Subcommittee debates child Medicaid waiver’s participant-directed services; no vote taken

A legislative subcommittee reviewed proposed Medicaid regulations to implement a new 1915(c) child waiver that would authorize participant-directed services (PDS) and allow up to 100 participants, but the panel did not take a formal vote.

The cabinet’s legal counsel, Wesley Du, said the waiver has secured Centers for Medicare & Medicaid Services approval and "we are ready to implement. There's a 100 slots." Program staff said the slots reflect current fiscal planning while acknowledging demand will exceed initial capacity.

Advocates from Kentucky Protection and Advocacy supported the waiver’s goals but warned the proposed rules could exclude participant-directed services and other community living supports in a way that conflicts with the Kentucky Independence Plus statute. Lucy Huskins, an attorney supervisor with Kentucky Protection and Advocacy, said the statute "adopted the principles of consumer driven participation" and argued that excluding participant-directed services "is just outside of their ability, under the mandates of that statute." Bridal Dolan, also with Kentucky Protection and Advocacy, agreed and emphasized the importance of PDS to help children remain in family or foster homes.

Co-chair West and other members expressed sympathy for both sides but said the Health and Welfare Committee might be better positioned to handle detailed policy questions. West cautioned members that he was "not ready to call for a deficiency motion," noting procedural considerations and saying the committee can pull a regulation for further review if needed.

Sen. Rocky Adams asked whether the waiver covers children up to age 21; advocates and staff confirmed the waiver applies through age 21 and said the cabinet would attempt to transition participants who age out to appropriate adult waivers, while acknowledging limits in some adult waivers. When asked how many children might qualify, advocates estimated "in excess of 100" and said the cabinet’s 100‑slot cap was likely to be filled.

The subcommittee did not vote on the waiver rules during the meeting. Members encouraged continued dialogue among the cabinet, legislative staff and stakeholders; Co-chair West suggested the matter could move to the Health and Welfare Committee for deeper review. The subcommittee adjourned without taking formal action on the waiver.

Next steps: the cabinet will continue stakeholder outreach and technical work, and members indicated they may revisit the regulations or request further hearings in Health and Welfare before any formal deficiency motion or rule blocking occurs.