Making the decision to leave your home and move into a nursing facility is difficult. Where do you draw the line between needing full-time care and needing help with a few activities of daily living?

Medicaid offers a program called Home and Community Based Services, or HCBS, which is much closer to the preference of many people who need some care. Although HCBS is not adequate for people who need a high level of assistance, it can provide an alternative to nursing facility care. The goal is for recipients of HCBS to remain at home as long as possible. These services promote independence in the community setting and ensure residency in the least restrictive environment. HCBS can also include self-direction, or "consumer-directed" care.

Individuals may qualify for eight HCBS programs, each offering services for a specific group of people. The groups are people who are frail and elderly, have a physical disability, have a developmental disability, are severely emotionally disturbed, need a psychiatric residential treatment facility alternative, have autism, need technology assistance, or have a traumatic brain injury.

To qualify for HCBS for the frail elderly, you must be 65 years of age or older, financially eligible for Medicaid as determined by the Kansas Department of Social and Rehabilitation Services, meet the functional eligibility criteria, and choose HCBS for the frail elderly.

"Self-directed care" is an option that allows persons who need attendant care services to live in the least restrictive environment and direct their attendant care services. These services are determined by the recipient and a case manager to be essential to the maintenance of their health and welfare. In many cases, this means that the person may hire a family member, a friend, or a neighbor to provide some help in the person's own home. If people with a disability need help with bathing, dressing, and grooming, usually they are more comfortable having a family member or close friend provide the help. If self-directed HCBS is available, the recipient may with a few exceptions determine whom to hire for these services.

Generally the recipient's spouse cannot be paid to provide services, and the provider of services paid by an HCBS Medicaid waiver cannot be the same person who has been appointed by the recipient or the court to represent him or her (Acting on Behalf, Activated Durable Power of Attorney, and Guardian/Conservator).

Self-directed HCBS allows recipients to determine the hours in which they receive services and sometimes what services they receive. Even if family members are not the service providers, self-directed services allow recipients to hire culturally appropriate helpers. For rural recipients, for example, the provider may be a neighbor who would have to commute and work inconvenient hours to obtain other employment.

Self-directed HCBS may also allow recipients to control their budget and receive more services by negotiating for the cost of services, rather than paying the set fees of a home-care agency.

HCBS may still subject the estate of the recipient to "estate recovery" (reimbursement of Medicaid for care), but the amount in question will be much smaller. In many cases the amount might be small enough that the agency would not pursue the reimbursement from the recipient's estate. This would provide an alternative to nursing home care for some eligible people—an alternative that would allow them to remain at home, where they may be more content and comfortable, while saving money for the Medicaid program.

For additional information about HCBS, start by calling Johnson County Aging Information at 913-715-8861. Aging information specialists with the Area Agency on Aging can connect you with the appropriate staff to determine your eligibility for HCBS.

You also might want to visit www.agingkansas.org/faq/faq_hcbs_fe.htm.

If you have been denied HCBS, you have a right to a hearing before the State Hearings Officer. Your request must be received in writing within 30 days of the date on the notice that provided the information you are appealing. The Fair Hearings staff at the Kansas Department of Aging can answer any questions regarding the hearing procedure. They can be reached at 800-432-3535.