KANSAS
Budget cutting dominated the long-term care agenda in Kansas in 2002. The budget reductions caused increases in waiting lists for home and community-based services as well as legal action from advocates who were fighting proposed reductions in spending. Two legislative reports addressed long-term care insurance, transfer of assets for Medicaid eligibility, and controlling the costs of long-term care.
The Budget
In August and November 2002, Governor Bill Graves called for buget allotment reductions that included a $13.6 million cut from the Department on Aging and a $32.6 million cut in the budget of the Department of Social and Rehabilitation Services. The actions taken included cuts to a Department of Social and Rehabilitation Services program that provides in-home assistance for daily activities, such as bathing and dressing for frail and elderly people. An estimated 350 people who were receiving services no longer were eligible for the program.
The 2002 Legislature reduced the Medicaid nursing home budget by $8.9 million. The Department on Aging was preparing to reduce funding for Meals on Wheels programs. Eligibility was to be capped for health and homemaking services through the Senior Care program. As of December 31, 2002, the number of eligible seniors on the waiting list for the Senior Care program totaled 650. A freeze on new applicants to the Medicaid Frail Elders home and community-based waiver program was instituted in April 2002. At that time, enrollment in the program totaled 5,350. As of January 2003, the waiver program had a waiting list of more than 1,000.
In October 2002, a statewide advocacy organization (InterHab) that represents agencies serving people with developmental disabilities filed a lawsuit against the state for failing to provide adequate funding of community services under the 1996 Developmental Disabilities Reform Act. The advocates contended that the cumulative shortfall in spending since passage of the legislation was at least $300 million.
In further action in January 2003, the organization asked the courts to stop the implementation of emergency budget cuts ordered by Governor Graves. InterHab attorneys said the level of funding already was illegal, with the cuts only making it worse. The lawsuit also said the Kansas Department of Social and Rehabilitation Services failed to give service providers 30 days' notice of the cuts, as required by state law. On February 11, 2003, the court turned down the request for a temporary restraining order.
When incoming Governor Kathleen Sebelius presented her FY 2004 budget, she urged restoration of some of these cuts, including funding of the Senior Care Act, state aid for mental health, and additional funding to help those on waiting lists for home and community-based services.
Planning and Reports
The President's Task Force on Medicaid Reform issued its final report to the 2003 Legislature on March 21, 2003. Long-term care was one of the issues the task force addressed, including a proposal for a statewide public education campaign on the importance of buying long-term care insurance. The task force also recommended a tax deduction and refundable tax credit for long-term care insurance premiums. The task force also proposed a number of legislative and regulatory changes to tighten transfer of asset requirements for Medicaid eligibility, including increasing the look-back period to 60 months from the current 36 months and supporting legislation that would permit a lien on property of a Medicaid recipient who had been in a long-term care facility for a year or more.
The Legislative Division of Post Audit released a report Medicaid Cost Containment: Controlling Costs of Long-Term Care, in August 2002. The report noted that Medicaid long-term care costs had increased by 33 percent from FY 1998 to FY 2001 (from $472 million to $629 million), and that services provided in the community under Medicaid waiver programs accounted for almost 70 percent of that increase. One of the cost containment options identified in the report was limiting the number of people eligible for Medicaid-funded long-term care services by tightening financial and functional eligibility requirements. The other major option noted in the report involves limiting the amount the state pays for long-term care services, including using spending caps per consumer, managing program costs by analyzing key data, strengthening efforts to recoup amounts paid in error, and providing financial incentives for the purchase of long-term care insurance.
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