Community Support Waiver

Community Support Waiver Services

The 2022 Special Committee on Intellectual and Developmental Disability Waiver Modernization (Special Committee) recommended the development of a Home and Community Based Services Community Support Waiver (CSW) to serve youth and adults with intellectual and developmental disability (I/DD) who need less intensive services and supports than those provided on the existing comprehensive I/DD Waiver. The services provided would be tailored to meet individual needs and would not include day or residential services. The Special Committee envisioned the CSW as a means to reduce the waiting list for individuals seeking I/DD Waiver services. With the inclusion of individual budget authority, the Kansas Department for Aging and Disability Services (KDADS) anticipates current I/DD Waiver participants not using day or residential supports may choose to transfer to the CSW to allow them to tailor goods and services to their individual needs and preferences.

Services discussed by the Special Committee for inclusion in the CSW are:

• Transportation to and from work;
• Staff support with employment;
• Individual budget authority;
• Individualized personal care services to assist with activities of daily living;
• Respite services for families caring for a family member on the waiver;
• Various therapy services;
• Assistive technology to increase a person’s independence;
• Minimal staff supports to allow independent living in one’s own home or apartment;
• Support and training for family and caregivers;
• Financial management services and support brokers to assist with personal budget and expenditures; and
• Benefits counseling provided by a navigator to assist the person and their family in understanding KanCare.

Fiscal Impact Estimate

At the request of the Special Committee, KDADS estimated the fiscal impact for each service recommended for possible inclusion in the CSW. Because a CSW would offer a limited number of services, its cost is anticipated to be less than the current I/DD waiver.

KDADS based its cost estimate on Missouri’s comparable CSW, with the following considerations:

• Annual per-person cap on services of $20,000 (Missouri’s waiver is capped at $28,000);
• Cost match of approximately 60 percent federal funding and 40 percent State funding;
• Range of participants from 3,600 to 7,461, which would be refined based on the findings of the Kansas University Center on Developmental Disabilities Waiting List Study, which is currently in-progress;
• Emphasis on supported employment, respite, training, and personal care options;
• Increase in self-directed services; and
• Phased rollout with assistance from community developmental disability organizations and other stakeholders to avoid overloading system capacity and ensure adequate service provision and correct waiver implementation.

Based on these considerations, KDADS estimates the cost of CSW implementation would range from $72 million all funds, including $29 million State General Funds (SGF), to $149 million all funds, including $40 million SGF.

Implementation Timeline

In August 2023, the Centers for Medicare and Medicaid Services (CMS) approved the State’s proposal to use Federal Medical Assistance Percentage (FMAP) funds to hire staff to develop and write the CSW application. KDADS noted most of the funds would be used to develop and enhance the provider network.

The anticipated CSW implementation timeline is:

• September-October 2023: Hire and on-board CSW staff;
• November-December 2023: Form stakeholder groups with the Wichita State University Community Engagement Institute;
• January-June 2024: Feedback on services from stakeholder groups to State;

July 2024-July 2025:

• Staff and workgroups draft CSW with technical assistance from CMS; grants to providers;
• August 2025-September 2025: Public comment;
• October 2025: Submit CSW to CMS; and
• March 2026: Approval by CMS.

KDADS estimates the earliest date for utilization of services through the CSW would be state fiscal year 2026. Upon approval, KDADS proposes adding 500 participants in the first year at a cost of $10 million all funds, including $4.0 million SGF. Each subsequent year, KDADS would add additional individuals based on provider capacity.