Community Support Waiver Services
The 2022 Special Committee on Intellectual and Developmental Disability Waiver Modernization (Committee) recommended the development of a Home and Community Based Services Medicaid 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 Committee envisioned the CSW as a means to reduce the waiting list for individuals seeking I/DD Waiver services. 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 take advantage of the flexibility to tailor goods and services to their individual needs and preferences.
Services discussed by the 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 to understand KanCare.
Fiscal Impact Estimate
At the request of the Committee, KDADS estimated the fiscal impact for each service recommended for possible inclusion in the CSW. Because a CSW would offer a limited menu 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 these 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;
- 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 $72.0 million all funds, including $29.0 million State General Fund (SGF), to $149.0 million all funds, including $40.0 million SGF.
Implementation Progress
KDADS has employed internal CSW staff, contracted with a third party to assist in writing the waiver application, and has convened a Technical Advisory Group made up of stakeholders that will meet monthly to advise the State on improvements to the I/DD system.
The anticipated CSW implementation timeline is:
- August 2023: Approval from the Centers for Medicare and Medicaid Services (CMS) to use Federal Medical Assistance Percentage funds to hire staff and a contractor for the CSW;
- Remainder of 2023: Hire an on-board internal CSW staff and draft a request for proposal to contract for additional assistance in development and application of the CSW;
- April to June 2024: Contractor will form and convene stakeholder groups to provide feedback to the State regarding services;
- July 2024 to July 2025: Contractor will draft CSW and expand the provider network;
- August 2025 to September 2025: Public comment period on the waiver application;
- October 2025: Submit CSW application to CMS, anticipating approximately six months to review and approve the application; and
- April 2026: Waiver approved by CMS.
KDADS estimates the earliest date for utilization of services through the CSW would be state fiscal year (FY) 2026. Upon approval, KDADS proposes adding 500 participants in the first year at a cost of $10.0 million all funds, including $4.0 million SGF. Each subsequent year, KDADS would add additional individuals based on provider capacity. The agency’s FY 2026 budget submission will include an enhancement request to fund a partial year’s cost to serve the first 500 individuals.