Kentucky implements 70% of Medicaid waiver rate study; providers and legislators raise concerns

Kentucky Department for Medicaid Services officials told the Budget Review Subcommittee on Health and Family Services that the state implemented 70% of a Guidehouse rate study for 1915(c) home-and-community-based waivers, effective Jan. 1, 2025, and outlined enrollment, funding and federal-match risks tied to the program.

The Department for Medicaid Services’ commissioner, Lisa Lee, described the six 1915(c) waivers administered through the department and said waiver eligibility generally requires meeting a nursing-facility or intermediate-care-facility level of care. ‘‘The purpose of the 1915(c) home and community based waivers is to allow individuals to remain in their home or community and receive services,’’ Lee said. She said some waiver services — for example, personal care, homemaking, adult day services and minor home modifications — are not covered by Medicare or commercial insurance.

The rate study, conducted by Guidehouse, produced benchmark reimbursement rates across waiver services; the Beshear administration and the General Assembly funded implementation of part of that study. Steve Bechtel,…