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KY Innovative Medicaid
Waiver Promotes Work & Safe Housing
Center for Self Determination,
Alliance for Freedom News, January/February 2006
Edition
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http://www.bridges4kids.org.
Within the State's new 1115 Waiver, Kentucky is launching a
model self-determination demonstration that is the most
innovative in the country. Designed to promote employment and
self-employment as well as safe and affordable housing, this
Waiver demonstration will be carried out under the experimental
or demonstration section of the Social Security Act that permits
states and the Centers for Medicare & Medicaid Services (CMS) to
waive practices that would otherwise be prohibited. It
represents a challenge never undertaken before to test whether
or not typical Medicaid funding and service categories serve
only to increase the costs of long term care without many
discernable positive outcomes. The twin goals of this
experimental demonstration changes what can be purchased with
Medicaid in order to set high expectations and real cost
effectiveness. It proposes a ceiling on personal allocations
that is 5% less than typical service costs and it includes a
fiscal incentive for promoting savings at the individual and
family level.
It will cover all disabilities and aging. Using a complete
self-determination foundation, including free choice of broker
and fiscal agent, persons with disabilities enrolled in the
Kentucky self-determination waiver will be able to:
· Use Medicaid funds to supplement room and board in order to
promote safe, affordable and personal housing in regular homes,
apartments or condos
· Use Medicaid funds to begin to capitalize a micro-enterprise
or tiny business
· Pay employers directly for any needed assistance
· Pursue post secondary training and education
· Purchase the means of transportation including cars,
accessible vans etc.
· Purchase necessary communications and/or mobility technology
· Use one half of any money saved for critical one-time
purchases
It seems only a short while ago that Center Director, Tom Nerney,
met with Kentucky Governor Ernie Fletcher in a meeting set up by
the Secretary of the Cabinet for Health and Family services and
requested by advocate Glenna Taylor and Patty Dempsey, ARC
Director of Kentucky. Following this positive half-hour meeting,
another longer meeting took place with key state officials led
by Mark Birdwhistell (now Secretary of the Cabinet for Health
and Family Services) and attended by Medicaid Commissioner
Staff. As a result the demonstration within Kentucky's new 1115
Waiver was developed and planning is now beginning. Some issues
will differ depending on type of disability and age and
certainly the allocations available to develop personal budgets
will vary. But, this approach narrows the focus of public
spending to control of one's home (when the person does not live
in a family home), long term relationships, community
connections, and, for those of working age, the production of
income,
A 24 person stakeholder group has been created and it is
co-chaired by Deborah Anderson from the state office and Pat
Seybold, Director of the Kentucky Developmental Disabilities
Council. Both the Council and the Kentucky P & A, directed by
Maureen Fitzgerald, have offered to support this important
endeavor.
While this demonstration holds the potential for important
reforms to the Medicaid program it is fraught with danger. It
requires an unprecedented degree of cooperation and trust
between the advocacy community and the state. Similar attempts
in the past have resulted in critical compromises and failures.
As this project begins it is hoped that Kentucky will lead the
nation in re-thinking the purpose of public funding for
individuals with disabilities based on high expectations,
increased quality and better use of a rapidly dwindling supply
of public dollars.
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