Advocates for people with significant disabilities have long argued that the best place for them to receive care is in their own homes and communities whenever possible. Home-based services for disabled Americans have the advantage of saving money over costly institutional or nursing home care while allowing more dignity and autonomy for people receiving services.
An unfortunate limitation in the Kansas Medicaid program has, until this month, kept people with certain brain injuries from receiving the rehabilitation services that help them live independently. A bipartisan group of lobbyists, legislators and community advocates have thankfully helped change qualifications for people with acquired brain injury, allowing more individuals to qualify for home-based rehabilitation services.
There are more than 2.5 million brain injuries annually in the United States, according to the US Centers for Disease Control, and can affect people for a few days or the rest of their lives. A Kansas Medicaid waiver was created in 1986 for those with significant disabilities from traumatic brain injury, typically caused by a blow to the head. The Home and Community Based Services (HCBS) Medicaid waiver covers such home-based rehabilitation services as therapies and assistance with dressing, bathing and eating.
However, until this month, people who had acquired brain injuries, caused by strokes, tumors, oxygen deprivation, viruses or other internal health conditions, did not qualify, despite have very similar conditions, prognosis and care needs. If people with an acquired brain injury could not afford to pay out-of-pocket for care providers, they would end up in skilled nursing facilities, with Medicaid often footing the bill for costly nursing home care.
People with acquired brain injuries were not originally included in the waiver out of concern for the number of people receiving services, but their exclusion has been a sore spot for advocates, who have lobbied extensively for the change in law. Their efforts will help ensure better care for people with brain injuries.
Further changes in the HCBS Medicaid waiver are worth considering, particularly the amount of income recipients are allowed to keep. Kansas recipients have a $747 monthly cap on income, with the rest of their income going to pay for health care. Their protected income must cover housing, groceries and all other expenses not covered by Medicaid, a formidable challenge.
Kansas’ protected income is well below that of surrounding states. HCBS protected income is $1,113 in Missouri, $2,022 in Iowa, and $1,011 in Oklahoma, according to an AARP survey.
Caring for people with disabilities in their own communities provides better care and allows our neighborhoods to be enriched by people who may otherwise be kept in institutions. Changes that make Medicaid more responsive to the needs of people with disabilities makes Kansas a stronger and more compassionate state.