Kansas Department on Aging Secretary Martin Kennedy said Wednesday that it is “fairly likely” he will have to start a waiting list for Medicaid-funded in-home services for the frail elderly, something that hasn't happened since 2002.
“We’re looking at our options,” he said at meeting with advocates and program directors.
Kennedy explained that earlier cuts in spending had fallen short – “by about $2 million” - of the amount needed to balance the department’s budget for the 2010 fiscal year, which ended June 30.
The deficit, he said, was offset with some last-minute “cuts and some shifts in funding.”
But in the current fiscal year, the shortfall is expected to be between $5 million and $6 million.
He said the department’s budget wasn't keeping pace with the demand for home and community based services.
Without these services, he said, many frail seniors are likely to end up in nursing homes, significantly increasing the department’s costs.
“That’s really a terrible option,” Kennedy said of the possible waiting list. “It forces us to cut expenditures in a program that saves us money.”
Kennedy said he will ask for a midyear increase in spending authority but had no way to know if it would be approved by Gov. Mark Parkinson, his successor, or the 2011 Legislature.
Parkinson is not seeking re-election. His replacement will take office in January.
Though the Parkinson administration is assembling a proposed budget for fiscal 2012, the next governor will be free to accept or reject any or all of it.
“Some tough decisions are going to be made,” Kennedy said, noting he’s already shelved plans for a $1.1 million expansion of telehealth services for frail seniors. Instead, that money will be used to help offset the agency's budget gap.
Faced with a similar deficit in 2002, KDoA enacted its first and, thus far, only waiting list for in-home services for the frail elderly. That waiting list remained in place for about two years.
According to KDoA data, the waiting list coincided with a 337-person increase in the numbers of frail seniors moving to nursing homes.
Currently, about 5,700 seniors receive Medicaid-funded, in-home services. Each month, about 146 begin receiving services and 105 leave the program.
Dan Goodman, executive director at the Johnson County Area Agency on Aging, warned that a waiting list is sure to hurt vulnerable seniors.
“Studies have shown that when both of us – HCBS and nursing facilities – care for someone who’s considered frail elderly, it’s usually for about three years,” Goodman said. “So for me the question comes down to two things: Quality of life and cost to the state. Now, we ought to be looking for win-win solutions. Going to a waiting list is lose-lose. It’s going to cost more and it’s not what people want.”
Shannon Jones, executive director for the Statewide Independent Living Council of Kansas, urged Kennedy to propose taking advantage of federal health reform provisions meant to expand access to home and community based services.
“Medicaid was passed 45 years ago,” Jones said, “and we all know that a lot of the rules and regulations that came with it are, in the world we live in today, antiquated. I mean, the fact that nursing services are an entitlement and home and community based services are optional is totally upside down.”
Kennedy said he was all for expanding access to in-home services.