Legislative Budget
Committee
and Long-Term Care
Services Task Force
November 8, 2004
Long-Term Care Funding
Chairman Morris, Chairman Salmans, and members of the Committees, thank you for the opportunity to appear before you today. My name is Tanya Dorf, and I am the chair of the governmental affairs committee for the Kansas Association of Centers for Independent Living (KACIL). I am also the Executive Director of one of the KACIL members, Independence, Inc., in Lawrence.
KACIL’s mission is to coordinate efforts within Kansas, the United States, and internationally to the extent that these efforts will further independent living for all. KACIL will advocate for the civil rights of Kansans with disabilities, regardless of age. Centers for Independent Living (CILs) are at the core of the disability rights movement. CILs provide a unique type of service for Kansans with disabilities by ensuring they have the independent living and advocacy skills they need to live and work independently.
Home and Community-Based Services (HCBS) are one important way both the federal and the state government are able to partner with the community to provide the supports people with disabilities need to live and work independently. Thus, Centers for Independent Living are particularly interested in ensuring the HCBS waivers are funded and that Kansans with disabilities have access to these important community services. Two current issues related to funding for the Home and Community-Based Services waivers are of particular concern to Centers for Independent Living. These are including the waivers in the consensus caseload estimating process and ensuring the successful Money Following the Person program continues into the future.
Through the consensus caseload estimating process, state officials are able to estimate how many people will need services and how much those services will cost. The state has an obligation to fund the services included in the consensus caseload estimates. The services included in caseload estimating are mandated services; the majority of Medicaid services are included in these estimates.
One major omission from consensus caseload estimates, however, is the Medicaid Home and Community-Based Services (HCBS) waivers. The waivers offer Kansans with disabilities the services they need to ensure they can remain independent in the homes and communities. Similar services are available in institutional settings, but these cost more and do not provide people with their right to be independent members of their communities. One of the basic requirements of the waivers is that the services offered through the waivers must be more cost efficient in the aggregate than institutional-based services. Since services provided in institutional settings are considered to be mandated services, and because the similar services in the community are both more cost-effective and provide people with more freedom, the logical conclusion is to include the HCBS waivers in the consensus caseload estimating process.
Each year SRS proposes a funding increase to pay for some of the people on the HCBS waiting lists to begin receiving services. Each year we, as advocates, support that request and ask that even more funding be dedicated to the waiting lists if possible. Thankfully, each year the Legislature provides additional funding for the waiting lists. But, if the HCBS waivers are included in consensus caseload estimating, the need for this routine each year will be eliminated.
KACIL believes SRS has taken the first step toward embracing the idea of including the waivers in consensus caseload with their FY 2006 budget enhancement proposal to fully fund the Developmental Disabilities and Physical Disabilities waivers. The SGF amount necessary to eliminate these two waiting lists is $17.1 million. Thus, there is a significant fiscal impact involved in including the waivers in consensus caseload, but it is worth the expense for two important reasons.
1. Kansans with disabilities who qualify for the waivers will be able to count on those services being in place. They will not have to wait, and in some cases, this could lessen the length of time for which they need the services by providing critical rehabilitative services as soon as people need them. They would also not have to make a choice between more costly institutional-based services and HCBS, which will have a more positive impact in their own lives and could have a positive effect on the amount of revenue needed each year to fund institutional-based services.
2. The U.S. Department of Health and Human Services issued a letter to State Medicaid Directors and Governors in January 2000, six months after the U.S. Supreme Court’s L.C. v. Olmstead. In the letter, then Secretary Donna Shalala said, “Our country's progress in this regard reflects a shared belief that no person should have to live in a nursing home or other institution if he or she can live in his or her community.” Each state is encouraged to ensure its policies reflect the spirit of the Olmstead decision. The state of Kansas cannot make a more significant step toward making the spirit of the Olmstead decision real than making HCBS waiver services mandated services by including them in consensus caseload estimating. The message this change would send to the people of Kansas would speak volumes about the state’s belief that no Kansan should have to live in an institutional setting if he or she can live in his or her home.
At the beginning of FY 2004, the state of Kansas began affirming its belief that people have the right to live in the community and should not be discriminated against by having to live in a nursing home when that is not their choice. This was affirmed with the inclusion of a very simple proviso in the FY 2004 Omnibus Budget bill – a proviso which ensures money will follow people when they transition from nursing homes to HCBS services. Lawmakers and state officials knew it was the right thing to do to make this small change. This small change has had a significant impact in the lives of the people who have made the transition out of nursing homes. It has not affected the ability of other people to choose nursing home services at all.
To ensure Kansans will continue being able to choose to move from nursing homes into the community, KACIL will propose legislation in the 2005 Session to put the Money Following the Person concept into law. Transitioning this concept from proviso to law will affirm that it is the policy of the state to allow people who live in nursing homes to choose community-based services. It is another way in which Kansas can demonstrate its commitment to the spirit of the Olmstead decision.
I have outlined KACIL’s highest priorities in terms of long-term care funding issues. There are several other issues about which we have particular concern:
Thank you for the opportunity to appear before you today to talk about long-term care issues in Kansas. This concludes my testimony, and I am happy to stand for any questions.
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