06/25/2026
Medicaid. When most people hear that word, they aren’t thinking about the 1915(c) Home and Community Based Waivers. To over 20,000 Kentuckians with disabilities, these waivers are a lifeline. Because of waivers, vulnerable Kentuckians can access services like 24/7 supervised care, in-home care, respite for caregivers, and essential therapies in the community, instead of an institution. A significant number of Kentuckians on one of the 7 Medicaid waivers have family to advocate for them. However, an estimated 4,500 Kentuckians are “wards” of the state, who have a guardian to make decisions for them. A significant number of those are on a Medicaid waiver.
Guardianship services aren’t the ones responsible for the day to day care.
Who is the advocate for the ward? Who provides daily care, access to their community, and housing?
Providers.
We help give those people a voice through the amazing direct support professionals we hire.
We ensure that Kelly gets to volunteer every Monday at the local hospital. We watch for signs that Alan is beginning to get agitated, and provide support to make sure his needs are met. We make sure we order Krista's favorite flavor of Ensure. We make sure Jimmy gets to go to Holiday World every summer. We support Todd in being able to rehabilitate cats at the humane society so they won’t be euthanized. We assist Jane in using her coping skills so she doesn’t self-harm and end up in the hospital. All while administering medications, assisting with activities of daily living, making sure they receive the medical and psychiatric care required, and ensuring other personal and health needs are met with dignity and respect.
Unfortunately, these services are only available through Medicaid. Our revenue comes completely from Medicaid dollars. We are already operating under reimbursement rates lower than those recommended by the multi-year rate study that was done in an effort to ensure these Kentuckians are provided access to quality services. Waiver services SAVE the state and federal government money by providing cost-effective community care that, if waivers did not exist, would be provided in institutions. It's not a question of if Medicaid is going to pay for this kind of care - this population will always receive Medicaid- it's a question of how much Medicaid is going to pay.
Cutting the already low waiver rates by 4% will fully deplete the provider network. Providers like ourselves, we can’t sustain that kind of cut. There would be no one to make sure that Ella got to go to her favorite fast food restaurant every Friday. No one to take Cindy to game night the second Thursday of the month. No one to ensure Sarah gets her favorite brand of ci******es. No one to administer nutrition through a feeding tube for Todd. No one to provide housing for Ronnie. No one to take Linda to her dialysis appointments. No one to ensure Travis’s type 1 diabetes is managed.
Simply put, these are real people, real lives, that deserve the care they are entitled to through the Medicaid waivers. Please do not cut Medicaid waiver rates.
*All examples are real people, names have been changed to ensure privacy.
-Kaitlyn
