Kansas preference program 2026

1. Click ‘Get Form’ to open the Kansas Preference Program form in the editor.
2. Begin with Section I, 'Employer Background.' Fill in your Business/Organization Name, Total Number of Employees, Contact Name, Phone, and Business Address. Indicate if your organization is a charitable entity by circling 'Yes' or 'No.'
3. Proceed to Section II, 'Employee Background.' Enter the employee's Name, Hire Date, Job Title, Job Location, and the Last Four Digits of their SSN.
4. If applicable, complete Section III regarding Home and Community-Based Waiver Services. Circle the appropriate Medicaid waiver type and provide the Medicaid Number.
5. In the Employer Certification section, sign and date the form to confirm that all information is accurate.
6. If necessary, have a health professional complete Section IV for Health Professional Certification regarding any physical or mental impairments.

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