Hey you all!
The Alliance for Healthy Kansans who has taken a lead on advocating for KanCare Expansion. I have pasted below why Expansion is important. As we have talked about in the past, this could provide health insurance to many direct support workers/ personal assistants that fall in that gap between regular KanCare and the insurance marketplace. The main argument that legislators are using to oppose moving expansion forward is one that they have used for awhile. They keep saying that “providing healthcare through KanCare will take away from people with disabilities.” The disability community has repeatedly said this is not true. Looking at other States that have approved Medicaid expansion, it has actually made things better for people with disabilities. We have said there are some people with disabilities who currently work and are not eligible for traditional KanCare (Medicaid). We also have said that there are DSW/PCAs that work but do not have healthcare coverage. Both of these groups of people make too much income for traditional KanCare (Medicaid) but they do not make enough income to purchase insurance through the marketplace.
WHY DOES EXPANSION OF KANCARE MATTER? HERE ARE THE REASONS:
- Economic growth – KanCare expansion will help stimulate the economy and create thousands of jobs. A study by an economist from Kansas State University found that expanding KanCare would create more than 13,000 new jobs.
- It is a Kansas-based solution – Each state that expands its program can tailor it to the state’s particular needs. Among the features Kansas could draw on are requirements that beneficiaries share the costs of premiums and out-of-pocket expenses, incentives for healthy behaviors, and referral to job training for those who might need it.
- It protects access to care, especially in rural areas – Four rural Kansas hospitals have closed in recent years, resulting in loss of access to emergency care, surgery, and other health care services; hundreds of people lost their jobs. Effects of hospital closures are felt throughout the community.
- It helps 150,000 hardworking Kansans who cannot afford coverage – These are our family members, friends, and fellow Kansans who don’t make enough money to afford quality health insurance but have incomes that are too high to qualify for KanCare. Most are employed and many work multiple jobs to provide for their families. These are Kansans stuck in the coverage gap, with no affordable insurance options.
It helps thousands of uninsured military veterans and their families – About 7,400 veterans and their spouses would gain access to quality, affordable health care coverage with KanCare expansion. Veterans often do not have automatic and easy access to health care through the Department of Veterans Affairs, despite their service to our country.
- It controls health insurance costs – Without KanCare expansion, the state’s uninsured will continue to forego necessary health care. As long as thousands of working Kansans remain uninsured, the health care they inevitably need but cannot afford ends up raising the costs of care for others in the state — employers, hospitals, local governments and privately insured individuals and families.
The Alliance has asked us for some help. The disability argument seems to be the lead argument for the opposition. They asked if we had any caregivers that are in the gap or people with disabilities that are not yet able to get onto traditional medicaid but could benifit by expansion or others that may benefit and would be willing to talk about us to get in contact with me. Can you please let your members know, we would like to get something together ASAP.
- by Sean Gatewood & Lou Ann Kibbee
There are many laws at the Federal and State levels that protect the rights of people with disabilities. Laws protecting our right to access Federally funded programs and State and local programs, businesses, flying, education, housing, and assistive technology, are a few of the most prominent. Two rights that many people do not know about is first the right to receive Medicaid (KanCare) Home and Community Based Services (HCBS) in the most integrated setting. Second, the right to be able to self direct your HCBS in the State of Kansas.
There was a suit filed under the Americans with Disabilities Act (ADA) by attorneys representing Lois Curtis (L.C.) and Elaine Wilson (E.W.) in Georgia. Both women were admitted, treated, and determined ready to move out of the institution, but were confined several years longer than needed. On June 22, 1999, the U.S. Supreme Court confirmed that in Olmstead vs. L.C. & E.W. that unjustified segregation of persons with disabilities constitutes discrimination in violation of title II of the Americans with Disabilities Act. The Court held that public entities must provide community-based services to persons with disabilities when (1) such services are appropriate; (2) the affected persons do not oppose community-based treatment; and (3) community-based services can be reasonably accommodated, taking into account the resources available to the public entity and the needs of others who are receiving disability services from the entity. The Supreme Court explained that its holding “reflects two evident judgments.” First, “institutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable of or unworthy of participating in community life.” Second, “confinement in an institution severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement, and cultural enrichment.” https://www.ada.gov/olmstead/olmstead_about.htm
The Olmstead Decision was a big win for people with disabilities across the country. Those of us with disabilities living in our communities already believed we should have the right to live in our homes if we choose, as well as receive services needed to live there independently. But this ruling confirmed our belief and has given thousands of individuals the legal support to enforce their rights to live free rather than confined to a nursing home or institution. So if you know someone who is in a nursing home or institution but would prefer to live in their home and community, this ruling could support them to do so. If they are being told that they cannot move out to the community, they should contact the Disability Rights Center of Kansas at 1-877-776-1541 to help them.
In addition, the second law I would like to make sure you know about is the Kansas Self-Direction law K.S.A. 39-7,100 which passed in 1989. There are a couple of important points from this law that affect people with disabilities in receiving in-home care through KanCare. Individuals who need in-home care or receive attendant care services, or are the parents or guardians of minors at least 16 years of age who need in-home care, shall have the right to choose the option to make decisions about, direct and control the attendant care services received, including, but not limited to, selecting, training, managing, paying and firing of an attendant. Also, providers should include individuals in need of in-home care in the planning, startup, delivery and administration of attendant care services and the training of personal care attendants.
Individuals may choose to not self direct and use agency directed services if you do not want to hire, fire, train your own personal care attendants and if the home health agency can meet your needs. But if you do choose to self direct your attendant care services, as most recipients in Kansas do, it is important that you know your rights and responsibilities that go with it. You should also know that the Kansas Self-Direction law is to protect your right in doing so. Your Care Coordinator is required to include you in planning your services, so be sure that you are involved and that they communicate with you. You have the right to choose which providers you use when you are self directing your services. So your Care Coordinator should give you a form with a list of providers to choose from. Some of you may be a little nervous about being an employer, as you are the person in charge when self-directing your services. It is important that you still stay within the requirements of the program as the employer, but it is also important that you be a good employer that respects your attendants who are your employees. By self-directing your attendant care services, you have a great deal more control over your life.
By Lou Ann Kibbee, Systems Advocacy Manager at Southeast Kansas Independent Living (SKIL) Resource Center.
I wanted to talk about the responsibilities you have as an employer of your personal care attendants if you self-direct your Home and Community Based Services (HCBS) in Kansas.
I talked about some of our rights when we self-direct our personal care attendants in last month's article which are so important for us to know. But it is equally important for us to know what our responsibilities are when we receive KanCare HCBS and self-direct our attendants or Direct Support Workers (DSWs). Self-direction allows you to have more control over who is providing your services, but it does take more work on your part, although some providers can help or guide you along the way. But you are the employer when self-directing.
First we are responsible for hiring our attendants or DSWs. Many providers like SKIL can help you to recruit applicants but you are ultimately responsible for the hiring. After being approved to receive services on one of the HCBS waiver programs, you will receive a Plan of Care which tells you how many hours your attendant or DSW can work and what tasks they should be helping you with. For example if you get two hours of housecleaning, then it is your responsibility to work with your attendant on what housecleaning tasks they will do in those two hours. You are responsible for deciding the tasks under each category on your plan of care although some tasks may be specific on your plan. For example with bathing, your plan may detail that you need help with transferring if that is what is determined when you visit with the Care Coordinator from your Managed Care Organization (Aetna, Sunflower, or United). You are responsible for also training your attendant or DSW which gives you the ability to make sure things are getting done the way you want it done. This is so important to me in that I can make sure my personal care and housecleaning is done my way, rather than the way another employer may have trained my worker. You also need to make sure your employees know how to use the Authenticare system, so they are clocking in and out correctly and their work hours are being recorded accurately.
Of course since you are the employer, you manage and supervise your employees as they work in providing you assistance as approved. Be sure to treat your employees (attendants or DSWs) with respect and dignity as they should also treat you the same. While managing and supervising your employees, you should maintain control and watch to make sure to prevent fraud and abuse. If you suspect your employee is committing fraud, such as reporting work hours when not working, or if you feel fearful that you are being abused in any way, you should report it immediately.
You should also make certain that your employees know what their responsibilities are when working for you. They should be on time. They should treat you with respect, as you should your employees. They should follow your direction on tasks that need done, which should follow your plan of care as stated earlier. You must work with your FMS provider or payroll agent, like SKIL, to get any paperwork that you as the employer and your employees or DSWs need completed on time, employee hours and attendance are accurate, and other things required by the State and needed by your providers are done.
It may seem like a great deal of responsibilities to self-direct sometimes, but if you want control of who comes in your home to work for you, this is the way. If you have never been an employer or supervised employees, you can learn. And the skills you learn could help you in other situations in your life. SKIL is always available if you have questions or need help. Do not hesitate to reach out to us.
I wanted to let you know that the 2020 KS Legislative session starts January 13th. I will be writing about some things we will be working on this session to improve life for Kansans with disabilities. I hope that I can get your support on some of these issues.
By Lou Ann Kibbee, Systems Advocacy Manager at Southeast Kansas Independent Living (SKIL) Resource Center.