KHI News Service

Legislator pushing for new department on long-term care

Agency would oversee broad array of services for the elderly, disabled and mentally ill

By Dave Ranney | July 22, 2010

A key legislator says he will propose putting a single agency in charge of the state’s home and community based services for the elderly and for people with disabilities.

“It’ll either be in the form of a bill or a proposal to the next governor,” said Rep. Bob Bethell, an Alden Republican and chairman of the House Committee on Aging and Long-term Care.

Bethell said he’s already shared the concept – “but not in great detail” – with advisors to U.S. Sen. Sam Brownback, a Republican considered the front runner in the governor’s race.

Rep. Bob Bethell, R-Alden

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“My job now is to meet with Dr. Colyer,” Bethell said, referring to State Sen. Jeff Colyer, an Overland Park Republican, plastic surgeon, and who is running as Brownback’s lieutenant governor.

Sherriene Jones-Sontag, a spokeswoman for the Brownback campaign confirmed receipt of Bethell’s proposal. But she declined further comment.

“I’m sorry, but the campaign is not commenting on policy proposals or on possible legislation until after Sen. Brownback announces his ‘Roadmap for Kansas’ next month,” Jones-Sontag said.

A single agency

Bethell said his proposal will call for creating a Kansas Department of Aging and Long-term Care.

The department, he said, would oversee services for the frail elderly, people with physical and developmental disabilities, and people who have suffered traumatic brain injuries.

Today, services for the frail elderly are administered by the Department on Aging; those for people with disabilities or brain injuries by the Department of Social and Rehabilitation Services.

“My argument is that if an individual is physically disabled or developmentally disabled or has a brain injury, sooner or later, he or she is going to end up among the frail elderly,” Bethell said. “That’s where we’re all headed. We may not get there, but that’s where we’re headed.

“So I think it makes sense for us to put all of these programs in a single agency and to create an atmosphere that has us functioning in a way that gets people the services they need rather than what may be available,” he said.

Bethell said he’ll also propose amending the state’s process for projecting social service caseloads to include the physically and developmentally disabled.

These projections – called consensus estimates - are used in crafting the governor’s spending proposals at the start and toward the end of the each year’s legislative session.

The process currently does not include home and community based services for the physically and developmentally disabled because those services aren’t subject to a federal mandate and are considered optional.

“That needs to change,” Bethell said.

Not a "budget buster"

He said he didn’t believe, as some legislators do, that expanding the consensus estimates to include the physically and developmentally disabled would lead to thousands more people applying for services, causing tens of millions of dollars in additional spending.

“I don’ think it would be a budget buster. I don’t think it would cause people to come out of the woodwork,” he said. “I do think it would give us more control over what we’re doing now and I think it would let us do some increased-efficiency kinds of things that would save money. It would let us be more creative than we are now.

“And let’s not forget that the mandate that we’re under now moves people into the most expensive long-term care there is – a nursing home,” Bethell said.

Currently, Medicaid-funded services for the physically and developmentally disabled in Kansas are subject to long waiting lists. Some who can’t get the services end up in nursing care, which the state is required to pay for, if the individual qualifies for Medicaid.

Advocates for the disabled said Bethell’s plan warranted discussion.

“I know it’s been done in other states,” said Jane Rhys, executive director at the Kansas Council on Developmental Disabilities. “It could be a good thing because the differences between services for the frail elderly and for someone with a significant disability aren’t all that great. But on the negative side, when the disabled get put in with the elderly – in the past, at least - they tend to be forgotten.

“A lot would depend on how it would be set up and who’d be in charge,” Rhys said.

Different silos

Shari Coatney, chief executive for Southeast Kansas Independent Living in Parsons, said that for as long as most people can remember, service availability has depended on a person’s disability rather than need.

“There are all these different silos now,” she said. “As advocates, a lot of us would like to see them done away with. The way it is now, your label determines what silo you’re in and your silo determines how long you might have to wait, even though the service may be the same.

“If you’re FE (frail elderly) and you need a ramp or you’re PD (physically disabled) and you need a ramp –it’s the same ramp,” Coatney said. “It shouldn’t matter if you’re PD or FE. A ramp is a ramp.”

For years, Medicaid regulations have blocked states from mixing the different services’ funding streams. But with federal health reform, that appears to be changing.

“States do appear to have a lot of flexibility to determine the package of benefits that will be offered to the expanded Medicaid population, which will include those who need personal support or other community based services,” Kansas Health Policy Authority Executive Director Andy Allison wrote in an email to KHI News Service. “Rep. Bethell has raised some important questions about how these benefits might be structured. Right now, KHPA is making plans to identify the range of options, flesh them out for stakeholders and policy makers and try to make sure Federal officials leave the flexibility in regulations that Congress appears to have written into the bill.”

Bethell said he’ll also propose putting the new agency in charge of mental health services, which are now under SRS purview.

“For a lot of the people we’re talking about, mental health is a long-term care issue,” he said.