Kentucky Medicaid Waivers Compared: HCB vs Michelle P. vs SCL vs ABI

Direct answer: Five Kentucky 1915(c) waivers include case management: HCB, Michelle P., SCL, ABI and ABI Long Term Care. They share the MWMA application and the conflict-free case management rule. They differ in who they serve, how often the case manager must meet the participant face to face, and what the case manager's note must contain.

Quick comparison

What the five waivers share

• One application route. Each regulation has the individual or their representative apply for 1915(c) services through MWMA and upload a MAP-115.
• Conflict-free case management. In each, the provider that gives case management does not also provide another 1915(c) waiver service to the same participant, unless it is the only willing and qualified provider within thirty miles of the participant's residence. The exemption uses the MAP 531 form in MWMA and is requested again at reassessment or at least annually.
• A person-centered service plan. Services are prior authorized and delivered under the participant's plan.
• Annual review. Level of care or patient status is looked at again at least once every twelve months.

HCB: Home and Community Based waiver

HCB serves people who meet nursing facility level of care and could be admitted to a nursing facility without waiver services (Section 4). The case manager contacts the participant at least monthly, sees them face to face every other month, and visits the residence at least three times a calendar year (Section 8). The regulation requires documentation of each contact but does not set a note format.

We cover HCB in more depth in the HCB waiver case management guide and the HCB contact notes guide.

Michelle P. waiver

Michelle P. serves Medicaid-eligible people who meet the Michelle P. level of care criteria and would otherwise be admitted to an ICF-IID or a nursing facility (Sections 4 and 5). The department redetermines level of care at least once every twelve months.

The case manager contacts the participant monthly through a face-to-face visit at the participant's home, in the ADHC center, or at the adult day training provider's location (Section 9). The case manager documents services by entering two things into MWMA each month: a department-approved person-centered monitoring tool, and a monthly entry that includes:

• the month and year the note covers;
• an analysis of progress toward the participant's outcomes;
• barriers to achieving those outcomes;
• a projected plan for the next step;
• the case manager's signature and title; and
• the date the note was generated.

SCL: Supports for Community Living

SCL serves people who meet ICF-IID patient status requirements and have received notification of potential SCL funding (Section 2). To stay eligible, a participant has an ICF-IID level of care determination at least once every twelve months and a Supports Intensity Scale assessment at least once every twenty-four months.

Case management includes monthly face-to-face contact at a location where the participant is engaged in services (Section 6). A person-centered team meeting does not count as that visit. If a monthly contact shows the plan needs to change, the case manager initiates a team meeting and receives prior authorization within fourteen days of the contact visit. Services are documented by a detailed monthly summary note uploaded into MWMA, with the same six elements as the Michelle P. monthly entry. One unit of case management equals one month.

ABI: Acquired Brain Injury waiver

ABI serves adults 18 and over with an acquired brain injury from physical trauma, anoxia or a hypoxic episode, or an allergic condition, toxic substance or other acute medical incident (Section 3). The person must meet nursing facility patient status criteria, be medically stable, show cognitive, behavioral, motor or sensory damage with rehabilitation and retraining potential, and rate at least four on the Rancho Levels of Cognitive Functioning.

This waiver asks the most of the case manager's calendar: two face-to-face meetings with the participant in a calendar month at a covered service site, with one visit each quarter at the residence (Section 5). For a participant in supervised residential care, at least one of the two monthly visits is at the residential provider's site. Case management is documented in MWMA by a detailed staff note covering health, safety and welfare, progress toward plan outcomes, the date, the beginning and ending times, and the signature and title of the person providing the service. A quarterly summary documents monthly contact with each chosen ABI provider and shows that services and the plan's effectiveness were monitored.

ABI Long Term Care waiver

ABI Long Term Care serves adults 18 and over whose acquired brain injury necessitates supervision, rehabilitative services and long term supports (Section 3). The person must meet nursing facility patient status criteria, and that status is reevaluated at least once every twelve months. The regulation says progress toward plan outcomes is not required to stay eligible.

The case manager conducts one face-to-face meeting with the participant in a calendar month at a covered service site, with one visit each quarter at the residence (Section 5). The staff note and quarterly summary follow the same structure as the ABI waiver.

Model Waiver II

Kentucky also runs Model Waiver II under 907 KAR 1:595 for people who need ventilator support at least twelve hours a day. Its covered services are skilled nursing and respiratory therapy, and the regulation has no case management service, so it is not part of the comparison above.

What this means for a case management agency

An agency that serves more than one waiver is running several rulebooks at once. Three things change by program:

• The visit count. From a telephone contact that satisfies most HCB months to two face-to-face meetings a month for ABI.
• Where the visit can happen. Residence, ADHC center, adult day training site, or wherever the participant is engaged in services, depending on the waiver.
• The note. A monthly outcomes note for Michelle P. and SCL, a timed staff note with a quarterly summary for the ABI waivers, and no set format for HCB.

Kentucky Michelle P., SCL, HCB and ABI/ABI-LTC case management agencies can use One Care Portal to keep that work in one place: assigned caseloads, visit schedules, contact notes that record date, time, method and location, follow-up items that carry forward, and supervisor review. Note sections, custom questions and required fields are set up per agency and program, so a Michelle P. note and an ABI note do not have to look the same.

Important boundary: One Care Portal does not connect to MWMA and sends nothing to it. Four of these regulations put the case manager's monthly or staff note in MWMA, so staff still enter or upload there what MWMA requires. One Care Portal is not certified, endorsed or approved by Kentucky, and each program's forms, permissions, reporting, authorizations and billing route are confirmed before implementation.

Pricing is pay as you go and month to month: a $299/month platform fee plus $7.99 per active participant. See the Kentucky overview or the Case Management Care Module.