Kentucky Medicaid Waiver 101 Webinar

Rhonda Logsdon: [00:00:00] But I’m Rhonda with Kentucky SPIN and it is my great pleasure- we have, uh, along with the Kids SpOt and of course the Cabinet for Health and Family Services, this would not be possible. Um, we have the great, uh, webinar that’s gonna be shared today, and Alicia Clark.

I mean, first of all, I can’t tell you all how grateful that we are for you all at the Cabinet because no matter if it’s regardless of a webinar that families and providers need, you all and individuals with disabilities, you all are always right there ready to help, and not just that, individually with families.

So I do hope you know how grateful we are for that, and I’m going to hush and, uh, hand it over. But if you all have- we’re gonna be monitoring if you all have any technical difficulty, we’ll be monitoring the chat. Um, and just get- please give us grace. Some of us don’t have as good of internet. Um, and you’ll see [00:01:00] in the chat, we’ve shared the handout that is the PowerPoint today. But Alicia, take it away and thank you so much for joining us.

Alicia Clark: First of all, thank you, Rhonda, for inviting us, um, from the Department to come and speak to families and those who are just wanting to learn about, um, Medicaid and the waivers. So we really appreciate being here.

Um, I will be presenting today. Also, um, my director, Pam Smith, um, she will probably be on at some point and we will love to take questions, um, after I get done presenting. Now, I don’t ever promise to know all the answers to every question, but we are always willing at the department to, um, go back, take a look at any questions that you may have and to provide those answers. And we work with, uh, Rhonda and her group, um, numerous times on giving webinars and just teaching families. And if you’ve ever been around Pam or I that’s what we love to do. We love to educate, um, and just get the information out there and get [00:02:00] the correct information out there.

So I will begin. Um, I am gonna stop my video just because I have multiple screens, so I’m actually sharing a different screen and just so that it’s not distracting, you all probably won’t wanna look at the side of my face. So I am gonna stop that, but I’ll bring it back on when we have questions if you want.

Okay. So just to let y’all, like I said a little bit ago, um, we’re just medi- uh, presenting the Medicaid kind of one oh one is what we call it. It’s just an overview of our 1915(c) Home and Community Based Waivers.

N Y O? See technology, sometimes it’s our brand. Here we go.

Okay. So just to provide a little bit of history about Medicaid and long-term care, um, for you all. Back in 1965, Medicaid actually was created to provide healthcare to low- low income individuals. Long-term care is actually only covered in [00:03:00] institutions.

Now, fast forward to 1981, uh, the 1915(c) Home and Community Based Services, the waivers were created as kind of a long-term care option. So for those, um, you know, not everybody wants to live in an institution and it’s, uh, very important that we give people choice. And so that kinda is why we have our Home and Community Based Waivers is to provide people that would meet nursing facility level of care, um, or intermediate care facilities, our ICFs. Um, you have to meet that long-term level of care in order to be in our waivers. But you don’t live in an institution. You live out in the community and you’re able to get the services that you need.

So kind of what our 1915(c) HCBS Waivers, and you will notice, we will call them HCBS Waivers. It’s the Home and Community [00:04:00] Based Services Waivers. And within that, um, and I’m gonna talk about all the different, uh, waivers that we have, but it’s kind of, you think about it, the HCBS is a big umbrella. And then, um, with different, uh, spokes, uh, in different waivers under that.

But they basically are, um- traditional Medicaid does not cover all of the services needed to help our age or disabled individuals live in the community. So we cover things that regular Medicaid does not cover. It gives, uh, states a way to offer Medicaid-paid long-term care in the community. So there is the option of, you know, going through traditional agencies and having individuals come in. And there’s also, uh, the option of what we call participant directed services. And that is where you can hire people to come in and provide those services for you or your [00:05:00] loved one. And then the big thing in the community, it means the individual gets to live in their home or in a non-institutional setting, uh, such as maybe a residential home, which might have, you know, three people in it.

So we do have some state requirements that we have to go by, um, in order to have our waiver programs. So we must determine who is eligible for the services and the settings offered. And we have to set rates and payments for providers. We have to provide a level of care that is equal to what an individual is going to receive in an institution. It’s kind of like that option that I was talking about earlier. Um, they’re gonna meet that same level of care and we have to provide the same types of services, but they’re just living out in the community.

We also have to demonstrate that the cost of care out in the community is going to be equal [00:06:00] or less to the cost of institutional care. Um, so that is one of the things that, uh, we have to do in order to continue to be able to receive funds from the federal government to continue our HCBS uh, waiver programs.

And then we also have to assure that the quality of services and supports that the individual receives is going to be the same as in- in an institution.

And it’s very, very important to know that the states receive federal dollars in order to pay for these waiver programs, and we actually receive 70%. So when you think about that, 70 cents of every dollar is coming from the federal government.

So the next little thing we’re gonna just talk about here is the different, um, programs that we have here in Kentucky through our waivers. Um, the first two on the screen that is kind of in a- a darker navy blue [00:07:00] is our Acquired Brain Injury. So we’re gonna have an acute, um, Acquired Brain Injury Program.

Then we also have a long-term care Acquired Brain Injury Program. We have a Home and Community Based Waiver Program. That’s why I said some people kind of get confused because overall, when you think about that huge umbrella, we call it the HCBS Waivers, but somebody was very creative way back in time and, uh, decided to call one of our waivers the HCB waiver.

Uh, we have a Model II Waiver, and then we also have, um, two other waivers that are in the light green, that’s called our Michelle P. Waiver and our Supports for Community Living Waiver.

So let’s talk about who is eligible for waiver services. Um, and I kind of alluded to this a little bit earlier, but, uh, you either, depending on the waiver, you must meet nursing facility level of care or intermediate care facility, [00:08:00] um, level of care requirements.

So your nursing facility, it requires, um, high intensity nursing care or rehabilitative services. Uh, also complex medical needs that can only be performed by supervi- or supervised by a professional. Um, an individual could also have like an unstable medical condition with at least two care needs in specific areas. Um, or they may have a stable medical condition with at least two care needs in different, um, areas. And all of this is outlined in regulations.

And then with our ICF, um, you either would have an intellectual disability or related condition that has to be diagnosed prior to the age of 18 or 22, depending on, uh, what type of condition it is.

The individual would also, um, have deficits in at least one activity of daily living, and then the individual would need to, um, require a planned [00:09:00] treatment program or a protected environment to live safely in the community. And just to provide a little more information, um, I did go ahead and put the regulation in here. So our nursing facility in ICF level of care, it is defined in 907 KAR 1:022.

So one of the questions that we always get is like, “Who is eligible for these waiver services?” So not only do you have to meet the level of care, so it’s all about the care that you need in order, um, to be- to have your care needs safely met, but you also must meet financial eligibility. And so you have to, um, meet those qualifications for Medicaid.

However, there are financial considerations, um, special financial considerations that are made when applying for 1915(c) HCBS [00:10:00] Waivers. I don’t wanna act like that I am a subject matter expert, um, in this area. Um, when we get those financial eligibility questions, I do rely on other partners within the cabinet to help us answer those questions because we have a contract with them, and, um, they are definitely the subject matter experts. But there are different, um, guidelines and different information that they look at when you are on, uh, when you meet long-term, uh, level of care.

So we’re gonna look now at the different, um, types of waivers that we have and just a little bit, um, of the requirements that you must meet in order to be in one of those waivers. So for our ABI, you have to be 18 years or older. Of course, you’re gonna have a brain injury. You must meet nursing facility level of care that we talked about a little bit ago. [00:11:00] And the need for acute rehabilitation.

So these are individuals that, you know, they’re a little older, they’ve had a brain injury, it could have been from a car accident, or you know, anything just from an accident. And then, um, we’re trying to really provide them with that, uh, intense acute rehab to get them back out in the community.

Now, some of our individuals, um, and they’re gonna have the same types of eligibility requirements, but they’re gonna need long-term intensive support. So these are individuals that are gonna need, um, care throughout the rest of their lives. So then we have the ABI Long-term Care Waiver, and that is just like it sounds, it’s for long-term care. And so they move to the ABI Long-term Care Waiver once we see that it’s going to be, um, a long term process, um, in order to [00:12:00] provide those services to them.

We have two other, um, waiver service- our waiver programs, one of them being our Home and Community Based Waiver Program. This is more for our, um, aged population. So 65 years or older, or it could be any age with a physically, um, a physical disability. And within this waiver program, they must meet nursing facility level of care.

The next one we have is our Model, uh, II Waiver Program. Individuals that are on this program are gonna be ventilator dependent for 12 or more hours a day. They may also be on an active weaning program that is monitored by a physician. And then for this, uh, particular waiver, nursing facility level of care is, um, the requirements.

And then we have two, um, last waiver [00:13:00] programs here that are going to be for our intellectual or developmental disability, um, individuals. And for the Michelle P. Waiver Program, you must meet nursing facility or the ICF level of care. For the SCL, you must meet, um, ICF level of care. Now, one thing to note that is, um, kind of different between these two waivers is that our SCL waiver does have a housing, uh, component to it. So that’s when I talked about sometimes people live in residential that might have three or less individuals, or it can have four to eight, um, depending on the care needs. But, uh, this is the program that does have that housing component, which is the SCL program or Supports for Community Living.

So when we talk about all of our waivers in Kentucky, we have six. Um, [00:14:00] services do vary by, um, each waiver. Um, here’s just some of the services that I kind of put in here. Um, but to know exactly which services are for each waiver, I would encourage you to go, um, and look at the regulations or ask us here at the department, but many of them are Goods and Services. Uh, Environmental and Minor Home Modifications. Uh, Respite, I’m one that, uh, and I- I believe that if you’re around Pam or I, uh, very long, you will see that we really push for Respite, especially when we have individuals, uh, who are parents who are taking care of their kids, you know, day in and day out. They, um, you- you don’t get a break.

And so I know how hard it is just raising kids in general when I do go to work for eight hours a day. So you will always- if you talk to us, we’re probably gonna ask you, “Do you have respite?” Do you, you know, just for [00:15:00] you to be able to go out to the grocery for 20 minutes just to have some alone time. Cuz we feel that it’s very important when you’re taking care of other people, you have to really be, um, healthy yourself. And so not only, um, physically healthy, but emotionally healthy.

Um, there’s also services for like Personal Care and Homemaking that individuals can receive. Adult Day Health or Adult Day Training. Uh, we have Counseling and Behavior Services. Uh, like I mentioned earlier, Residential Services. Um, Supported Employment is a huge one that I really like to- to push out there because many individuals, um, and then sometimes I see that this is not as utilized as possibly it could be, but individuals wanna go out and work and, um, you know, have a life just like everybody else.

So we do have services to help support that. Uh, we do have, and the [00:16:00] only, and I didn’t mention this earlier, but the only waiver program that we have that is, um, skilled, I would say, is going to be our Model Waiver II, because they are on a ventilator. So for that program we have respiratory therapists, um, and registered nurses that, uh, provide the care in that waiver program.

But for all of our other waiver programs, it is not skilled care. It is community care. We want these individuals to live out, you know, to live in the community, um, at their choice, obviously. And then in here you can see that we’ve put in a full listing of these services that are available. Also just to note that each individual who has Medicaid and on one of our waiver programs, they have access to all the services offered through Kentucky’s Medicaid state plan.

That is [00:17:00] one thing that we feel that sometimes individuals don’t understand, or they might need wraparound services that they don’t necessarily know that they can get, uh, which could be, you know, home health. Sometimes individuals need home health to come in, um, possibly private duty nursing, um, or durable medical equipment.

Sometimes, you know, individuals might need a, um, let’s say a bed, like a hospital bed or a walker. And we do have, through the state plan, where these different services are available for the participants that are receiving waiver services here in Kentucky.

So the waiver services here, um, in Kentucky, you have, uh, a couple different options and it’s all about choice. So the first one, the Traditional service option is where participants can use a agency that’s gonna [00:18:00] deliver all of their waiver services. So say if they need personal care, somebody to come in, um, do some homemaking items around the house, then they can reach out, they can, you know, um, set up a meeting with this agency to see if they are, you know, compatible, meet with them and say, I want you to provide the care that I receive in my home.

There’s also the option of Participant-Directed Services, and this is where participants can hire their own employees, which may be, you know, friends, family, uh, you know, somebody that they know down the street that can come in and provide the specific care.

And then we also have the option of what we call Blended. So sometimes you might wanna use, um, some services, say you need some behavior supports. That is going to be a service that is done by a traditional agency, but with your homemaking or your personal care, you have a [00:19:00] neighbor that you are very close to and that you trust. Um, you know, a lot of times these are, um, very intimate things that they’re doing when they’re bathing you and you feel more comfortable with them.

And so you can then at that point, you can hire those individuals to come in to assist you. So that’s kind of what we call our Blended, um, service option.

So From Application to Services. So first you’re going to apply at, um, kynect.ky.gov. Um, you can also, what we do is when we have individuals come in to the, um, we- they call us or maybe they email us. Then what we do is we can also, uh, recommend the CMHC or the ARDC in your area to help you fill out a waiver application.

Um, or if you are technology savvy, there’s nothing [00:20:00] wrong with that. You can go online and actually apply there. So, and then, so once the application and all the information is uploaded that we need, this application is reviewed. What we do is we look at the entire application and how the, uh, questions are answered.

And then we, you know, so if you don’t have, if you’re not on a ventilator, then we’re not gonna send you to the ventilator waiver to be reviewed. If you don’t have an ABI, we’re not gonna send you there. So we look at that and then we send you to the appropriate waiver that would mess- best meet your needs based on the disability that you have.

Um, if they’re-

Rhonda Logsdon: Alicia-

Alicia Clark: -selectable. Oh, I’m sorry.

Rhonda Logsdon: Sorry. I’m so sorry to interrupt you, but I did just want to, cuz I know we all use different acronyms, but the in person ones, um, it’s the Community Mental Health Centers, and where was the other spot? [00:21:00] Cause that everybody may not know the acronyms. Yeah-

Alicia Clark: The ARDCs and those are through our triple, um, A’s, those are agencies- area on agency, uh… Oh, Pam… I’m gonna have to get her to jump in on this one. Our area-

(crosstalk)

Pam Smith: I like just drew a complete blank, too.

Alicia Clark: I did, too.

Pam Smith: Um, it’s the, um… The ARDCs are the Resource Development Councils, um-

Alicia Clark: Through the Area on Aging.

Pam Smith: Yeah, through the Area on Aging, um, Center. So it’s like your KIPDAs, your Pennyrile, um, Bluegrass. Um, they also provide a lot of the aging services, um, within that region. So, you know, in addition to any kind of Medicaid services, they may, um, provide meals on wheels, um, senior services, senior centers, that type of services. [00:22:00]

Rhonda Logsdon: Thank you so much. And I didn’t mean to interrupt, I just, uh, always know that, uh, acronyms throw me, so I didn’t know if anyone else knew.

Alicia Clark: Absolutely. I appreciate that because, you know, working in the world of Medicaid, I feel like everything is an acronym and so I- I try to, you know, say what they are, but sometimes I forget. So, um, I appreciate that.

(crosstalk)

Rhonda Logsdon: Yes, and I do the same thing when it has to do with special education and- and everything, too. So-

(crosstalk)

Alicia Clark: You get just used to working in, you know, day in and day out, so, um-

Rhonda Logsdon: Right.

Alicia Clark: Thank you. Thank you so much. And yes, if anybody has any questions about anything that we’re saying or whatever, definitely throw that in the chat and- or interrupt me.

Um, so once that application is reviewed and we, um, look to see which waiver, um, you would meet the, um, if there is a slot [00:23:00] available, then we would reserve you into that waiver. If there’s not, then you would go on the waiting list.

So let’s go down the happy path and say that you, um, there’s a slot available and that you, um, that you’re going to- to get that slot. And so the next piece that you’re going to get is an assessment, and that is where somebody will come in and they’re gonna ask you lots and lots of questions about, you know, your bathing, your dressing, your medication management, um, how you go about your, you know, the daily activities that you do. Um, so it’s very, very important that when, you know, I always tell the assessors, um, ask open-ended questions.

But if you- if that happens to you and you’re asked a yes or no question, go ahead and say, “Well, yeah, I can walk, but I use a walker because I’m unsteady on my feet.” And so [00:24:00] we like to have as many details as possible, um, when looking at the assessments based on our regulations.

So then let’s say that the assessments completed and you meet the level of care for the waiver program in which you were, um, given a slot in. Then you have the option to pick your case manager. So we want you to find a case management agency that, um, is going to be compatible, uh, with you. And then what they will do is they come in, um, there’s lots of paperwork, but the next important thing is, is the person-centered, uh, service plan is created.

So finding out how do you want your services delivered? Um, by whom do you want your services delivered? And starting that process. So once all the paperwork’s filled out, you’ve got your providers that you’re wanting to provide services or possibly, um, if you’re wanting to hire individuals, [00:25:00] then what you do is all that stuff gets done, they submit that into a system, and then once you receive a prior authorization, the services can begin.

And then to continue receiving these services, um, you have yearly reassessments and re-certification. Um, these are a little bit different, sometimes people put them, uh, kind of together, but what we call our yearly reassessment is actually about the functional needs. You know, how you’re bathing, dressing, like I said, the medication management, if you’re having any behavior issues. Um, and then the recertification part, every year you have to be recertified financially as well. And that’s through the Department for Community Based services. Um, sometimes those go hand in hand with each other, and then sometimes they don’t because some individuals might already have Medicaid and they already might be on, you know, a [00:26:00] cycle for that, and so they don’t match up. But there are definitely a lot of instances in which, um, they do.

So we have some waiver resources that I’ve put here. There is this link that’s been provided to you all. We put our program updates out there. There’s links to our regulations and other related, uh, Medicaid programs. We have, uh, brochures and just, you know, community resources. We have information on how to contact us, um, out there.

Uh, we have, um, one way that you can- some people like telephone and like talking to people. Um, sometimes I- I do as well. Other times I’m busy and it’s easier for me to send an email. But we have a help desk here and that number is 844-784-5614. Uh, we have [00:27:00] individuals that answer the phone, um, can- and can help you and direct you to the right organizations to assist you, whether you know it be, uh, trying to get an application in or they can provide you if you’re looking for different case management agencies, they can give you a list of case management agencies in your area. Um, or if it’s easier, you can always email our help desk. It creates a ticket. Um, these are, uh, compiled and then we have individuals that are working those, um, throughout the day as well.

Please make sure that, um, if you want to receive email updates, if you email this Medicaid public comment box here that’s on the screen, uh, Kelly actually that I was talking about, oh well, I was telling Rhonda, kelly is amazing on our side. Um, she is our Communication Specialist, but she will, uh, put your name into our listserv that when we send out different blasts [00:28:00] of information, you will get those. You can always follow us on different social media. I’ve got here, we’ve got Facebook, Instagram, and Twitter. That is updated. Um, and if you need to, um, apply the kynect right here that we were talking about and then the, um, HCDS waiver info, um, just to find out more information.

So that concludes, um, our presentation. So I will stop sharing my screen here. And then what questions do you all have for us?

Rhonda Logsdon: We do have one in the question box, and I saw in the chat too that there was one and uh, Pam, you’ll have to forgive me because I didn’t introduce you. Your name shows up as um, “Alicia”, so [00:29:00] I do apologize. I got, uh, messed up there. So we are so grateful you’re on with us. Um, and um, I know that you had answered one that was in the chat.

We do have, um, one, um that is if an adult has been approved for the HCB, can you have Blended Services with the Traditional and Participant, uh, Directed? For example, can you hire a sitter through the Participant Directed as well as a sitter through, uh, Traditional? I’ve had a hard time finding a full-time, uh, person, um, that they’re wanting to not, um, to lose the part-time person, too. So can you do a mixture when it is for those hours?

Alicia Clark: So you can do a mixture of, um, Participant Directed and Traditional Services. One thing that is very, very important to remember is that, um, like for HCV, there [00:30:00] is, um, within the regulation, there are requirements around how many hours you can have through the week.

So it’s very important that they work together to ensure that you don’t go over the hours, uh, the limits, because then at that point, um, somebody will not get paid for those additional hours because you didn’t have a prior authorization for that.

And also just, and I- I think this probably goes without saying, but um, they can’t provide the services at the same time, so they would need to be at different times.

Rhonda Logsdon: Well, and I know, um, that it has been, um, a blessing for many, especially with, uh, COVID, um, being able to mix that, whether you’re consumer or I may use the older term, but the Directed options. Um, or with Traditional, if you typically would’ve just [00:31:00] used one with the shortages in- in being able to find people, it has been very beneficial to be able to mix those, to meet the needs.

Um, how, uh, how many months will a person wait on a list, both for SCL and the, uh, com- uh, Michelle P. Waiver program?

Alicia Clark: Um, so to be honest, I don’t have a particular, um, waiting period length, okay. Um, so let’s talk about SCL. SCL, there are three different categories for the waiting list. You have future planning. So this is somebody that’s gonna need services in the future. Um, they’re probably getting services, uh, through another type of program. But they don’t need those right now.

The urgent is, uh, more than likely you’re gonna need, um, services like within the next six months [00:32:00] to a year.

And then the emergent is you need services right now. Um, there are specifics, and I don’t want to quote them off the top of my head because I know that I will get them wrong, but, um, there’s very specific criteria that you must meet. Uh, one of those is like loss of housing. Um, you don’t have a caregiver, um, available and basically like you would be institutionalized, um, without getting an emergency slot.

Um, for the Michelle P. Waiver right now, that waiting list, uh, the way that those regulations were written is it’s a first come, first serve basis. Um, I do know that that waiting list is long. We do monitor that. We have, um, I always tell- we advocate, Pam, every budget session asks for more and more slots. Uh, we know that we’re not [00:33:00] gonna get as many that we ask for, but we shoot for the stars.

Um, so what I would tell you all is, is to continue to advocate to the legislators. Um, because not only do we have to have the funding from our legislators, uh, once we get that funding, then we can request those slots from CMS. So, um, it’s kind of a two part process cuz some people think, “Oh, we have funding, give me the slots.” Well, we also have to go through that process, the application process with CMS. But, um, you know, I’m not trying to not answer your original question, we just don’t have, like, I can’t tell you how long, uh, the wait length is on those programs because it really all depends on how many, um, spots we have total, and then how many people come and go.

A lot of times, uh, it’s like that Michelle P. is kind of a stepping stone for the SCL program, but if somebody [00:34:00] comes off of the Michelle P., uh, that does free up a slot. Another thing that we like to educate people on is just because, um, a slot has been freed doesn’t mean that I can give it away tomorrow.

In our applications that are approved by CMS, they have to be unduplicated slots. So our waiver year for Michelle P. is going to be September the first, through the next August the 31st. So if I had a slot in Michelle P. and I receive, uh, one service, so one day I have case management and um, I had personal care done. Because I received services in that waiver, that slot is mine for that entire waiver year.

Um, so we- so maybe something happens to me, I decide that I wanna go live in a- a nursing facility for whatever reason, then nobody can use that slot for the waiver year. Once that waiver year’s up, that slot is freed [00:35:00] and then we can, um, give that to the next person in line. We are constantly, um, we allocate as quickly and as, you know, as we can. We are always going back through just to see, cuz some people have moved outta state, they might not want their slot. Um, so there’s a reconcile process that is ongoing. And, um, we do allocate, uh, as quickly as we can on those waiting lists.

Pam Smith: Yeah, I just looked at Michelle P. It looks like we probably within the next 60, probably 60 to 90 days, but hopefully closer to 60, we’ll be doing another round of allocations.

And that’s, you know, our waiver year just restarted two weeks ago, so that’s not a- that’s not uncommon. It takes us, as Alicia said, a period of time to do that reconcile- those reconciliations. But we’ve been trying to, with Michelle P. in particular, because of the size of the waitlist. Um, I believe honestly since I came into this position, [00:36:00] um, almost, um, actually it was four years ago, um, this month, we have been allocating Michelle P. about every 90 days, we’ve been giving some slots. So we’ve been trying to stay, um, very on top of that waitlist and- and allocating as often as we can.

Rhonda Logsdon: And we’re so grateful for that, cuz I- I know that many people may not know, um, but you all are always there at the forefront, always advocating, um, for everybody to get all they can. Um, and it’s greatly appreciated.

And- and one of the things we did have a question, um, a couple questions here. Where can I find the income guidelines for the HCB waiver? If the person is a child, does it go by the parent’s income? Also, can the parent be a caregiver? [00:37:00]

Alicia Clark: So for the waivers, there are the special income guidelines and I don’t know, I- I don’t have those, but, uh, DCBS, uh, would have that information and- and I think it was, uh, about the parents’ income versus the child’s.

So that’s one thing that is a little bit confusing to individuals because once you meet level of care, it’s kind of- always tell people it’s almost like a 30 day hold. Um, that kind of- kind of sounds weird, but for the first 30 days they will look at the parents’ income. But starting that 31st day, they look at the child’s income.

Um, so that’s why it’s you- you see it takes a little bit longer in order for, um, some individuals to flip into gain and enroll in a waiver program through Medicaid. [00:38:00] Did I answer all that question, Rhonda, or was there more to that?

Rhonda Logsdon: Uh, the- just the- the only thing on there was, um, I think that the parent be the caregiver. I guess if they did, if it had the consumer, that was the only part I think that didn’t, if the parent could be a caregiver, I guess, through the waiver.

Alicia Clark: So we do have a Participant-Directed option in the HCB program as well. And, um, parents can be the caregivers. There is a process that you have to go through. Now during, um, the public health emergency that has been relaxed a little bit, but once the, um, the public health emergency federally is over, then we will be putting, um, that process back into place.

But, um, you- you have to be approved, uh, for that. And like I said, there is a process, but it- there is the possibility [00:39:00] that a parent could be the, um, caregiver.

Rhonda Logsdon: Thank you. There’s- there’s another one here. If a, um, for a parent applying, uh, applying for the HCB waiver for their dependent child, should they apply for Medicaid first or put in their application for the HCB waiver evaluation first?

Alicia Clark: That’s a great question. A great question. Um, you put in an application for Medicaid first in order to, um, complete the waiver part of the application.

Um, sometimes I do understand you, you know, when you go in and talk to DCBS, I always tell people, use the words long-term, um, eligibility because they, um, they [00:40:00] just think, you know, low income. And so they’re just kind of focused on that. But if you talk about long-term care eligibility, uh, for the financial part of it, that kind of is a key to them to know that, oh, they’re probably, you know, nursing facility or waiver. And sometimes those applications, they can either be pended or if you’re denied, but it does allow you then to go ahead and complete the waiver portion of that.

Now, DCBS cannot complete that for you. You can either, um, like I had mentioned earlier through the Kynect, you can go through there and do that. Or we can always, um connect you with the local community mental health centers or your triple A’s, um, in order to, uh, finish applying if you need assistance.

Amber Hamm: Alicia, uh, is- what would the best route be, or how do we assist parents who, um, have maybe [00:41:00] applied already for the Medicaid for their children? Um, they have a qualifying disability, but the parents earn too much income. If they are thinking along the lines of a waiver, how would we best assist them in- in that situation?

Alicia Clark: So if they’ve already applied, um, previously, they’ll have to go back in and reapply in order to, um, to get that, uh, the option to able to apply for the waiver. But even if they’re denied, that’s okay because then the- once you get the assessment and the level of care, it actually then goes to DCBS and there’s a task and they look at it and then they start going down the other pathway.

But if at any point in time you have questions, um, about that, don’t hesitate. You can contact DCBS or I- I always tell people I feel like we’re a one stop [00:42:00] shop. We don’t have all the subject matter expertise in our area, but we can definitely, um, help you and guide you, uh, by looking at the systems and, um, giving you exactly where you need to go. If you have any questions, don’t hesitate. Like I said, in, um, the- the PowerPoint, that phone number there, uh, don’t hesitate to reach out to our staff. They’re always- they’re here and they are willing to help.

Amber Hamm: Thank you.

Rhonda Logsdon: And there’s a- there’s another question. Can you please explain how the supported employment works and which waiver that falls under?

Alicia Clark: So the supported employment, we have that under our ADI waiver. Uh, we have it under our SCL and Michelle P. waivers. Um, that is for individuals [00:43:00] who are, um, you know, wanting to, uh, get a job. And at first there are individuals, um, and your case manager can help you navigate that and can help you find supported employment specialists in your area. But they actually meet with the individual and find out what their interests is- are and what’s important to them. Um, then they’d go out and they help them try to find a job that would, you know, best meet their needs and their wants, uh, and their desires.

And then, you know, at first there’s a lot of hands on, but over time that is, uh, dropped back and the hours, um, you know, to where individuals are just, uh, the supported employment specialists are checking in and seeing how they’re doing and, you know, working with their manager, say, um, at Wendy’s, um, if that’s where they wanna work, and just, um, kind of doing those periodic check-ins and just to make sure that they’re successful [00:44:00] in, uh, the option that they chose.

And then we-

(crosstalk)

Alicia Clark: if there’s any there and if you, you know, there, um, we have a couple websites out there where you can look for providers and stuff. So even if you call our help desk, if the case manager, if you feel like you know, “Hey, I’m just not getting, you know, what I feel like I’m- I need”, again, that’s another area in which you can reach out to us and we can help you navigate the system and to find different, uh, supported employment specialists in your area. And we can provide you a list of that.

Rhonda Logsdon: Wonderful, and we can share that, um, out with everyone too, if you would like, um, that’s attended the webinar. Um, and one thing I did wanna ask, so with the employment, um, are- are the- are individuals, um, able to use their personal [00:45:00] assistance hours, um, while they’re working so that they have the support that they need?

Alicia Clark: So the personal assistance hours are for personal assistance. The supported employment is what they should be using, um, for the working hours.

Rhonda Logsdon: Oh yeah, um, but um, if they need, um, i- if it’s they don’t need the help for the supported employment, but they need their personal care needs met while they’re working, can they use those hours?

Alicia Clark: Um, it’s- it’s possible that, you know, because your supported employment specialist, you might not want them, you know, taking you to the restroom or something like that. But I would, um, just caution, um, the- the distinction between the two types of services. [00:46:00]

Rhonda Logsdon: Okay. Absolutely. I appreciate that, cuz there’s, um, because we, um, if I- you know, working with a lot of families and- and everything have, you know, heard different things and just wanted to kind of clarify that, um, because individuals, um, many can work but do need those supports.

I don’t know if I’ve missed any here. Um, oh, there’s one that is, is there anything being done to address the, uh, shortages in service providers, for example, residential options?

Alicia Clark: So, Pam, do you wanna take that one?

Pam Smith: Of course, if you will repeat the question. I- I got asked a, um, question by one of our attorneys at the same time. She sent me a message.

Alicia Clark: Oh, I’m sorry.

Pam Smith: Just let me know what the question is again.

(crosstalk)

Alicia Clark: What we’re doing to address the, um, worker [00:47:00] shortage, uh, within our waiver programs and, um, they specifically had mentioned residential.

Pam Smith: Okay. So I- I will say first, I will say that in the over 20, um, years that I have worked within the waiver programs, I do not believe that we’ve seen a, um, shortage to this point. And- and for it to be also nationwide. We collaborate regularly with other states trying to look at innovative solutions for, um, addressing the workforce issues.

Um, so, you know, on a more global level, so we’re trying to work with other states, um, to learn, you know, is there something that they’ve done? Um, is there a best practice we can learn from? Shorter steps that we’re trying to take in, in- within what were allowed. So with Appendix K, because it- it got [00:48:00] worse. So it existed prior to the pandemic, but once COVID hit, it- it just expand- you know, the- the problem just expanded.

Um, so one of the- the Appendix K, which is what we’re allowed to use when there is any type of natural disaster, pandemic. Um, well, we can request additional resources from CMS and it allows us to have some flexibilities, um, within our waiver so that we can do things to specifically address those problems.

Um, we have, uh, given some pay increases, um, some incentives, um, right now for, um, those services where there is, well, for residential we’ve been allowing a 50% increase, um, in that, uh, since the beginning. Um, at first it had to be tied to an individual not being able to go to like adult tra- a day training or to, um, if [00:49:00] they were do- utilizing supported employment. Um, but that we, um, eliminated that restriction. So we’ve increased the pay.

Um, we also, um, anything that’s a direct hands-on service, so your personal care attendance, the respite workers, um, we are allowing the- the agencies to bill up to 50% more. And as part of that, they have a requirement and they have to give us an attestation. And then we go back and monitor that, that 85% of that increase is passed directly onto the workforce. Now, they have some flexibility in how they can do that. So for example, um, some of them have raised rates, some of them have given- have given bonuses to, you know, all of their staff. Some of them are using it as kind of a recruitment or a retention, um, bonus. Um, some of them have used it for additional training and support and development of staff. [00:50:00] Cause it’s all about trying to hire and retrain- and retain that workforce.

Um, you know, it- we’re continuing to, you know, look at every, um, option there is. And I don’t know that I honestly have a good- have a good answer. It’s a hard problem. It’s not something that’s just Kentucky-specific. And I am always open to- I tell everybody that I speak to, and Alicia can attest to this, if you all think of something that, you know, “Hey, have you all thought about this?”, “What about this?”, or “I heard about this”, email us that Medicaid waiver public comment. And Alicia if you’ll put that in the- the chat-

Alicia Clark: It’s in their handout.

Pam Smith: Um, if you can- if you think of something, send something to that email box and say, “Hey, I- I thought about this”, or “I have an idea.” You know, I think we- we are really open to, um, anything at this point, any ideas. And it’s very [00:51:00] important to me, and part of when I took this job, my commitment was stakeholder engagement and transparency. So, you know, I don’t believe we can be successful without the participation and help of the individuals we serve and the individuals that support them. So we’re always looking for ideas. And I will tell you that every comment that is submitted to that box, um, gets read.

Um, and, um, I think I heard Alicia, um, talk about Kelly, our phenomenal communications staff. She is, you know, she triages everything in that box and makes sure that, um, if she can’t address it, that it gets exactly where it needs to go. So, you know, I guess that’s a request partner with us. If you all think of something, even if you think it may sound silly, hey, I- I’m open to, you know, listening to anything.

I- I think at this point it is such a- such a systemic problem that it’s gonna take some innovative ideas to get [00:52:00] us to a point, um, where we have, you know, a- a stronger workforce and, you know, the caliber of people that we wanna hire. You know, these are, I think I heard Alicia, you know, referencing how these people are involved in the most intimate activities in an individual’s life. And a lot of times they become more than just an employee. They- they become natural supports, they become friends, they become part of the family. So it’s important that we can support the individuals that work as employees, um, and that we really have structure in place to ensure we’re hiring the right types of people that have the intentions to- they’re in this job for that reason, that they want to become, um, an advocate, a partner, um, a support for someone.

So I know that really kind of, I felt like I went all the way around the circle and didn’t really give you an answer, but it’s- it’s a perplexing problem and it’s one that I don’t think we’re [00:53:00] gonna solve overnight. But, you know, we- we are committed to trying, um, everything that we can to, um, to regrow the workforce and to maintain the workforce.

Rhonda Logsdon: Well, Pam-

(crosstalk)

Amber Hamm: I wanna say thank you. I’m so sorry, Rhonda, I just wanted to say thank you so much for that, Pam, because partnership is- is everything. And- and the individual’s voice and family’s voice and wanting to partner with them, I think that is phenomenal.

Pam Smith: I think it- it’s- it’s critical.

Rhonda Logsdon: Well, and- and as a sister, um, you know, our- and you all know Grant and, um, you all know too, we- one thing that we live by, whether it has to do with- with work or with personal, um, is that the wrong person’s worse than no person.

Um, and wanting to make sure and, you know, um, in everything that we do, and it- and it’s not just, you know, [00:54:00] the shortages again, like you had mentioned, is not just in Kentucky and it’s not just with providers for waiver services, it’s across the board. Um, and I’m just grateful for the dedication. Um, and- and go back to Alicia, when you were talking about- cuz I know that you and Pam always bring up wanting to know about the respite, you are actually taking into consideration the needs of the individual and the family, um, on a level that, um, as a sister, I’m grateful for. And I know all of our- all of our individuals and families are.

And I think that we had, uh, we had got to all the questions. If there was anything left out, um, again, um- go ahead.

Kellie Smith: Rhonda, it’s Kellie, uh, from Kentucky SPIN, and I had written down a couple of questions if- if we have a minute.

[00:55:00] Um, the first one I wanted to ask on, uh, on behalf of the families who we serve is, “Do you have to have a guardian, um, or can an individual be their own guardian, uh, to apply for waiver services?”

Alicia Clark: An individual can be the-

(crosstalk)

Alicia Clark: – an individual can be their own guardian. Um, some individuals can, and then some individuals, um, might have a state-appointed guardian.

It’s all based on, you know, the individual themselves and being person-centered.

Kellie Smith: Perfect. Um, and then I have a question- or I have a question about, uh, you- and I know you don’t know a lot of the- you said you don’t know a lot about the Medicaid, but we should apply for Medicaid, uh, for a long-term care prior to filling out the application.

So do you know that, uh, what- if a person is [00:56:00] approved for the long-term care Medicaid, uh, how long does that application last? Or do they have to go about, you know, doing that, um, you know, more than once while they’re on the wait- while they’re on the waiting list or, uh, do you know anything about that?

Alicia Clark: So if- in order to meet the long-term care part of it, you would have to meet a long-term level of care. So you wouldn’t get the long-term care portion of Medicaid unless you were in a nursing facility or a waiver. If you received Medicaid, it would be on the other income standards. And- but each, um- so while you were on the waiting list- so if you’ve got, you know, continued Medicaid, that is required, uh, once a year that you must continue to meet financial eligibility.

And I know that DCS sends out, um, letters when those times is due, [00:57:00] but, uh, you know, so if you don’t have the Medicaid while you’re on the waiting list, then once you get the level of care, um, sometimes we have an e- oh, not an email, I’m sorry, a letter that goes out and it’s gonna tell you, you do not have the right type of Medicaid for the waivers, please apply. You know, and it’s got- I don’t know the exact words, but please apply for Medicaid that will, um, work for the long-term care, uh, portion for financial eligibility. And then once you get that, once you meet the, um, the financial part, then you’ll get a letter saying, please, you know, pick a case manager.

Um, and one thing, just- and just to let you all know, I know that we’re running short here, but I did share a couple- a few links, um, to everyone. The first one that I shared is our [00:58:00] DMS page and in the middle of that, it’s gonna tell you how to apply. It’s also going to- we have links that we keep up to date there of the, um, Area on Aging. Um, and then also the community mental health centers. So there’s a couple links in there that you- if you just wanna get around and look.

And then I know that it was asked about, um, finding providers. So I’ve also put two links in there for, one through the Medicaid system, and then also a link through DBHDID, which is our Behavioral Health Department, um, that we contract with them for our SCL and Michelle P. waivers. They have a provider directory as well. So, um, I put that link in there and then Pam had asked me to share again, the Medicaid public comment email box. So I- I’ve done that as well.

Rhonda Logsdon: Wonderful. And what I’ll do is I will make sure that on, um, when we send out the follow up [00:59:00] email, that if you didn’t get a chance to download the PowerPoint, um, to have it, that I include all those links that you shared in the chat, in that follow up email.

Alicia Clark: Okay, great.

Rhonda Logsdon: Well, and- and I just hope you all know how much we appreciate you all so much, um, for helping us, um, and coming and sharing knowledge with us and always just ready, willing, and able to do all we can to help our families and individuals.

Pam Smith: Thank you so much for having us, and I know Alicia said it earlier, but you know, I’ll echo that. We- we love, um, the education and the engagement part of our job. Um, I- you know, really like the opportunity to be able to share information and to be able to share correct information. We know a lot of times, and many times it’s with good intentions of someone, but not exactly the right information gets shared, and it can lead to confusion. It can lead to being [01:00:00] people being afraid and we don’t want that to happen. So, you know, we are always willing to, um, to present and to be part of these.

Rhonda Logsdon: Absolutely. And that’s just one of the many, many reasons that I just love you all and always making sure so that we do get that accurate information out there. Um, and helping to share with everyone.

Well, and uh, you all will see there’s a QR code you can scan here. We greatly, uh, appreciate your feedback. Um, and we also shared in the chat the link to the survey if you all could just take a moment. But I hope everybody has a great rest of your day and thank you all so much for joining us.

Alicia Clark: Thank you all so much for having us today. And if you all have any questions, don’t hesitate to reach out, um, through our email box or through the phone number that was shared.[01:01:00]

Rhonda Logsdon: Thank you.