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May 4, 2012
Last week U.S. Health and Human Services Secretary Kathleen Sebelius decided to refer her agency’s review of Olmstead complaints filed against Kansas to the U.S. Department of Justice. The complaints allege Kansas is not in compliance with a 1999 U.S. Supreme Court decision known as the Olmstead ruling. That decision outlines the rights of people with disabilities to live in their communities instead of in an institution if that is their desire.
Some advocates for the disabled charge that Kansas violates the Olmstead ruling because the state does not adequately fund home and community-based Medicaid services, they also contend that the state’s policies force people with physical disabilities to wait too long to receive these services.
The waiting lists at issue are not new. The current waiting list is the result of a 2008 order imposed by former Governor Sebelius’ administration. The order stated that only one person could come off the waiting list and into the program if two persons left the program. Under Sebelius’ policy, the waiting list grew to more than 3,000 individuals who had asked for but not received community-based services.
The Brownback administration, which inherited the waiting list, has taken a number of steps to reform the program and more efficiently utilize our resources while improving the effectiveness and integrity of services. These reforms include the implementation of conflict-free eligibility, conflict-free case management and credentialing programs concurrent with the implementation of KanCare in January 2013. Short-term solutions have included more flexibility for individuals on the waiting list through crisis exceptions, as well as new standards for continual assessment while on the waiting list to determine if other service options can be accessed. In addition, the administration is in the process of implementing greater oversight standards that will more effectively use the resources available and allow us to use savings to reduce the waiting list.
The administration also is committed to finding employment for people with physical disabilities who want to work. Two months ago, the administration asked those waiting for community- based services if they wanted to work - 2,000 of the 3,400 Kansans waiting for services said they were interested in working.
It is important to look at these waiting lists and find a holistic solution. In comparison to other states, Kansas ranks very high on the utilization of Medicaid home and community-based services, which are intended to keep older adults and adults with disabilities out of nursing homes. The total cost for a person with physical disabilities have increased 50 percent from 2007 to 2011, and the per client costs have increased 37 percent during this time. It is evident to our administration that home and community-based services need to be reformed and that merely increasing funding for home and community-based services will not solve the problem.
Not only is Kansas in full compliance with all federal requirements, we have a strong history as an innovator in the delivery of home and community-based services to those with physical disabilities since the waiver programs began in the 1980s – long before the Olmstead suit was ever filed. Our administration will continue to work to find Kansas solutions to this challenge. We will continue to spend tax payers’ money as effectively and responsibly as possible, while making sure that Medicaid programs improve the health outcomes of Kansans.
— Shawn Sullivan Secretary Kansas Department on Aging. The opinions in the columns solely reflect those of the author. They aren't endorsed by the Kansas Health Institute, which seeks a broad range of opinion to stimulate discussion.