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Kansas State Building in Topeka

Advocates say that Kansas’s ability to care for people with disabilities in home- and community-based settings will be further hampered by proposed cuts to state Medicaid costs.

One proposal, advanced by Lieutenant Governor Jeff Colyer (R), would lower Kansas’s Medicaid spending to $400 million, from $600 million.

“Deep cuts to services, an increase in the eligibility threshold, or other negative changes to home- and community-based services are some of the feared consequences of a large Medicaid budget reduction,” said Mike Oxford, executive director of the Topeka Independent Living and Resource Center.

“These consequences could cause the nursing-facility census — already approaching record levels — to really go up,” he continued.

A Violation of Olmstead

The loss of this choice could also put Kansas in violation of a 1999 Supreme Court ruling in the case Olmstead v. L.C.

The Olmstead decision says that states are responsible for ensuring that people with disabilities can choose the most integrated care settings possible in order to meet their needs.

Since the proposed Medicaid cuts would reduce home- and community-based options for many Kansans with disabilities, the federal government could find that the state has violated Olmstead.

Already Poised

Indeed, the Department of Health and Human Services already appears poised to do just that.

Although an announcement won’t be made until mid-August, reports suggest that Kansas will be among the states identified as being in violation of Olmstead. Federal officials have met with disability advocates there several times in recent months.

They have paid special attention to the length of waiting lists for people who want to transition from nursing homes into home- and community-based care.

According to Nick Wood of the Disability Rights Center of Kansas, it is “not unusual at all” for people with disabilities who are seeking community-based services in Kansas to be placed on waiting lists of up to two years.

In certain cases, those waits can be even longer, Wood said. People with developmental disabilities, for example, can face wait times of up to five years for community-based services, Wood told the Kansas Health Institute News Service.

Renee Wohlenhaus, a deputy chief in the Disability Rights Section of the Department of Justice, said that the federal government views wait times of longer than six months as violations of the Olmstead decision.

– by Matthew Ozga

Starting September 1, Kansas’s Medicaid self-directed in-home care program will begin to see some significant changes — caregivers will receive higher wages, while the program’s administrative costs will be cut.

Under the new system, people who care for the frail elderly will be paid, on average, $9.32 an hour — an increase of nearly 10 percent from the current average wage of $8.55, according to the Kansas Department of Aging (KDoA).

Average wages will vary depending on the severity of the conditions of those receiving care. Caregivers working with people who have developmental disabilities will be paid $8.98 an hour, while those caring for people with physical disabilities will receive $9.64.

Background on Kansas’s Self-Directed Program

Since 1989, Medicaid-eligible Kansans who are elderly or who have a disability have had the option of receiving care in their homes and hiring the caregiver themselves, rather than moving to a long-term care facility or receiving care through a home health agency.

The KDoA and the state Department of Social and Rehabilitation Services (SRS) have contracts with hundreds of payroll agents, who are responsible for paying the caregivers and keeping track of the services. Some agents may also provide care coordination and caregiver training as well.

Cutting Costs

In an effort to reduce overhead resulting from so many payroll agents, another change is also taking effect on September 1.

Starting on that date, the state will lower payments to payroll agents to a flat monthly rate of $115 per client, regardless of the condition. Previously, agents were paid an hourly rate, which covered both the caregivers’ wages and administrative costs.

While there is some concern by advocates that a flat rate will create an incentive for agents to accept people whose needs are the least complex and who require the fewest caregivers, the state believes this administrative rate will be enough for agents to break even.

In addition, SRS and KDoA plan to introduce an electronic timekeeping system to reduce fraud and abuse, which should help with overhead.

Combined, the wage increases for home care workers and the lowered Medicaid rates will save the SRS more than $4.6 million a year, while the KDoA stands to save about $2 million a year, according to a KDoA spokeswoman.

– by Matthew Ozga and Meghan Shineman

L-R: Kathleen Sebelius, Barack Obama, and Nancy-Ann DeParle at the White House on Monday, Mar. 2

On March 2, President Obama announced his picks for Secretary of Health and Human Services (HHS) and the National White House Office for Health Reform.  Kathleen Sebelius, the governor of Kansas and an early Obama supporter, will lead HHS if confirmed by the Senate, while Nancy-Ann DeParle will head White House health reform efforts. Read the full story

Steve Shields

Steve Shields’ journey from heading up a long-shore drilling operation in the Middle East to becoming a key player in the eldercare culture change movement began with the loss of his mother.

In the mid-80s, his mother had advanced Alzheimer’s and his father had Parkinson’s, two “headline diseases,” as he calls them. So, Shields went home to Kansas to help.

“The options available to them were dismal,” he remembers. Read the full story

As Kansas Gov. Kathleen Sebelius is considered for the position of Secretary of Health and Human Services in the Obama administration, an AP story that appeared in The Kansas City Star on Feb. 11 (“Invisible Kansans”) highlights the predicament of the nearly 4,000 Kansas residents who suffer from developmental disabilities and fear the state’s current budget troubles will result in a failure of services. Read the full story