Revised March 2005

• Medicaid HCBS/FE Eligibility
• HCBS/FE Benefits
• Your rights and responsibilities
• Glossary of Terms
• Contact information

Introduction

Kansas has a variety of programs promoting independent living in safe, healthy environments. Individuals age 65 or older who qualify for Medicaid benefits may be eligible to receive services through the Home and Community Based Services Frail Elderly program (HCBS/FE). The goal of HCBS/FE is to provide long term care services in the least intensive care setting of your choice.

The HCBS/FE program has been administered by the Kansas Department on Aging since July 1, 1997. The purpose of this booklet is to assist Kansans who need help as they grow older. The HCBS/FE program may enable them to stay in their homes or make other successful living arrangements in the community.

Program Definition -

HCBS/FE helps Kansans age 65 or older who are in frail health. Services include:

• Personal care such as feeding, bathing, and dressing;
• Household tasks, such as shopping, meal preparation, house cleaning, and laundry;
• Health services, such as health monitoring, 24-hour support for medical emergencies, and respite care to temporarily relieve caregivers.

Am I eligible for Medicaid HCBS/FE Benefits?

• You must be age 65 or older and in frail health
• You must be assessed by a qualified case manager and determined to need long-term care services
• Your countable assets cannot exceed $2,000 (a home and vehicle are not included in the total).
• You will be asked to help pay for services if your countable income is greater than the allowable income per month (your local SRS office will help you determine your current allowable income).

See Estate Recovery information

How do I apply for Medicaid Benefits?

To see if you qualify for Medicaid benefits, contact your local Kansas Department of Social and Rehabilitation services (SRS) office ad tell them you would like to apply for Medicaid and the HCBS/FE program. You can find contact information at the end of this online publication .

You will need to fill out an application for Medicaid assistance. Information and verification of your income and assets will be required. An Economic and Employment Support Specialist at the SRS office will help you with this process. If you now receive Medicaid assistance and think you are eligible for the HCBS/FE program, you may contact your local Area Agency on Aging (AAA) directly.

What Else can I Expect?

In order to obtain home and community based services, your health care needs will be assessed to determine the services necessary to maintain your highest level of independence.

This screening will be done by the AAA or by an assessor approved by the Kansas Department on Aging (KDOA). Contact your local AAA to obtain an assessment. This process is very detailed and will take approximately two hours to complete.

What will Happen If I Am Eligible for HCBS?

A plan of care will be developed before you can begin to receive services. This plan of care is based on information gathered during the assessment process. You will be actively involved in creating this plan with help from a case manager from the AAA. You will have final approval of the plan. This process is meant to ensure your health and well-being are protected. You will have the opportunity to chose your provider(s) and direct your attendant care, if desired.

Your plan of care will include:

• The type, amount, frequency, and length of time each individual service is to be provided.
• The providers who you decide are best able to furnish each of the services you need.

What Happens If I Am Not Eligible for HCBS?

If you do not meet the eligibility criteria for the HCBS/FE program, there may be other services that can help you. Your case manager from the Area Agency on Aging can help you review your needs and connect you with the appropriate services. The case manager will then check back with you to see how things are working and to review any changes to your situation.

What Benefits Can I Receive Through The HCBS/FE Program?

The HCBS/FE Program has many services available to you including:

• Adult Day Care
• Assistive technology
• Attendant care services
• Medication Reminder
• Nursing evaluation visit
• Personal emergency response
• Sleep cycle support
• Wellness monitoring

Case management is also available to individuals who qualify for this program. The following definitions give a better understanding of the services available.

Adult Day Care -

Adult day care is a service to maintain a person's optimal social functioning. Depending on your personal plan of care and your chosen provider, this service may include:

• Daily supervision
• No more than two meals a day
• Assistance with eating, toileting, or mobility.

Assistive Technology -

Assistive technology provides equipment or modifications in your home to increase, maintain or improve your ability to perform daily activities.

Attendant Care Services-

An attendant is trained to assist you with activities you cannot perform or for which you may need some assistance. There are two levels of care.

Level one services may include...

• Shopping, house cleaning, meal preparation, laundry, grooming, toileting, or feeding
• Supervision of mobility, such as getting in and out of bed, the bath, a wheelchair, or vehicle
• Accompanying to medical appointments
• Assisting in completion of paperwork; for example, filling out forms or paying bills
• Supervision of medication

Level two services may include...

• Physical assistance with bathing, dressing, walking, or transfers
• Routine monitoring of vital signs, such as blood pressure
• Care of ostomies, wounds, or catheters
• Feeding which requires tubes and/or special nutrients
• Assistance with medications (nurse delegation may be required)
• Assistance with range-of-motion activities

You may choose to direct either level of service yourself by hiring, training, and supervising your caregivers. Self-direction of some Level Two activities requires your physician's or nurse's written approval.

Medication Reminder-

A medication reminder system provides a scheduled reminder when it is time for you to take medications.

Nursing Evaluation Visit-

Nursing evaluation visit is completed by a Registered Nurse to evaluate your health care needs and determine the appropriate assistance to be provided by the attendant(s).

Personal Emergency Response-

Personal Emergency response provides consumers, whose health status may require immediate attention, with 24-hour on-call support Persons with heart conditions, diabetes, epilepsy, breathing difficulties, or those prone to falls and injuries may be candidates for this service. Emergency response systems are usually electronic and involve the rental of specialized equipment which can alert family or medical personnel that assistance is required.

Sleep Cycle Support-

Sleep cycle support provides assistance in your home, during your sleeping hours. This service may include help with toileting, transferring in and out of bed, getting around, or reminding you to take medications.

Wellness Monitoring-

If your care plan includes wellness monitoring, a Licensed Nurse will visit you in your home to provide health assessment, education, counseling, and monitoring of any treatment program prescribed by health care professionals.

Case Management-

A case manager will help you to assess, coordinate, and obtain the services that you need. Your case manager will ensure that services are appropriate, adequate, and are of high quality. This program is committed to the efficient use of all available resources. It will assure that the services being rendered are sufficient in quantity and quality to meet the needs and preferences of those involved in the program. A case manager may advocate on your behalf with health care providers and other agencies.

What Are My Rights And Responsibilities?

Consumers who are eligible for the HCBS/FE program have the following rights and responsibilities:

I understand I have the right to...

• Have my financial eligibility for the HCBS/FE program determined within 45 days by the SRS Economic and Employment Support Specialist.
• Have services provided in accordance with the state Medicaid plan, dependent upon availability of services and financial eligibility.
• A fair hearing if I am dissatisfied with the decision made on my application or I feel there has been undue delay in acting on my application.
• Equal treatment as other applicants or recipients who are in similar situations.
• Confidentiality
• Freedom of choice regarding services for which I am eligible including:
  • Being informed about all feasible alternatives;
  • Whether to receive HCBS;
  • Refusing recommended services;
  • Choosing which qualified providers perform each service in my written plan of care;
  • Choosing to direct my own attendant care services;
  • Entering a nursing home.
• A review of my HCBS eligibility and plan of care at least every 12 months or any time my circumstances change.

To Appeal a Decision-

If you have any questions about an action taken or if you want more information considered before a planned action is taken, discuss these matters with you case manager. If you remain dissatisfied, you have the right to a hearing before the State Hearings Officer. Your request must be received in writing within 30 days of the date on the notice which provided you the information you are appealing. The Fair Hearings Staff at KDOA can answer any questions regarding the hearing procedure. They can be reached at 800.432.3535.

You may have legal counsel or other representation at the hearing. If a request for a fair hearing is received prior to the effective date of the transaction, assistance may continue at the current level pending the decision. However, any overpayment from a continuation may have to be repaid if the decision is not in your favor. If you are dissatisfied with a fair hearing decision, you may request a review by the State Appeals Committee.

Your Civil Rights-

No person shall be denied benefits on the grounds of race, color, national origin, age, disability, religion, or sex. No person may be excluded from participation in, of, or be subject to discrimination under any program or activity of KDOA, SRS or Medicaid.

If you feel you have been discriminated against on the above grounds, you may make a complaint in writing to KDOA's Diversity Manager at:

Kansas Department on Aging
503 S. Kansas Ave.
Topeka, Kansas
66603-3404
785-296-4986 and 1-800-432-3535

I understand that I have the responsibility to...

• Supply information essential to establishing my eligibility and to report fully all circumstances affecting my application.
• Allow a full investigation of my eligibility, including inquiries of employers, bankers, doctors, other business or professional persons as well as review of any state agency records. I further understand that if SRS needs additional information of my employers, I will be asked to sign a release. If SRS is given consent for release of any information from Supplemental Security Income and Social Security records, I understand that my Social Security Number will only be used in the administration of SRS or Medicaid programs.
• Report any changes in my circumstances which affect my eligibility.
• Cooperate in current and subsequent agency efforts to establish my eligibility.
• Pay my share of service costs, if applicable, in accordance with any fee schedule.
• Report if I plan to move or be away so that my Economic and Employment Support Specialist, Case Manager, and I can appropriately plan services.

Reporting to local Area Agency on Aging...

If you plan to move or be away temporarily, your Case Manager and Economic and Employment Support Specialist should be informed so that arrangements regarding your service needs can be planned with you. You are also required to report any change in income, family size, temporary assistance to needy families (TAF), or Supplemental Security Income status.

Estate Recovery-

This is a program which allows SRS and Medicaid to recover medical care costs from the estates of recipients who, prior to their death:

• Were 55 years of age or older;
• Resided in a nursing facility or received HCBS services; and/or
• Did not have a spouse, children under 21, or disabled dependents.

• A person's estate includes the home, savings, or other assets remaining upon death.
• No lien will be placed upon property while the recipient or spouse is living, but a claim may be filed on the estate upon the death of both the recipient and spouse.
• The claim will be in the amount of any medical expenses paid by Medicaid after June 30, 1992.
• All medical expenses paid by SRS may be included in the claim, including Medicare premiums paid by SRS, Medicare cost sharing paid by the QMB program, and any other regular Medicaid expenditures.
• Questions regarding the Estate Recovery Program can be directed to the Estate Recovery Unit at 785.296.6707.

Glossary

AAA - Area Agency on Aging

Case Manager - An individual authorized by KDOA and SRS to provide assessments, service coordination, and cost containment for Medicaid long term care programs.

Economic and Employment Support Specialist - An SRS employee who determines financial eligibility for medical assistance.

Frail Elderly - Persons who are 65 years of age or older and in frail health.

HCBS/FE - Home and Community Based Services for the Frail Elderly.

KDOA - Kansas Department on Aging.

Medicaid - The state health care program that helps eligible people pay for medical services. An Economic and Employment Support Specialist at SRS determines financial eligibility for this program.

Medical Assistance - Another name for the Kansas Medicaid program

Primary Caregivers - Individuals or professionals providing care and support to a frail elder.

SRS - Kansas Department of Social and Rehabilitation Services

SS - Social Security

SSI - Supplemental Security Income

Contact information...

You can locate your local SRS office by visiting the office locator on the SRS web site.

To find out more about the Area Agency on Aging that serves you, visit the Area Agencies on Aging section of Agingkansas.org.

You can find out more about this and other programs by contacting the Kansas Department on Aging.