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Disability Community Abuzz About Kansas Waiver Integration

Advocates for elderly and disabled Kansans are anxiously awaiting the publication of the state’s plan to combine seven Medicaid waivers into one.

The waivers currently provide home and community-based services for people within a range of support categories, including developmental disability, physical disability, traumatic brain injury or frail/elderly.

Janet Williams, who runs an Overland Park company that provides services for brain injury survivors, said the waiver integration plan is a hot topic for people in her line of work.

“It’s all anybody’s talking about,” Williams said.

Officials with the Kansas Department for Aging and Disability Services initially said they planned to post details of the proposal on Sept. 30.

But Angela de Rocha, a spokeswoman for the agency, said in an email Tuesday that was not a hard deadline and the plan may not be published until late this week or early next week.

Waivers allow states to try new ways to deliver and pay for Medicaid services. The waivers at issue allow Kansas to provide longer-term care in home and community settings rather than institutional ones.  

State officials say combining the seven waivers will reduce bureaucracy and allow enrollees to receive services that better fit their individual needs, rather than being constrained by a disability label.

But advocates for Kansans with disabilities have expressed anxiety about the overhaul.

Williams said she hopes the result will protect the rights of Kansans with the most severe disabilities to remain in their homes rather than live in institutions.

“Combining waivers to me is watering down what’s available to people with the most significant disabilities,” she said. “You can’t design a waiver that’s going to meet every need. That’s why you’ve got individual waivers.”

The waiver integration plan was also on the agenda when a new advocacy group for case managers met Sept. 17 at an Overland Park church.

Minutes from that meeting show that while some of the case managers saw the potential for positives to come from the change, they believed it had to be done carefully to avoid losing services.

Others said problems with the eligibility process for the individual waivers should be addressed before they’re combined. KDADS will seek public comment on the proposal after it is posted.

Williams, whose company has lately seen people with brain injuries struggle with the amount of documentation required to qualify for the waiver, echoed that sentiment.  

Matt Fletcher, associate executive director of Topeka-based developmental disability provider network Interhab, said the waiver integration plan is “potentially the most profound change to service delivery in the last 20 years or so.”

He said that includes KanCare, the state’s recent move to place nearly all Medicaid services in managed care administered by three private insurance companies.  

Fletcher said much of the discussion in the disability community about waiver integration has focused on the state’s “very aggressive timeline” for completing the change.

State officials expect to submit their plan to the federal Centers for Medicare and Medicaid Services by the start of 2016. If CMS signs on, the state plans to implement the changes by July 2016.

“It might behoove the state to have perhaps a slower timeline that allows for greater amounts of collaboration so we make sure we can do this in best possible way,” Fletcher said.

In that sense, he said it might be a good sign if the waiver integration plan is not released Sept. 30 as originally expected.

“If they don’t feel like it’s ready, then move the timeline back,” Fletcher said. “That’s responsible.”

Andy Marso is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team.

Andy Marso is a reporter for KCUR 89.3 and the Kansas News Service based in Topeka.
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