KanCare Frail Elderly (FE) Waiver: Medicaid Home and Community Based Services for Seniors

Last updated: February 23, 2024

 

Overview of the KanCare Frail Elderly Waiver

The Kansas Frail Elderly Waiver Program, abbreviated as the FE Waiver, is a statewide Medicaid program for seniors (65+ years old) who are at risk of institutionalization (nursing home admission). Intended to assist the elderly in living independently, a variety of long-term services and supports are available. The exact benefits a program participant receives is dependent on the individual’s specific needs and existing supports. Potential benefits include adult day care, personal emergency response systems, personal care / attendant care, assistive technology, and wellness monitoring.

Program participants can reside in their own home, the home of a loved one, an assisted living facility, a boarding care home (similar to adult foster care), a home plus facility, or a residential heath care facility.

The benefits available via the FE Waiver are provided by a Managed Care Organization (MCO), which is essentially a private healthcare company. The MCO has a network of care providers and program participants receive services via these providers. Currently, there are three long-term care managed care health plans from which to choose.

There is, however, an option for self-direction of attendant care services for persons living in their own home. Also called participant-directed care, program participants can select, train, and manage the person from which they receive personal care assistance. A friend or relative, such as an adult child, can be hired, but a spouse cannot be hired.

Kansas’ Frail Elderly Waiver, formally called Home and Community Based Services for the Frail Elderly, is a 1915(c) Home and Community Based Services (HCBS) Medicaid Waiver. It is not an entitlement program; meeting eligibility requirements does not equate to immediate receipt of program benefits. The number of participant enrollment slots are limited, and when these slots are full, a waiting list for program participation forms.

Medicaid in Kansas is called KanCare.

 What are 1915(c) HCBS Medicaid Waivers?

Historically Medicaid only paid for long-term care in nursing homes. 1915(c) HCBS Medicaid Waivers allow states to offer benefits outside of these institutions. “HCBS” stands for Home and Community Based Services. The goal of HCBS is to delay or prevent institutionalization, and to that end, care may be provided in one’s home, the home of a relative, assisted living, or adult foster care / adult family living. Waivers can target specific groups who require a Nursing Home Level of Care and are at risk of institutionalization, such as the elderly, disabled, or persons with Alzheimer’s. Waivers are not entitlements. This means that meeting eligibility criteria does not guarantee receipt of benefits, as there are a limited number of slots for program participants.

 

Benefits of the KanCare Frail Elderly Waiver

Follows is a list of benefits available via the Frail Elderly Waiver. An individualized service plan determines which long-term services and supports a program participant receives.

– Adult Day Care
– Assistive Technology – may include durable medical equipment and home modifications
– Comprehensive Support
– Enhanced Care Services
– Financial Management Services – for persons who self-direct their personal care services
– Home Telehealth
– Medication Reminders – may include a medication dispenser
– Nursing Evaluation Visits
– Oral Health Services
– Personal Care Assistance / Attendant Care Assistance – may include homemaker services
– Personal Emergency Response Systems
– Wellness Monitoring

While program participants can reside in assisted living facilities, boarding care homes, home plus facilities, and residential heath care facilities, the FE Waiver does not cover the cost of room and board.

 

Eligibility Requirements for the KanCare Frail Elderly Waiver

The FE Waiver is for elderly Kansas residents who are 65 years of age or older. Additional eligibility criteria is below.

 The American Council on Aging offers a quick and easy Medicaid Eligibility Test for Kansas seniors.

 

Financial Criteria: Income, Assets & Home Ownership

Income
Rather than have an applicant income limit, there is a Protected Income Level (PIL). Any income above the PIL must go towards one’s cost of services. The PIL is equivalent to 300% of the Federal Benefit Rate (FBR). This figure increases each January, and in 2024, is $2,829 / month. When both spouses are applicants, each spouse is considered individually, with each spouse allowed a PIL up to $2,829 / month. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the PIL of their spouse. Only the applicant spouse’s income is considered, which has a PIL of $2,829 / month. Furthermore, the non-applicant spouse may be entitled to a Spousal Income Allowance, called a Monthly Maintenance Needs Allowance (MMNA), from their applicant spouse.

Kansas has a minimum Spousal Income Allowance of $2,465 / month (eff. July 2023 – June 2024). This allows an applicant spouse to supplement their non-applicant spouse’s monthly income to bring their income up to this amount. The state also sets a maximum income allowance, which in 2024, is $3,853.50 / month. While this potentially allows a non-applicant spouse a higher income allowance, the exact amount one can receive is dependent on their shelter and utility costs. However, a Spousal Income Allowance can never push a non-applicant’s total monthly income over $3,853.50.

Assets
In 2024, the asset limit is $2,000 for a single applicant. For married couples, with both spouses as applicants, the asset limit is $3,000. When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are limited. This is because Medicaid considers the assets of a married couple to be jointly owned. In this case, the applicant spouse is allowed up to $2,000 in assets and the non-applicant spouse is allocated a larger portion of the couple’s assets as a Community Spouse Resource Allowance (CSRA) to prevent spousal impoverishment.

The CSRA allows the non-applicant spouse to keep 50% of the couple’s assets, up to $154,140. If 50% of the couple’s assets falls under $30,828, the non-applicant spouse can keep all of the couple’s assets, up to $30,828.

Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.

Assets should not be given away or sold under fair market value within 60-months of long-term care Medicaid application. This is because Medicaid has a Look-Back Rule and violating it results in a Penalty Period of Medicaid ineligibility.

 To determine if you might have assets over Kansas Medicaid’s countable limit, and if so, receive an estimate of the amount, use our KanCare Spend Down Calculator.

Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. For eligibility purposes, KS Medicaid (KanCare) considers the home exempt (non-countable) in the following circumstances.

– The applicant lives in the home or has Intent to Return, and in 2024, their home equity interest is no greater than $713,000. Home equity is the current value of the home minus any outstanding mortgage. Equity interest is the portion of the home’s equity value that is owned by the applicant.
– The applicant has a spouse living in the home.
– The applicant has a minor child living in the home.
– The applicant has a disabled or blind child of any age living in the home.

Learn more about the potential of Medicaid taking the home here.

 

Medical Criteria: Functional Need

An applicant must require a Nursing Facility Level of Care (NFLOC). For the Frail Elderly Waiver, the Functional Assessment Instrument (FAI) is used to determine if this level of care need is met. Activities of Daily Living (ADLs), such as toileting, bathing, dressing, transferring, mobility, and eating, and one’s limitations and capabilities in completing these activities, is one area of consideration. Another area that is considered are Instrumental Activities of Daily Living (IADLs), like preparing meals, laundry / housekeeping, money management, and shopping for essentials. Furthermore, cognitive deficits, which are commonly seen in persons with Alzheimer’s disease or a related dementia are considered. While persons with dementia commonly meet the NFLOC need, a diagnosis of dementia in and of itself does not mean one will automatically meet it. As part of the functional assessment process, a numerical score is generated, and to be functionally eligible, one must have a total level of care score over a specified amount. Furthermore, one must have a score over a specified value for IADLs OR have impairments with 2 ADLs and 3 IADLs.

 Learn more about long-term care Medicaid in Kansas.

 

Qualifying When Over the Limits

Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for KS Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.

As mentioned above, rather than a set income limit, there is a Protected Income Level (PIL). Persons who have income over the PIL are still eligible for services, but they must pay a monthly premium towards services. This is called a “client obligation” and is the amount of income one has over the PIL. One may reduce their client obligation by paying for health insurance premiums and medical expenses that are not covered by insurance. This pathway to eligibility is often called the Medically Needy Pathway.

When persons have assets over the limits, trusts are an option. Irrevocable Funeral Trusts (IFTs) are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Medicaid Asset Protection Trusts (MAPTs), which must be implemented well in advance of the need for care, are trusts that protect assets from Medicaid and for family as inheritance instead. Another option, which also protects assets for loved ones, is the Modern Half a Loaf Strategy. This is a complicated strategy that combines gifting assets and purchasing an annuity. There are many other Medicaid planning strategies available when the applicant has assets exceeding the limit.

Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in Kansas to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Some of the strategies violate Medicaid’s 60-month Look-Back Rule, and therefore, should only be implemented with careful planning. However, there are some workarounds, and Medicaid Planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid Planner.

 

How to Apply for the KanCare Frail Elderly Waiver

Before You Apply

Prior to submitting an application for the FE Waiver, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a free Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid Eligibility Test.

As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, bank statements up to 60-months prior to application, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, a common reason that applications are delayed is required documentation is missing or not submitted in a timely manner.

Since the Frail Elderly Waiver is not an entitlement program, there may be a waiting list for program participation. This Waiver is approved for a maximum of approximately 6,528 beneficiaries per year. In the case of a waiting list, persons are awarded a participant slot based on the date and time of one’s functional assessment. However, priority is given to persons transitioning from a Medicaid-funded nursing home or from another HCBS Medicaid waiver.

 

Application Process

To apply for the Frail Elderly Waiver, applicants must apply for KS Medicaid (KanCare). Persons can call 800-792-4884 to request an application or the Elderly and Persons with Disabilities Medical Assistance Application can be downloaded from this page. It is important that one checks the box that indicates home and community based services are needed. This is the “HCBS (includes assisted living)” box on page 5 of the application. Alternatively, persons can apply online at KanCare’s Medical Consumer Self-Service Portal. If application assistance is needed, the KanCare Clearinghouse can be reached at 800-792-4884.

Applicants should also contact their local ADRC (Aging and Disability Resource Center) at 855-200-2372 to schedule a functional assessment.

Persons can learn more about the Frail Elderly Waiver Program here and here. For questions and / or additional information, the KanCare Ombudsman can be reached at 855-643-8180.

The FE Waiver is administered by the Kansas Department for Aging and Disability Services (KDADS). The KanCare Clearinghouse within the Kansas Department for Health and Environment (KDHE) determines financial eligibility. Functional eligibility assessments are completed by the Aging and Disability Resource Center (ADRC).

 

Approval Process & Timing

The Kansas Medicaid / KanCare application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further. Furthermore, as a waiting list may exist, approved applicants may spend many months waiting to receive benefits.

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