up to age 19 in households with incomes up to 255 percent of the federal poverty level. Families above 166 percent of the poverty level pay monthly premiums from $20 to $50; two months of unpaid premiums ends coverage and triggers a 90-day lockout.15Kansas Legislative Research Department. Briefing Book: Children’s Eligibility for CHIP, M-CHIP, Medicaid, and HCBS
Therapy, Equipment, Hospice, and Telehealth
Physical therapy, occupational therapy, and speech-language pathology are covered. For adults 21 and older, therapy is limited to six consecutive months per injury or illness and must be rehabilitative, meaning it addresses physical debilitation from acute trauma or illness. For members under 21, there are no visit limits on medically necessary therapy, and coverage extends to habilitative and developmental therapy for conditions like autism and developmental delays.16KMAP. Rehabilitative Therapy Fee-for-Service Provider Manual
Durable medical equipment is covered when medically necessary and prescribed by a physician: wheelchairs, walkers, hospital beds, oxygen equipment, CPAP and BiPAP devices, insulin pumps, and prosthetics.17KMAP. Durable Medical Equipment Fee-for-Service Provider Manual Orthotic braces and external cochlear implant components fall under the DME benefit too.18UnitedHealthcare Community Plan. DME, Orthotics, Medical Supplies, Repairs, and Replacements
Other covered medical services include weight-loss surgery and heart and lung transplants for adults.1KanCare. Benefits and Services Hospice is covered when a physician certifies a terminal illness with a prognosis of six months or less; the benefit includes physician care, nursing, social services, counseling (including bereavement counseling for up to a year after death), and therapies.19KMAP. Hospice Fee-for-Service Provider Manual Palliative care is also covered and, unlike hospice, can run alongside curative treatment at any stage of a serious illness.20Kansas Department of Health and Environment. Hospice Versus Palliative Care Flyer
Telehealth is covered on the same basis as in-person care. Kansas law prohibits excluding coverage for a service solely because it’s delivered via telemedicine, and reimbursement matches face-to-face rates. Live video is the primary covered modality, along with remote patient monitoring.21Center for Connected Health Policy. Kansas Telehealth Policy
Long-Term Care at Home
KanCare administers seven home and community-based services waivers that let eligible people receive long-term care at home or in the community instead of in an institution. Each waiver targets a specific population:22Kansas Legislative Research Department. Medicaid HCBS Waivers
- Autism waiver: children up to age six with autism spectrum disorder, with early intervention and caregiver respite.
- Frail Elderly waiver: adults 65 and older who meet long-term care requirements, with personal care, household assistance, and health services.
- Intellectual/Developmental Disability waiver: people five and older with an intellectual or developmental disability.
- Physical Disability waiver: adults 16 to 64 who need daily living assistance and meet nursing facility level-of-care criteria.
- Serious Emotional Disturbance waiver: children 4 to 18 with a mental health condition that disrupts functioning and risks inpatient placement.
- Technology Assisted waiver: children up to 21 who require daily care comparable to hospital-level care.
- Brain Injury waiver: people from birth to age 65 with an acquired or traumatic brain injury.
To qualify for any waiver, you must be both financially eligible for Medicaid and functionally eligible under the specific waiver’s criteria. People whose income exceeds monthly limits pay a “client obligation” based on gross income.22Kansas Legislative Research Department. Medicaid HCBS Waivers
Rides to Medical Appointments
KanCare covers non-emergency medical transportation to and from medical appointments for eligible members in all 105 Kansas counties.1KanCare. Benefits and Services Rides are managed by Modivcare. Members request a ride at least three business days in advance, by phone at 866-697-0496 or online, and can book up to 30 days ahead. Urgent same-day trips are possible when the appointment is medically necessary and can’t be rescheduled, though arranging one can take up to three hours. Service levels run from basic car service to wheelchair-accessible vehicles and prior-authorized stretcher transport. Modivcare does not handle emergencies; call 911 for a medical emergency.23Modivcare. Kansas NEMT Services
What KanCare Doesn’t Cover
Cosmetic procedures that change appearance without improving physical function are generally excluded. Specifically non-covered procedures include facelifts, dermabrasion, chemical peels, hair transplants, liposuction, collagen injections, ear piercing, and otoplasty for protruding ears. Reconstructive surgery is covered only when documentation proves a physical abnormality causes a functional impairment.24UnitedHealthcare Community Plan. Cosmetic and Reconstructive Procedures Policy
Some services need prior authorization before the plan will pay, including hospital admissions, certain outpatient imaging such as PET scans, some durable medical equipment, weight-loss surgery, and some medications. If your provider doesn’t get authorization, the health plan won’t pay. If you travel outside Kansas, coverage is limited to emergency and urgent care.25UnitedHealthcare Community Plan. KanCare Frequently Asked Questions
Extra Benefits From Your Health Plan
KanCare members enroll in one of three managed care organizations: Healthy Blue, Sunflower Health Plan, or United Healthcare. The physical health, behavioral health, and substance use services described above are the same across all three. Each plan then adds its own “value-added benefits” on top of the standard package.1KanCare. Benefits and Services These extras vary by plan and can include things like additional transportation, allowances toward eyeglass frames or specialty dental work, cell phone service through Lifeline, and maternal health rewards.26UnitedHealthcare Community Plan. 2026 Value-Added Benefits Provider Training Compare the current year’s offerings before choosing or switching a plan.
Who Qualifies
KanCare covers children up to age 19, pregnant women, adult caretakers of children, people 65 and older, people who are blind or disabled under Social Security rules, former foster youth under age 26, and people diagnosed with breast or cervical cancer through the Early Detection Works program.27KanCare. Eligibility Kansas has not expanded Medicaid under the Affordable Care Act, so non-disabled, non-elderly adults without dependent children generally don’t qualify, regardless of income.28Kaiser Family Foundation. Status of State Medicaid Expansion Decisions Apply online through the KanCare website or by calling the KanCare Clearinghouse at 800-792-4884. Coverage usually begins the month of the application, and you can request retroactive coverage for up to three months before you applied.