KHI News Service

KanCare to allow self-directed care

By Dave Ranney | September 24, 2012

Under Kancare, frail elders and the physically disabled will continue to have a say in who cares for them in their home.

Kansas Secretary for Aging and Disability Services Shawn Sullivan.

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“That’s not going to change,” said Kansas Department for Aging and Disability Services Shawn Sullivan. “They will still be able to self-direct as they are now. That will remain an option.”

In recent weeks, advocates for the disabled have wondered if the processes for choosing a caregiver would be taken over by the KanCare managed care companies.

Sullivan said they will not. “There were some concerns,” he said. “I had the three MCOs come in and talk to one of work groups about it, and it’s been taken care of. (Self-directed care) will remain an option for people who are already on the wavier, and it will be an option for those going on the wavier” after Kancare’s proposed Jan. 1 startup.

KanCare is Gov. Sam Brownback’s plan for letting three insurance companies – UnitedHealthcare, Amerigroup, and Sunflower -- manage virtually all of the state’s $2.9 billion Medicaid program.

Brownback officials have estimated the KanCare reforms will curb anticipated increases in Medicaid costs by $1 billion over five years while improving health outcomes for the program's 380,000 beneficiaries.

Federal officials have yet to approve the governor's plan.

In Kansas, frail elders and people with disabilities have long been able to have a say in deciding who would provide the services that allow them to live in community-based settings and avoid expensive moves to nursing homes. They also have the option of letting a provider – a home health agency, for example – decide for them.

It’s not unusual for someone receiving Medicaid-funded home- and community-based services to choose a relative, friend or neighbor over someone they may not know.

“Self-direction of services has been a vital part of our message for a long time,” said Deone Wilson, who runs the Resource Center for Independent Living in Osage City. “People should get to choose. We don’t want that to go away.”

Wilson said she welcomed Sullivan’s clarification but noted that the managed care companies have yet to define their policies on self-directed care.

“Each of them is different,” she said, “A lot of them are hiring individuals who are already helping deliver the services we’re talking about, so we’re hoping that some of Kansas' self-direction culture -- that people should have a choice -- will help shape the managed care culture of the future.”

The Resource Center for Independent Living is one of 10 centers for independent living (CIL) in Kansas.

Currently, a CIL is allowed to assess a physically disabled person’s needs, act as their case manager, and, in some cases, provide the in-home services.

Under KanCare, plans call for creating a single agency – an Aging and Disability Resource Center – to handle the assessments and putting the managed care companies in charge of case management. The managed care companies, in turn, will contract with the service providers.

The CILs’ role will be limited to helping seniors and the physically disabled hire, train, and pay their caregivers. Several private agencies will provide similar services.

The ADRC contract has yet to be awarded.

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