Highlights from January Bethell Committee

The Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight met on Friday, January 23rd, to hear updates and testimony on the state of long-term care and home- and community-based services (HCBS) in Kansas. The committee received presentations from KanCare Managed Care Organizations (MCOs), the KanCare Ombudsman, the Long-Term Care Ombudsman, the Kansas Department for Aging and Disability Services (KDADS), and the Kansas Department of Health and Environment (KDHE), along with individual testimony. Kansas Advocates for Better Care (KABC) provided testimony, delivered by Dan Goodman, Executive Director. 

KDADS shared updates on workforce capacity, policy changes, and HCBS planning:

• Surveyor staffing shortages remain a concern. 
• Currently, only 7 of 12 state licensed–only surveyor positions are filled. Regional staffing varies, with the Southwest Region having just 3.5 of 6.5 positions filled, highlighting ongoing challenges in timely oversight and enforcement.
• Federal Minimum Staffing Standards repealed. 
• On December 2, 2025, the U.S. Department of Health and Human Services repealed key provisions of the federal minimum staffing standards for long-term care facilities. HHS cited concerns that the rule disproportionately burdened rural and Tribal providers and could limit access to care.
• Involuntary discharge data collection. 
• The FY25 budget includes a proviso requiring KDADS to collect data on involuntary transfers and discharges in state licensed–only adult care homes and report findings to the 2026 Legislature. KDADS shared their updated data on involuntary transfers and discharges from August 2024 to October 2025.
• HCBS waiver waiting lists loom. 
• Public comment is open through February 14 on amendments to the Physical Disability (PD), Frail Elderly (FE), Technology Assisted (TA), and Brain Injury (BI) waivers. Proposed changes would allow waiting lists for the FE, BI, and TA waivers beginning May 1, 2026, if additional funding is not secured.
• Community Care Coordination pilot delayed. 
• KanCare Governance has temporarily waived certain contract requirements for six months while KDADS, KDHE, and MCOs assessed readiness for a Community Care Coordination pilot that has already been funded but not implemented.
• Kansas Senior Resource Guide update. 
• KDADS announced that the Kansas Senior Resource Guide will be published and distributed beginning in the third quarter of State Fiscal Year 2026 and updated annually, being completed in partnership with KABC.

KABC urged the committee to support additional funding for the HCBS Frail Elderly (FE) waiver, warning that projected shortfalls of $30 million ($75.2 million all funds) in FY27 could trigger an imminent waitlist affecting as many as 600 frail elders initially.

• A waitlist would worsen Kansas’s already low national ranking (47th) for supporting older adults in lower-acuity, community-based settings.
• Delays in services would accelerate health decline for older Kansans who do not have time to wait.
• The Legislature added approximately $200 million in annual base funding for the nursing facility industry last session, making targeted HCBS investments a reasonable and cost-effective alternative to premature institutionalization.

Dan also noted that when the FE waiver last had a waitlist in 2003, about 20% of eligible participants were affected. Applying that ratio today could mean as many as 1,700 older Kansans waiting for services. Given that individuals typically remain on the FE waiver for just over three years before transitioning due to death or institutional placement, this population cannot afford prolonged delays.

If a waitlist cannot be avoided, KABC recommended utilizing the $20 million already allocated for Community Care Coordination, which remains unimplemented, to help individuals navigate unmet needs while awaiting waiver slots.

The Long-Term Care Ombudsman highlighted persistent, systemic issues impacting residents’ rights and safety, including:

• Chronic understaffing and workforce shortages, underscoring the need for accountability and safe minimum staffing standards.
• Facility-initiated discharges, particularly in adult care homes. Concerns include:
• Discharges to hospitals or psychiatric units with refusal to readmit.
• Deceptive admissions practices around “aging in place.”
• Medicaid acceptance claims that result in discharge once private-pay funds are exhausted.
• Calls to require Ombudsman notification for all facility-initiated discharges, expand safe discharge definitions, and prevent unsafe placements such as homeless shelters or motels.
• Overuse of antipsychotic medications, with recommendations to expand reimbursement for non-pharmacological supports like music therapy, pet therapy, aromatherapy, and massage.
• Lack of ownership transparency and problematic ownership relationships.
• Need for increased KDADS surveyor staffing.
• Resident pharmacy choice violations, including excessive fees charged to residents who choose pharmacies outside of facility contracts.
• Insufficient personal needs allowance, limiting residents’ dignity and autonomy.