Kansas Medicaid (KanCare) HCBS Frail Elderly Waiver: Qualifications and Services

Page Reviewed / Updated - Jan. 2017

What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers," which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.

Waiver Description

KanCare began on January 1st, 2013 and is a managed care program that is available to all Kansas Medicaid recipients. Available throughout the state, this project integrated nearly all of the states’ Medicaid programs, including those providing Home and Community Based Services, such as the Frail Elderly (FE) waiver. This does not change the benefits of the program, only who provides the services.

FE is designed to help the elderly who require nursing home level care. Qualifying participants are provided with services and support to enable them to remain living in their homes, in family homes or otherwise in their communities instead of in a nursing home.

 Under this program, friends and family can be hired to provide personal care.

Some of the services provided under this waiver are open to self-direction. Self-direction or consumer direction is based on a Medicaid demonstration project called Cash and Counseling in which participants have the flexibility to select their own care providers. Most notable among the services that can be self-directed is attendant or personal care. As little to no professional training is required to provide this type of care, a wide variety of persons can be hired including friends and family members, with the exception of a spouse or legal representative.

KanCare is administered by the Kansas Department for Aging and Disability Services (KDADS) and the Kansas Department of Health and Environment (KDHE). KanCare has a contract with three managed care organizations. These are Sunflower State Health Plan, Amerigroup of Kansas, Inc., and United Healthcare Community Plan of Kansas, all of which coordinate care for eligible recipients.

Another HCBS program under KanCare that may be of interest to the young elderly is the Physically Disabled Program. This program is for adults 16 years of age to 65 years of age who are disabled. Click here to learn more.

Did You Know? Kansas is in the top 5 states for the highest percentage of persons living past the age of 100.

 

Eligibility Guidelines

The Frail Elderly Waiver considers the age, level of impairment and finances of its applicants.

Age - Applicants must be at least 65 years of age.

Level of Impairment - Applicants must be assessed by a medical team and determined to require the level of care typically provided in a nursing home. In simple terms, this means most applicants require assistance with at least 2 or 3 activities of daily living.

Income – Single applicants in 2017 are permitted monthly income of up to $2,205. However, those persons with income exceeding $727 / month will be responsible for some portion of their care expenses. Married couples will have their incomes considered separately if only one spouse of the couple is applying for Medicaid.

Assets – There are two categories of assets according to Kansas Medicaid; countable and exempt. The countable asset limit in 2017 for a single applicant is $2,000. Items which are exempt (their value is not counted towards the limit) include a home, vehicle, personal and household items. However, there are some additional complexities for home exemptions. First, the value of the owner’s home equity cannot be more than $560,000 (in 2017). Second, the owner of the home must live in the home. Since this waiver allows persons to live in assisted living, they cannot simultaneously live in their home and therefore, for single applicants who reside in an assisted living residence, their home will not be exempt. This does not apply to married applicants since a spouse can remain living in the home and therefore the home remains exempt.

 

Qualifying When Over the Limits
In Kansas, it is still possible to qualify for medical assistance through KanCare and the Frail Elderly Waiver when one's financial holdings exceed the monetary limits. There are two ways in which to do this.

1) Individuals with very high, recurring medical expenses that consume the majority of their income may qualify under the Medically Needy program if their medical and care expenses reduce their disposable income to less than $495 / month.

2) Persons can re-organization their finances to meet the limits. Medicaid planners help to re-structure incomes into trusts and assets into exempt assets. By doing so, they effectively lower one's income and assets to a Medicaid compliant level. Learn more.

 

Benefits and Services

The services available to waiver participants can include those listed below. Each applicant is assessed and re-assessed periodically to ensure their care needs are being met by their approved benefits.  Some of these services can be self-directed.

  • Adult Day Care
  • Assisted Living Care Services
  • Assistive Technology
  • Attendant Care Services
  • Comprehensive Support
  • Medication Reminder
  • Nursing Evaluation Visit
  • Oral Health Services
  • Personal Emergency Response
  • Sleep Cycle Support
  • Wellness Monitoring

 Assisted Living Clarification - Care services provided to individuals living in assisted living can be paid for by this Medicaid waiver. However, the room and board portion of assisted living fees are not covered.  Assisted living is defined as a residence with 6 or more individuals.  Services can also be provided to individuals in smaller board and care homes and those in adult foster care situations with the same no room and board rule applying.  

 

How to Apply / Learn More

The program is available statewide to all Kansas residents.  One can find a local office of their Aging and Disability Resource Center to apply or call 1-855-200-2372 for more information.  Learn more about the waiver here.

Wait lists for Medicaid waivers are common, but at the time of writing, the Frail Elderly Waiver did not have a wait list.