Home and Community-Based Services for Older People and Younger Adults with Physical Disabilities in Kentucky

This research was supported by Health Care Financing Administration Contract No. 500-96-0005. In this contract, the Urban Institute is a subcontractor to the Lewin Group. The opinions expressed in the report are those of the authors and do not necessarily reflect the position of the Health Care Financing Administration or the Urban Institute.

The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

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Table of Contents

Introduction

The Long-Term Care System in Kentucky

Programs and Administrative Structure

Eligibility Criteria and Assessment

Case Management and Service Planning

Services

Consumer Direction

Cost Containment

Quality Assurance

Federalism Issues

Issues for the Future

Introduction

Kentucky, a fairly small Southern state with about 4 million people in 1999,¹ provides home and community services to a substantial number of aged and physically disabled adult beneficiaries through its Medicaid home health benefit and the Home and Community-Based Services (HCBS) waiver. In 2000, the state expects to serve over 18,000 beneficiaries through the home health benefit and over 15,000 beneficiaries through HCBS waiver. These two programs can be characterized as traditional in that they rely largely on an agency-based model for provision of services. The state also has a large, agency-based, state-funded Home Care program, along with several other smaller state-funded programs. Despite the size of Kentucky’s home and community services programs, nursing home care dominates the state’s long-term care system.

Kentucky has expanded its home and community services programs steadily over the years, including implementation of two new Medicaid waivers in 1999. Innovations, such as consumer-directed services and coverage of assisted living facilities, do not play a large role in Kentucky’s system.

This paper analyzes the home and community-based service system for older persons and younger adults with physical disabilities in Kentucky, focusing on the state administrative structure for home and community services, eligibility and assessment, services covered by Medicaid and other programs, cost containment, and quality assurance. This report also summarizes government officials’ and key stakeholders’ opinions about how well the Medicaid and state-funded programs work.

Information was obtained from public documents, state of Kentucky web sites, and interviews with state officials, consumer representatives and provider associations. Interviews were conducted in person in Frankfort, Lexington, and Louisville, Kentucky, during July 2000. Questions were asked using a structured, open-ended interview protocol. To encourage candor in their answers, respondents were told that they would not be quoted by name or identified by type of respondent within a state (e.g. home health industry representative in Kentucky).

Notes

1. www.census.gov.

The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

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