State officials have proposed several changes in the Medicaid waivers that define the state’s approach to helping frail elders and people with disabilities live in community-based settings rather than in nursing homes.
The proposed changes, now posted on the Kansas Department for Aging and Disability Services website, were filed with the Centers for Medicare and Medicaid Services on Dec. 31.
CMS is expected to respond to the proposal within 90 days. Most of the changes are considered minor.
“We’re pleased,” said Barb Conant, a spokesperson for Kansas Advocates for Better Care, an advocacy group for frail elders and nursing home residents.
KDADS “backed away,” she said, from automatically transitioning people on the physical disability waiver to the frail elderly waiver when they turn 65.
“There seemed to be a lot of unanswered questions about the effect that would have on services, so we’re glad to see that they dropped it,” Conant said.
Earlier, Conant and other advocates objected to the change, saying it could lead to pay cuts for some attendant care workers and to fewer services — sleep cycle support, especially — for some of the program’s beneficiaries.
Angela de Rocha, a KDADS spokesperson, said that after weighing advocates’ concerns, department officials decided to instead propose making the transition to the frail elderly waiver optional.
“We’re not making anybody do anything,” she said. “They can, basically, choose.”
The initial proposal, she said, was driven by the department’s desire to remove administrative hurdles that may limit beneficiaries’ access to some services.
“Where we’re going with this is, eventually, we want the managed care companies to be able to provide services across waivers, so if you need something and you’re not in the waiver that provides that service, the MCOs will be able to add it to your care plan,” de Rocha said. “We’re not there yet, but that is where we would like to be.”
Since 2013, the state’s Medicaid waivers have been administered by three for-profit managed care organizations as part of KanCare. The waivers define which home and community-based services are available for frail elders, people with disabilities and people with traumatic brain injuries.
Tom Laing is executive director at Interhab, a Topeka-based association that represents many of the programs that provide services for people with developmental disabilities. He said his members were pleased that KDADS softened language that could have caused some consumers to lose access to the case managers they use to navigate the system.
“We are pretty cautiously optimistic about the effort the state is making,” Laing said. “They’ve indicated that they are requesting some additional technical advice from CMS. We’ve expressed our desire to be a part of that discussion, and we think they are interested in receiving that feedback from us.”
KDADS, Laing said, did a “good job” in gathering and responding to providers’ concerns before filing its final proposal.
Advocates for people who’ve suffered traumatic brain injuries said they were disappointed in the department’s decision to leave in language that would tie a person’s eligibility for services to whether they “show the capacity to make progress in their rehabilitation and independent living skills.”
People on the traumatic brain injury (TBI) waiver, according to the KDADS proposal, would have their conditions reassessed every six months. Currently, they are subject to annual reassessments.
The proposed change represents a shift toward short-term care, according to David Rundle of Wichita, a longtime advocate for people with disabilities.
“TBI is a lifelong disability,” he said. “As in all such conditions, a person with a traumatic brain injury reaches a point where no further progress can be made. Then, you can only maintain it.”
Rundle lives in a Wichita apartment complex designed for people with disabilities that is affiliated with the Cerebral Palsy Research Foundation.