The Bench & Bar magazine is published to provide members of the KBA with information that will increase their knowledge of the law, improve the practice of law, and assist in improving the quality of legal services for the citizenry.
Issue link: https://kentuckybenchandbar.epubxp.com/i/132126
FEATURE: KENTUCKY'S ELDER LAW KENTUCKY MEDICAID By: Bernard M. Faller & Misty Clark Vantrease WHAT IS KENTUCKY MEDICAID? Background Medicaid is a joint federal-state program designed to provide health care to aged, disabled, or low-income Since its creation in 1965, the Medicaid1 program has been regularly revised at the federal and state levels through legislation, administrative regulation, local practice and undocumented changes in interpretation and enforcement of existing regulations. Multiple agencies are involved with the Medicaid eligibility process in Kentucky. persons. It is an entitlement program. An entitlement program is a means-tested public assistance program that allows a person to receive benefits if circumstances, such as medical condition, income and assets, meet certain guidelines. Medicaid has two major categories of eligibility: 1) categorically needy, including Supplemental Security Income (SSI) recipients and 2) medically needy, including individuals who would be eligible for a government assistance program such as SSI, except income and resources exceed the eligibility limits. Nursing home residents are in the medically needy category. 8 While exact numbers vary depending on year and statistics used, only about 16,265, or 2 percent, of all Medicaid recipients in Kentucky are nursing home residents. Of the remaining 98 percent of Medicaid recipients, about 430,000 are children and the remaining 330,000 are non-nursing home elderly and others who fall within various Medicaid sub-categories. Given Kentucky's population of 4,300,000 (2010), the percentage of individuals on Medicaid is staggering, but not drastically different from many other states. In 2010, Kentucky's Medicaid budget was $5.6 billion. Of this amount, $836,000,000 (15 percent) went to pay for nursing home care. Kentucky pays about 30 percent of the above amounts; the Federal government pays the other 70 percent. B&B; • 05.13 The apex of the agency pyramid is a federal agency, the Centers for Medicare and Medicaid Services (CMS).2 The highest level in Kentucky is the Cabinet for Health and Family Services (CHFS).3 The operating division for Kentucky Medicaid is the Department for Medicaid Services (DMS),4 and a second state agency, the Department for Community Based Services (DCBS),5 is also part of CHFS and is structurally parallel to DMS. In Kentucky, the program is administered at the county level. These local offices are run by DCBS and contract with DMS to do the Medicaid application intake work. When an individual or an attorney on behalf of a client files a Medicaid application, it is not actually filed with "Medicaid", but rather with DCBS. Each county office run by DCBS is required to follow the same state regulations, although the application of these regulations may vary among different offices. DCBS does the intake and makes many initial eligibility decisions, but some issues get sent to DMS in Frankfort for review and some end up with CHFS for review. Regardless of claimed rapid turnaround, issues sent to DMS may often take one to six months for a response.