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Home > Kansas Member Home Page > Frequently Asked Questions



Frequently Asked Questions

Click here for a list of all questions and answers

 General Questions
What is HealthWave?
Who is covered under HealthWave?
What does it cost?
What benefits does HealthWave cover?
What is the difference between Medicaid, HealthWave and Children’s Mercy Family Health Partners?
How do I know if am eligible for CMFHP?
How do I know if am enrolled with CMFHP?
How can I find out if I have Medicaid or HealthWave coverage?
How do I apply?
What do I need to apply?
How do I get a new CMFHP ID card?
How do I get a new HealthWave card?
Why was I taken off CMFHP?
Why was I taken off HealthWave?
Can I have private insurance with HealthWave?
Can I use Medicaid or HealthWave if I travel out of state?
I’m moving – who should I notify?
What should I do if I receive a bill or if there is a charge on my credit report?


CMFHP Services
How do I access (medical) care? (How do I use my benefits?)
How can I get dental services?
How can I get mental health services?
What other services does Children's Mercy Family Health Partners offer?
How can I get approval (Prior Authorization) for a service?
What do I do if I think I need to go to the Emergency Room?
How can I file a grievance or appeal? (What can I do if I am unhappy with my health care or with the decision to not cover a service?


Pharmacy and medication questions
What pharmacy can I go to?
What medications are covered?
How do I get a prescription filled?
Will I have a co-payment for prescriptions?
Are there any over-the-counter medications covered?
What information do CMFHP members need to get their prescriptions filled?
Where can I get specific information on how the HealthWave Managed Care Fee-For-Service pharmacy program handles drugs, prior authorization or step therapy?
I am a diabetic. Where can I get my covered diabetic supplies?


PCP questions
What is a Primary Care Provider (PCP)?
Which provider can I see?
Who is my PCP?
Can I change my PCP?
What does it mean when a provider is accepting established patients only and why can't I have that PCP?


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What is HealthWave?

Kansas HealthWave is a program for uninsured or underinsured children and low-income families who do not have access to affordable health insurance. The HealthWave program receives both state and federal funding.

HealthWave provides low-cost or no-cost health insurance to eligible families with children.

HealthWave provides most eligible members with a Primary Care Provider (PCP), to coordinate all aspects of their health care and preventive care services.

HealthWave expands the availability of affordable health insurance for uninsured families and children. It also increases health care efficiency services and controls costs.

Who is covered under HealthWave?

Families (adults, children and pregnant women) whose income meets the eligibility requirements established by the state. For more information on eligibility, visit the Kansas HealthWave Web Site or call the HealthWave Clearinghouse at 1-800-792-4884.

What does it cost?

Children’s Mercy Family Health Partners offers low- or no-cost health coverage through HealthWave. Based on income, age of children and family size, you may be required to pay monthly premiums for professional services and prescriptions. For more information, visit the Kansas HealthWave web site or call the HealthWave Clearinghouse at 1-800-792-4884.

What benefits does HealthWave cover?

Listed below are your benefits. Some benefits are different if you are in Title 19 or Title 21. Some benefits are limited and may require prior approval. Call Family Health Partners at 1-877-FHP-9363 or 816-559-9598 for information about your health benefits.

Services Covered by Family Health Partners:
  • Allergy testing and treatment
  • Audiology or hearing services
  • Durable Medical Equipment
  • Emergency ambulance
  • Emergency room a
  • Family planning services
  • Home health services
  • Hospice services
  • Hospital, when an overnight stay is required
  • Immunizations (shots)
  • Inpatient admission
  • KAN Be Healthy (KBH) exams (newborn up to age 21)
  • Laboratory services
  • Newborn services
  • Non-emergency medical transportation
  • Office Visits
  • Orthotics and prosthetics
  • Outpatient surgery
  • Pregnancy care
  • Prescription drugs and some over-the-counter medications (go to www.fhp.org or call 1-877-FHP-9363 or 816-559-9598)
  • Rehabilitation Services (PT/OT/ST, cardiac and pulmonary)
  • Vision services and eyeglasses
  • Wellness exams/sports physicals
  • X-ray services
  • Wellness exams/sports physicals
Services From Family Health Partners or a Public Health Agency

You may get these services from your Family Health Partners or a public health agency:
  • screening, testing and treatment for sexually transmitted diseases.
  • screening and testing for HIV.
  • screening, testing and treatment for tuberculosis.
  • immunizations (shots) for children.
  • screening, testing and treatment for lead poisoning.
  • WIC (Women, Infant and Children) Program: Provides education and supplemental food to people who meet income, residency, or nutrition guidelines. Children under age five, or pregnant or breast-feeding women may be eligible.
  • family planning, including treatment and education (can be a provider of your choice).


Call Children's Mercy Family Health Partners at 1-877-FHP-9363 for information about your health benefits.

What is the difference between Medicaid, HealthWave and Children’s Mercy Family Health Partners?

Medicaid is a federal program that gives funding to states for health care. States use this federal funding to administer managed care programs (like HealthWave in KS) and provide health insurance for uninsured families with low income. Visit the Federal Centers for Medicaid and Medicare Services website for more information about Medicaid.

Kansas HealthWave is also part of the Kansas State Children's Health Insurance Program, a state health insurance program for uninsured children of low-income families who do not have access to affordable health insurance. Kansas HealthWave sets guidelines for and oversees two health plans for low-income families throughout the state of Kansas. Visit the Kansas HealthWave website for more information about Kansas HealthWave.

Children’s Mercy Family Health Partners is one of the health plan choices available to Kansas residents. We are contracted to provide low-cost or no-cost health care coverage through the Kansas HealthWave program. We are a not for profit organization owned by a safety-net health provider, Children’s Mercy Hospitals and Clinics. Visit the Children's Mercy Family Health Partners web site for more information.

We can help you if you have more questions. Please call our Customer Service line at 1-877-FHP-9363.

How do I know if am eligible for CMFHP?

Eligibility for HealthWave comes first. After you are eligible, then you can enroll in a health plan.

The state decides who is eligible, or qualified, for Kansas HealthWave.

Once the state says you are eligible for HealthWave, you can choose to enroll in a HealthWave plan. CMFHP is one of the plans you can choose.

To see if you or your children are eligible for HealthWave, you must apply. You can get an application by calling the HealthWave Clearinghouse at 1-800-792-4884. You can download and print an application from the Kansas HealthWave website. You can also get one at your local SRS office, school, or library.

If you have other questions about eligibility, how to apply, or how to qualify for HealthWave, please visit the HealthWave website or call the HealthWave Clearinghouse at 1-800-792-4884.

Once you or your family become eligible for HealthWave, you will get an enrollment packet. The enrollment packet will help you choose a managed care health plan. CMFHP is one of the plans you can choose.

How do I know if am enrolled with CMFHP?

Once the HealthWave Clearinghouse completes the eligibility determination process, a choice packet of health plan information is mailed that includes a fact sheet and a provider directory. Children's Mercy Family Health Partners is a managed care organization contracted through the State of Kansas as one of the health plan choices for HealthWave 19 and HealthWave 21 beneficiaries. Members are encouraged to call 1-866-305-5147 to choose a health plan. Once the choice is made, the chosen health plan will mail an identification card, member handbook, and a health risk assessment.

If the member is HealthWave 19 eligible, they will also receive a plastic medical card from the state. The plastic medical card is to be used along with the health plan card when receiving services, including pharmacy.

If the member is HealthWave 21 eligible, the member will only have a CMFHP health plan card to use when receiving services.

How can I find out if I have Medicaid or HealthWave coverage?

You will receive notification from the State that you are eligible for HealthWave. To find out if your coverage is active you can contact Children's Mercy Family Health Partners Customer Service at 1-877-FHP-9363.

You can also call the HealthWave Clearinghouse at 1-800-792-4884.

How do I apply?

Call the HealthWave Clearinghouse at 1-800-792-4884 and request an application. You can also go to the Kansas HealthWave web site and print an application.

Pick up an application packet, available at all Social and Rehabilitation Service (SRS) offices or access points in each county. They are also available at many hospitals, community centers, local public health agencies, mental health sites, libraries and schools.

Call the Children's Mercy Family Health Partners Customer Service Department at 1-877-FHP-9363 to have an application packet mailed to you.

What do I need to apply?

  • A completed application (signed and dated),
  • Proof of income (copies of the following: paycheck stubs, complete federal income tax return for self-employed persons, or a statement from an employer of the gross income from the past two or three months),
  • Any other household income verification (child support, alimony, social security, disability, etc.),
  • Social Security Number for each person requesting benefits,
  • Verification of citizenship and identity for each person requesting benefits,
  • Immigration status documents for documented non-US citizens requesting benefits,
  • Copies of health insurance cards if there is other insurance for any person requesting benefits, and
  • Copy of pregnancy verification that provides expected due date for those requesting pregnant women (PW) services.
Note: You will be notified by mail if additional paperwork is needed.

How do I get a new CMFHP ID card?

If you lose your Children's Mercy Family Health Partners ID card, call Customer Service at 1-877-FHP-9363.

How do I get a new HealthWave card?

If you lose your HealthWave Title 19 paper ID card, call the Medical Assistance Customer Service Center (MACSC) at 1-800-766-9012. Title 21 members only receive a Children’s Mercy Family Health Partners (CMFHP) white ID card if they are assigned to CMFHP.

Why was I taken off CMFHP?

Please call Customer Service at 1-877-347-9363 if you have questions about enrollment changes for Children’s Mercy Family Health Partners.

Why was I taken off HealthWave?

Children's Mercy Family Health Partners does not determine eligibility for HealthWave. If you have lost coverage, please contact the HealthWave Clearinghouse at 1-800-792-4884.

Can I have private insurance with HealthWave?

You can have private insurance with your HealthWave 19 (Medicaid) coverage.

If you have private insurance, it is your duty to report it to the HealthWave Clearinghouse at the time of application by providing a copy of the health insurance card.

Report any change in private insurance coverage (for example, if your insurance coverage starts, ends or changes in some other way) to the Medical Assistance Customer Service Center (MACSC) at 1-800-766-9012.

Private insurance will pay for covered services first. HealthWave 19 (Medicaid) coverage pays as a secondary benefit.

HealthWave 21 eligibility will be denied at the time of eligibility determination if the child, age birth to 19, is covered by comprehensive health insurance (access to PCP visits and hospital). If the HealthWave 21 member receives private insurance during their continuous eligibility period, the HealthWave 21 coverage will continue until the HealthWave review.

Can I use Medicaid or HealthWave if I travel out of state?

Services outside the United States are not covered.

Emergency: Emergency services are covered as long as the out of state treating provider agrees to enroll and accept the Kansas Medicaid amount. Emergency services are services required when there is a sudden or unforeseen situation or occurrence or a sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) that the absence of immediate medical attention could reasonably be expected to result in:
  1. Placing the patient's health in serious jeopardy; or
  2. Serious impairment to bodily functions;
  3. Serious dysfunction of any bodily organ or part.
  4. Serious harm to self or others due to an alcohol or drug abuse emergency; or
  5. Injury to self or bodily harm to others; or
  6. With respect to a pregnant woman who is having contractions: (a) there is inadequate time to effect a safe transfer to another hospital before delivery or, (b) transfer may pose a threat to the health or safety of the woman or the unborn.
Non-Emergency: Non-Emergency: Out of state is defined as " not within the physical boundaries of Kansas or any of the states that border Kansas." All non-emergent, Medicaid covered services that are to be obtained out of state must be approved before the services are received. To get the approval for out of state services a written request must be sent by a physician to:

Children's Mercy Family Health Partners
PO Box 411806
Kansas City, MO 64141-1806

or by calling our Prior Authorization line at 1-888-691-4872.

The written request must include a brief past medical history, services attempted in Kansas, where the services are being requested and who will provide them, and why the service cannot be done in Kansas. The out of state provider must agree to enroll and accept the Kansas Medicaid amount.

I’m moving – who should I notify?

If you move, it is important that you report your new address by calling HealthWave Clearinghouse at 1-800-792-4884. Then call Family Health Partners at 1-877-FHP-9363 or 816-559-9598. Your Family Health Partners coverage may be affected. If we do not know where you live, you will miss important information about your coverage.

Changes you need to report to HealthWave Clearinghouse at 1-800-792-4884 include:
  • family size (including the birth of any babies);
  • income;
  • address;
  • phone number; and
  • availability of insurance.

What should I do if I receive a bill or if there is a charge on my credit report?

You should first ask the provider to bill Children's Mercy Family Health Partners if the patient was eligible for HealthWave and enrolled with CMFHP. It is your duty to be sure the provider knows you have Medicaid or HealthWave. If they billed Medicaid and still billed you, send the bill or a copy of the bill to:

Children's Mercy Family Health Partners
PO Box 411806
Kansas City, MO 64141-1806

Include a note with the patient name and member ID number.

How do I access care?

To access medical care, you must choose a Primary Care Provider (PCP). If you do not choose a PCP, we will choose one for you. Your PCP will manage your health care. Your PCP's phone number is on the front of your CMFHP member ID card. Your PCP knows the Children's Mercy Family Health Partners network and can guide you to a specialist if you need one. You may ask for a specialist as your PCP if you have a chronic illness or disabling condition. We will work out a plan to make sure you get the care you need. You have a right to change your PCP at any time.

How can I get dental services?

HealthWave members can call the Medical Assistance Customer Service Center (MACSC) at 1-800-766-9012 to obtain information about dental services.

Dental services are limited for adults.

How can I get mental health services?

HealthWave 19 members can call 1-888-547-2878 for information about mental health services.

HealthWave 19 members can call 1-866-645-8216 for information about substance abuse services.

HealthWave 21 members can call Cenpatico Behavioral Health at 1-866-896-7293 for both mental health and substance abuse services.

Will I have a co-payment for medical, dental or mental health services?

You do not have a co-payment for HealthWave medical services if you are enrolled with CMFHP. You might have a co-payment for mental health or substance abuse services.

What other services does Children's Mercy Family Health Partners offer?

Non-Emergency Medical Transportation (NEMT)

We offer Non-Emergency Medical Transportation (NEMT) to help you get to PCP appointments, the pharmacy, and WIC appointments. There is no charge to you for this service.

We will give you a ride that meets your needs. We may be able to help with gas costs if you have a friend or a neighbor who can take you. This must be approved by CMFHP before your appointment.

Call 1-800-890-6026 to set up transportation or gas reimbursement. You must call at least three days before the day of the appointment or you may not get transportation. You may be able to get a ride sooner if your doctor gives you an urgent care appointment.

We may use public transportation or bus tokens, vans, or a taxi to get you to your health care appointment. You do not get to choose what kind of car or van or the company that will give you the ride.

Nurse Advice Line – 1-800-347-9369 (Hablamos Espanõl)

When your child is sick in the middle of the night, what can you do? Call the Nurse Advice Line! The phone is answered 24 hours a day, 7 days a week and is available at no cost to you. The nurse can answer your medical questions and give you advice on how to treat minor medical conditions at home. The nurse can also tell you if you need to go to an urgent care clinic. The number is 1-800-347-9369.

Asthma Care

If your child has asthma, Children's Mercy Family Health Partners is the right choice. We work with Children's Mercy Hospital experts to give you the best information about asthma. Our team also works to teach you and your PCP how to safely manage asthma.

First Touch Program for Expectant and New Mothers

We want your baby to be healthy. Our First Touch case managers offer a personal touch by calling each pregnant member. We work one-on-one with you to coordinate your care and answer the many questions motherhood brings. After your baby is born, we will send you a packet with information and tools to help you. We can also help you select a PCP for your baby.

Lead Testing

We want you to get the lead out! Kids need to be tested for lead poisoning at ages one and two. It is a simple blood test included in Children's Mercy Family Health Partners coverage. We provide education on lead testing for all children at local day care centers, WIC offices, Public Health Departments, PCP offices and schools. Call us at 816-855-1888 or 1-800-347-9363 for more information.

Well Woman Care

Children's Mercy Family Health Partners members are sent reminders to get annual screenings for breast cancer and cervical cancer.

Member Advisory Committee

Children's Mercy Family Health Partners invites you to join our Member Advisory Committee (MAC). The committee meets four times a year to discuss Children's Mercy Family Health Partners and give the plan feedback about what works and what doesn't.

If you would like more information about joining this group, please call Children's Mercy Family Health Partners Customer Service at 1-800-347-9363. We will mail you a short application with more information about MAC. We want to hear from you!

Community Advisory Council (CAC)

Children's Mercy Family Health Partners invites you to join our Community Advisory Council (CAC). The committee meets four times a year to discuss Children's Mercy Family Health Partners and give the plan feedback about what works and what doesn't.

If you would like more information about joining this group, please call Children's Mercy Family Health Partners Customer Service at 1-877-FHP-9363. We will mail you a short application with more information about CAC. We want to hear from you!

How can I get approval (Prior Authorization) for a service?

Contact Children's Mercy Family Health Partners Customer Service at 1-877-FHP-9363 or the Nurse Advice line at 1-800-347-9369 for more information on Prior Authorizations.

What do I do if I think I need to go to the Emergency Room?

If your situation is an emergency, go directly to the nearest Emergency Room or dial 911. Be sure to call your PCP the following day and schedule follow-up care.

If you are not sure if you have an emergency, call either your PCP or the Nurse Advice Line at 1-800-347-9369. Either your PCP or Nurse Advice can give approval for you to seek urgent care if needed.

How can I file a grievance or appeal? What can I do if I am unhappy with my health care or with the decision to not cover a service?

If you are unhappy with your health care or unhappy with the decision to not cover a service, you can file a grievance or appeal by calling Customer Service at 1-877-FHP-9363. Ask to speak to the Quality Management Nurse in charge of appeals.

What pharmacy can I go to?

Click here for a list of participating providers.

What medications are covered?

Please refer to the CMFHP website for this information: http://www.fhp.org/KSDocuments/2009_Drug_List.pdf. You can also call 1-877-FHP-9363.

How do I get a prescription filled?

You receive your pharmacy benefits directly by using your Children's Mercy Family Health Partner's member ID card. Remember to take your CMFHP member ID card with you when you go to the pharmacy.

Will I have a co-payment for prescriptions?

You do not have a co-payment for medications if you are a Children's Mercy Family Health Partners member.

Are there any over-the-counter medications covered?

Yes, there are some over the counter medications that are covered. You can find this information at http://www.fhp.org/fhpdocs/KSDocuments_current_Drug_List.pdf or by calling 1-877-347-9363 for a complete listing.

What information do CMFHP members need to get their prescriptions filled?

The members must provide their Children's Mercy Family Health Partners member ID card to the pharmacist. If the member ID card is not presented, the pharmacy can not fill the prescription. If the member is in urgent need to fill the prescription and does not have the member ID card, please call Children's Mercy Family Health Partners Customer Service at 1-877-347-9363 for additional assistance.

Where can I get specific information on how the HealthWave Managed Care Fee-For-Service pharmacy program handles drugs, prior authorization or step therapy?

You can call Customer Service at 1-877-FHP-9363. Your PCP can also help you with medications that require prior authorization.

I am a diabetic. Where can I get my covered diabetic supplies?

You can get your covered diabetic supplies from any of our contracted DME providers. Call Children's Mercy Family Health Partners Customer Service at 1-877-FHP-9363. Customer Service will direct you to the correct provider. Members can only receive emergency diabetic supplies or equipment at the local participating pharmacy. Prescriptions for diabetic medications, such as insulin, may be presented at a participating pharmacy.

WWhat is a Primary Care Provider (PCP)?

A PCP is a health care provider who specializes in the delivery of primary care services. The PCP is responsible for coordinating all healthcare needs for members. Your Primary Care Provider (PCP) will help you find a specialist if you need one. They can help you see any provider in the Children's Mercy Family Health Partners network. If you need care from a provider outside of the network, a prior authorization is needed.

Which provider can I see?

All providers must be participating providers with Children's Mercy Family Health Partners. If you need care other than what your PCP can provide, your PCP can direct you to a specialist.

Who is my PCP?

Your PCP is the provider that you selected as your personal health care provider. If you did not select a provider, one was selected for you. The name and phone number of your PCP is listed on your membership card.

Can I change my PCP?

You can change your Primary Care Provider (PCP) at any time. To change your PCP, call Children's Mercy Family Health Partners Customer Service at 1-877-347-9363. You can also change your PCP online by going to www.fhp.org.

What does it mean when a provider is accepting established patients only and why can't I have that PCP?

Some PCPs can offer care to a limited number of Children's Mercy Family Health Partners members. They can only see members that have been treated in their office already. Providers also limit their panels. They do this to ensure their current patients are able to continue to have access to care. Providers who are accepting only established patients are indicated in the Provider Directory.

If you have a question about a provider that is accepting established patients only, call Children's Mercy Family Health Partners Customer Service at 1-877-347-9363


revised 11/2008 - approved 12/18/2008