Year of Publication

2009

College

Martin School of Public Policy and Administration

Executive Summary

Kentucky Transitions is a Kentucky Medicaid program that is funded primarily by a grant from the Centers for Medicare and Medicaid Services. The purpose of this program is to transition individuals residing in long-term care facilities back into the community, where they will continue to receive health, social, and other benefits but do so in an approved residential setting. Individuals living in the community may experience higher quality of life and the increased ability to choose how and when they receive services, while Medicaid reaps the projected financial benefit of providing less-expensive community alternatives for care.

Though Kentucky Transitions operates within Kentucky Medicaid, several organizations contribute to the operation and oversight of the program. Coordinating services from multiple organizations has proven to be difficult and the program has been struggling to sort out the administrative procedures for hiring staff and sharing sensitive case information. This implementation analysis proposes to compare program goals with program achievements and to analyze the current process by which Kentucky Transitions receives and processes records and referrals.

Federally-set benchmarks were used in this analysis as performance indicators for Kentucky Transitions. The comparison for program goals versus actual achievement was made by reviewing program records and reports that were submitted to the Centers for Medicare and Medicaid Services by staff. Documents and records regarding patient referrals and marketing materials were analyzed and information regarding the source of referrals by type was extracted. Staff members from Kentucky Transitions, the University of Kentucky, and Kentucky Housing Corporation were interviewed for opinions regarding challenges and barriers faced by the program.

Kentucky Transitions did not achieve goals regarding the expected number of patient transitions or transportation allotments for the first two years of the grant period. Program goals were achieved, however, for target expenditures for Home and Community Based Services. Whether or not the goal for patient participation in self-directing their services was achieved is ambiguous due to discrepancies in program records and reports. Data collected regarding referrals indicates that the primary sources of reliable referrals come from facility ombudsmen and social workers.

I recommend that Kentucky Transitions clarify the responsibilities of staff and partners and that the web based system of record keeping be made available to staff members as soon as possible. I also recommend that the concept of self-direction be more clearly defined and that marketing efforts be focused upon social workers and facility ombudsmen. The final recommendation is that benchmarks be modified so that program-specific goals about Home and Community Based Services expenditures could be adopted to alleviate uncertainty about the effect of Kentucky Transitions on overall Medicaid expenditures.

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