Home and Community-Based Services for Older People and Younger Adults with Physical Disabilities in Kentucky

Home And Community-Based Services ForOlder People And Younger Adults withPhysical Disabilities In KentuckyFinal ReportPrepared for:U.S. Department of Health and Human ServicesHealth Care Financing AdministrationPrepared by:Jane TillyThe Urban InstituteThe Lewin GroupFebruary 27, 2001 Home And Community-BasedServices For Older People And Younger Adultswith Physical Disabilities In KentuckyFinal ReportPrepared for:U.S. Department of Health and Human ServicesHealth Care Financing AdministrationPrepared by:Jane Tilly and Jessica KastenThe Urban InstituteThe Lewin GroupFebruary 27, 2001 This research was supported by Health Care Financing Administration ContractNo. 500-96-0005. In this contract, the Urban Institute is a subcontractor to the LewinGroup. The opinions expressed in the report are those of the authors and do notnecessarily reflect the position of the Health Care Financing Administration or the UrbanInstitute. Final Report217218Table of ContentsINTRODUCTION.........................................................................................................................................................1THE LONG-TERM CARE SYSTEM IN KENTUCKY.....................................................................................2PROGRAMS AND ADMINISTRATIVE STRUCTURE...................................................................................2ELIGIBILITY CRITERIA AND ASSESSMENT................................................................................................9CASE MANAGEMENT AND SERVICE PLANNING....................................................................................10SERVICES.....................................................................................................................................................................11CONSUMER DIRECTION......................................................................................................................................13COST CONTAINMENT............................................................................................................................................14QUALITY ASSURANCE..........................................................................................................................................16FEDERALISM ISSUES.............................................................................................................................................19ISSUES FOR THE FUTURE....................................................................................................................................20 Final Report1217218INTRODUCTIONKentucky, a fairly small Southern state with about 4 million people in 19991, provideshome and community services to a substantial number of aged and physically disabled adultbeneficiaries through its Medicaid home health benefit and the Home and Community-BasedServices (HCBS) waiver. In 2000, the state expects to serve over 18,000 beneficiaries throughthe home health benefit and over 15,000 beneficiaries through HCBS waiver. These twoprograms can be characterized as traditional in that they rely largely on an agency-based modelfor provision of services. The state also has a large, agency-based, state-funded Home Careprogram, along with several other smaller state-funded programs. Despite the size of Kentucky’shome and community services programs, nursing home care dominates the state’s long-term caresystem.Kentucky has expanded its home and community services programs steadily over theyears, including implementation of two new Medicaid waivers in 1999. Innovations, such asconsumer-directed services and coverage of assisted living facilities, do not play a large role inKentucky’s system.This paper analyzes the home and community-based service system for older persons andyounger adults with physical disabilities in Kentucky, focusing on the state administrativestructure for home and community services, eligibility and assessment, services covered byMedicaid and other programs, cost containment, and quality assurance. This report alsosummarizes government officials’ and key stakeholders’ opinions about how well the Medicaidand state-funded programs work.Information was obtained from public documents, state of Kentucky web sites, andinterviews with state officials, consumer representatives and provider associations. Interviewswere conducted in person in Frankfort, Lexington, and Louisville, Kentucky, during July 2000.Questions were asked using a structured, open-ended interview protocol. To encourage candor 1 www.census.gov Final Report2217218in their answers, respondents were told that they would not be quot