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Committee hears explanation of Medicaid waivers and why IDD wait lists exist
Summary
Agency staff told the Committee on Welfare Reform that Medicaid waivers are optional state programs designed to provide community-based services for special populations, that waivers permit limited enrollment (creating wait lists) and that recent legislative additions and waiver expansions contributed to rising Medicaid costs.
The Committee on Welfare Reform on Oct. 27 received an explanation of Medicaid waivers, how they differ from the state plan and why some waiver programs maintain wait lists.
Megan Leopold, fiscal analyst with the Legislative Research Department, explained that waivers let the state ask the federal government to alter ordinary Medicaid rules so it can offer targeted community services to a select population. "Waiver services are programs that are put in place to provide services in the community for individuals that because of whatever they're experiencing, would likely otherwise be in an institution," Leopold said.
Leopold said waivers are optional under federal rules and are not mandatory state-plan services. "When someone comes on to the IDD waiver, they get all the services on the IDD waiver, plus they get all the state plan services. Everybody else on Medicaid ... is not gonna get any of the IDD waiver services because we don't cover those for everybody," she told the committee.
Because waivers create a selective subset of eligible people, states can limit enrollment and operate wait lists. Leopold and other witnesses said the IDD waiver wait list exists in part because waivers deliberately restrict slots; committee members also noted that some families place children on waiver lists years earlier in anticipation of adult needs after school services end.
There are seven waiver programs in Kansas that KDADS administers, Leopold said; she offered to have KDADS provide the committee with detailed eligibility rules and waiver service lists. Committee members asked for a written explanation of recent 2024 legislative changes affecting the IDD waiver and autism services; Leopold said she would follow up with written detail.
Leopold also described how waiver services relate to caseload estimates and budget planning. Waiver services are considered state options and are not part of the caseload-estimating group that budgets federally mandated entitlement medical services, though medical services for waiver participants are included in caseload calculations.
Ending: Committee members asked for additional materials on waiver eligibility, wait-list management and the fiscal effects of recent legislative changes; KDHE and KDADS were asked to provide follow-up documents to the committee and staff.
