Kentucky Assisted Living and In Home Care Medicaid Waiver Information and Rules for 2017

Introduction

Kentucky provides long-term care resources to seniors through its Cabinet for Health and Family Services (CHFS). The CHFS, Department for Aging and Independent Living offers the Homecare Program, providing supports and services for daily needs as well as coordination among caregivers and provider agencies to help adults at risk of institutional care remain in their own homes. Homecare Program participants must be: 1) 60 or older and unable to perform two activities of daily living or three instrumental activities of daily living; 2) be at risk of going to an institution; or 3) be in an institution but able to return to a private home environment if needed services are provided. Services included in the Homecare Program consist of: assessment and case management, home management and personal care, home delivered meals, chore services, home repair, respite for family caregivers and home health aide service are among the assistance provided. The program is offered statewide through the Area Agencies on Aging and Independent Living. In addition to the Homecare Program, the CHFS provides seniors additional resources such as help with prescription drug costs, transportation and mental health services.

Additionally, the Kentucky Health Care Partnership Program is a managed care system created and implemented in accordance with the term and conditions of Section 1115 Waiver Demonstration Project granted by CMS. The health care partnership is a coalition of medical providers in both the public and private sector that provides a comprehensive medical service package through an integrated service delivery network to Medicaid members residing in a state managed care region.

In addition to the State Homecare Program and Section 1115 Demonstration Waiver mentioned above, Kentucky offers a home-and-community based Medicaid waiver program for seniors 65 years and older who require a nursing home level of care but choose to remain in their own homes or in a community or residential setting while receiving services.

Medicaid Waiver Program for Assisted Living and In Home Care

Kentucky Home and Community Based Waiver (HCBS Medicaid Waiver)

The Kentucky Department for Medicaid Services (DMS) operates the Home and Community-Based (HCBS) Medicaid Waiver. HCBS is a non-residential waiver and includes the option for Participant Directed Services (PDS). HCBS participants are individuals who are elderly or disabled and meet nursing facility level of care, but are able to remain in or return to their homes.

The goal of the HCBS Waiver is the integration and access of waiver participants into the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, to the same degree as individuals not receiving Medicaid HCBS.

Services

Services included in the waiver: Assessments / Reassessments - for medical and personal care requirements; Case Management - for all waiver participants; Minor Home Adaptations - intended to increase the independence of the recipient; Adult Day Health Care / Adult Day Care- group care during normal business hours; Homemaker Services - includes laundry, housekeeping, and shopping services for the waiver participant only; Personal Care; Respite Care - temporary care-giving relief for the primary caregiver; and Attendant Care - provides assistance with daily tasks, such as dressing, eating, and moving from one location to another

Eligibility

  1. Health: An applicant must require a Nursing Home Level of Care.
  2. Financial: An applicant must meet certain income and asset requirements to be eligible for Medicaid for the HCBS Waiver. Kentucky has multiple tests to determine financial criteria, and one is the Special Income Limit (SIL). For 2017, this means that an individual is eligible if their income does not exceed $2,205.00 per month and their assets are not over $2,000 (or $3,000 if a married couple are both applying). In Kentucky, a Miller Trust, or Qualified Income Trust, is permissible in the case of too much income - where the applicant can put excess income in the trust to meet the strict financial criteria. Additionally, Kentucky permits applicants who are “medically-needy” to qualify, provided they spend down income on medical and remedial services such that it brings them within the financial limits. For a non-applicant spouse (the “community spouse”) certain rules apply to financial assets and allowances. For 2017, the community spouse may keep up to $120,900 in assets (known as the Community Spouse Resource Allowance, or CSRA), and is allowed a monthly allowance of up to $3,022.50 (known as the Personal Needs Allowance (PNA) or Maximum Monthly Maintenance Needs Allowance MMMNA). These standards are set by the Social Security Administration annually and adopted by the state in its Medicaid plan.

Practical Considerations

Kentucky determines eligibility through either the Special Income Limit, allowing Miller Trusts and through the “medically-needy” provisions of the Social Security Act. This flexibility is unique among most states and should give applicants more options when deciding whether their financial status meets the criteria for long-term Medicaid benefits.

Conclusion

Kentucky is a state with multiple routes to Medicaid for long-term care in either assisted living or in home settings. It is essential to consult with a Medicaid Planning specialist to go over the Special Income Limit (SIL) category and the “medically-needy” category of financial criteria to ensure you can be eligible or the waiver.