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States may also devise levels of service or payment methodologies by acuity or specialization of the nursing facilities. There is no exhaustive list of services a NF must provide, in that unique resident needs may require particular care or services in order to reach the highest practicable level of well being. The services needed to attain this level of well-being are established in the individual's plan of care.
Kansas Administrative Regulation requires nursing homes to have sufficient staff to provide 2.0 hours of direct care per resident on average. Nursing care is given by registered nurses, licensed practical nurses or certified nurse aides. The nursing home must have one nursing staff member for every 30 residents. In addition, a licensed nurse must be on hand at all times, with at least two nursing personnel on duty at all times in the facility. Kansas Advocates for Better Care educates and advocates for Kansas seniors in long-term facilities. This group ensures that the rights of seniors are respected in adult care homes and that residents are being treated with respect.
Penalty Information In Kansas For Medicaid
Again, the person in the nursing home must contribute all income except $62 per month towards their long term care costs. This program provides long-term care through a managed care network but is not part of the KanCare network. This is a program for persons age 55 or older living in select Kansas counties. In the fee-for-service model, the State pays the provider directly for medical services. The following Kansas programs are notin KanCare and are paid through the fee-for-service model.
Kansas Assistance Network provides hands-on help to those interested in applying for Medicaid. It details the requirements of the Medicaid program and goes over eligibility requirements as well. Nursing Facilities for Mental Health provide residential care and rehabilitation treatment for persons experiencing severe symptoms of mental illness. They provide round-the-clock supervision and care for persons with mental illness needing this level of service. The federal government regulates nursing homes that accept Medicare payment, because these facilities receive federal money. The Medicare Website maintains includes a tool for comparing nursing homes, with detailed information about the performance of every Medicare- and Medicaid-certified nursing home in the United States.
What Does Medicaid Insurance Cover
The administrator of the assisted living facility or a licensed nurse is required to conduct a screening and an assessment of the applicants before admission. The assessment will determine each residents functional capacity and the health care services needed. 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.
If you did, they would likely need to be liquidated with that money being used to cover your care costs before Medicaid will step in and start paying. But not only that, you can’t have had available assets within the last 5 years. Kansas looks back over the last 5 years to see if you had any assets that you sold, transferred or gave away.
Free and Low-Cost Resources for Seniors in Kansas
It covers life-threatening emergency care costs and baby deliveries only. Health services are purchased through either a managed care model or a fee-for-service model. Kansas has contracted with three health plans, or managed care organizations , to coordinate health care for nearly all beneficiaries.
Private pay is the amount that individuals who receive no public assistance pay for a nursing home. The “Medicaid reimbursement rate” is the amount a state Medicaid program pays the same nursing home for the same room. Because Medicaid covers approximately 50% of the total nursing home costs in the US, Medicaid is in a strong position to negotiate with nursing homes and therefore pays less than private paying individuals.
KanCare Frail Elderly (FE) Waiver: Medicaid Home and Community Based Services for Seniors
Fortunately, for eligibility purposes, KS Medicaid considers the home exempt (non-countable) in the following circumstances. The FE Waiver is for elderly Kansas residents who are 65 years of age or older. This program provides education to seniors and their loved ones on Medicare fraud and abuse so that they can report any issues they may have in this area. Program workers show seniors how to protect themselves in terms of identity and policy information within the Medicare system, and what to do if they suspect something amiss.
In 2022, the medically needy income limit, called the protected income level in KS, is $475 / month for an individual, as well as a couple. The “spend down” amount is the difference between one’s monthly income and the protected income level. This can be thought of as a deductible and is calculated for a 6 month period. Once one has met their “spend down”, they are eligible for Medicaid benefits for the remainder of the period.
Those in need of nursing home care for their loved ones may be interested in the ways in which Medicare can help to pay for some of the costs. While health insurance is an ideal choice for the interim, there are other resources that may be useful for longer-term solutions. Frail seniors who need around-the-clock supervision and nursing care can receive that in a nursing home. The Genworth 2020 Cost of Care Survey indicates the average cost for nursing home care in a semiprivate room in Kansas is $6,692 a month. Families who wish to use a private room for their loved ones will pay a little more at $7,092 a month.
Applying for KanCare when not financially eligible will result in the application, and benefits, being denied. 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 6,275 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.
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. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle. Medicaid eligibility can be a complicated matter as there are many factors that get considered. If you have a spouse and he/she will be keeping some of your assets, that also helps determine your eligibility.
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