Organizations that provide support services to Kansans with disabilities are anxious to see how the state will implement payment changes they fear will hamstring their operations.
The changes are part of cuts Gov. Sam Brownback announced last week after the Legislature approved a budget that didn’t balance.
Brownback’s administration projected about $2.6 million in savings from Medicaid reimbursement changes that affect providers of home and community-based services, or HCBS, which are intended to allow people with disabilities an alternative to institutional settings.
Cliff Sperry, vice president for CLASS Ltd., an organization in southeast Kansas for people with developmental disabilities, said he needs more information about how state is going to achieve those savings.
“Until they tell us what they’re really talking about, we don’t really know how to even figure an impact,” Sperry said.
The money in question comes from changes to how the Kansas Department for Aging and Disability Services enforces two policies: one governing “capable person” reimbursements and the other residential pay.
Angela de Rocha, a KDADS spokeswoman, said the first is a federal regulation that prohibits reimbursement for support services when a person with a disability lives with a non-disabled person who can perform the same task.
For instance, de Rocha said, if non-disabled people are making themselves dinner they also can make it for the people with disabilities who live with them, rather than the state paying them or someone else to do so.
De Rocha said the state expects to save $1.32 million through stricter enforcement of the policy, but she emphasized it would apply only to routine daily tasks for Kansans with disabilities.
“It has nothing to do with their personal care, like their medical treatment,” or nighttime sleep support, de Rocha said.
Sperry said he wants to know more about how KDADS enforcement of the policy will change, including how the agency will define “capable person.”
“You’ve got family members that, they need some assistance,” Sperry said.
Residential policy change
While the capable person change is stricter enforcement of an existing policy, de Rocha said the residential pay change is an alteration of the policy itself.
KDADS will give providers a per diem reimbursement only when they’re rendering services and not when they’re on call to assist if needed.
De Rocha said the agency currently pays for someone to be on call at all times.
“The change is going to be that we’re only going to pay for those services if the services are actually delivered,” she said. “We’re no longer going to pay for services that aren’t delivered.”
De Rocha said the change, expected to save the state another $1.32 million, should not reduce organizations’ capacity to serve clients with disabilities.
“It seems as though Kansas is creating a roadmap for seniors that leads only to nursing homes.”- Michelle Morgan, director of the Northwest Kansas Area Agency on Aging in Hays
But Sharon Spratt, CEO of Cottonwood Inc. in Lawrence, said she fears that it could.
Spratt’s organization serves Kansans with intellectual and developmental disabilities in Douglas and Jefferson counties. She said the residential pay change could mean her organization won’t be able to continue having staff available 24 hours a day, seven days a week to help clients when they get in a jam.
“They’re at greater risk of abuse, neglect and exploitation,” Spratt said, “to be taken advantage of in different ways, to not have assistance when there’s an emergency, not have assistance if they happen to get involved with the law.”
Spratt said she didn’t want to overreact to the policy changes, but a dearth of details is causing some concern.
“We’ve not had a discussion with KDADS,” Spratt said. “So we really don’t know for sure what their plans are or how they’re going to determine how they’re going to pay under this policy.”
Groups taken by surprise
Spratt and Sperry both said their organizations felt misled by Brownback administration statements that the recent budget cuts had “protected” HCBS services by not subjecting them to a 4 percent reimbursement rate cut imposed on other Medicaid providers.
Tim Wood is the executive director of Interhab, a Topeka-based nonprofit that represents service providers for Kansans with developmental and intellectual disabilities. He said that’s a common sentiment among Interhab’s members, given the changes to the capable person and residential pay policies.
“Both of those affect HCBS,” Wood said. “So in one breath they’re saying, ‘We protected you,’ but then they’re going to come around the back door and smack us with this.”
Wood said that when federal matching dollars are figured in, the policy changes stand to cost providers about $6 million.
Other groups that provide in-home services to elderly Kansas said they were similarly surprised by a $2.1 million cut to the Senior Care Act program.
Janis DeBoer, executive director of the Kansas Association of Area Agencies on Aging and Disabilities, said that represents about 30 percent of the program’s budget, forcing the leaders of her agencies to start a waiting list for services.
DeBoer and Michelle Morgan, director of the Northwest Kansas Area Agency on Aging in Hays, both said the cuts are short-sighted because they will force older Kansans out of their homes earlier.
“It seems as though Kansas is creating a roadmap for seniors that leads only to nursing homes,” Morgan said.
Sperry said seeking cost savings in the HCBS program also was likely to lead to more expensive care in institutional settings.
“It’s going to happen,” he said. “We’re talking about people with disabilities.”