State officials have reached a settlement with advocates for the elderly and individuals with disabilities to establish a new version of the adult day health care program, the Contra Costa Times reports (Taugher, Contra Costa Times, 11/17).
Background
The settlement resolves a lawsuit originally filed in 2009 against the state Department of Health Care Services (Creamer, Sacramento Bee, 11/18). Plaintiffs in the lawsuit included Disability Rights California, the National Senior Citizens Law Center and the National Health Law Program.
Lawmakers had moved to cut funding from ADHC centers as a way to trim Medi-Cal spending. Medi-Cal is California's Medicaid program. Plaintiffs argued that the elimination of ADHC centers without adequate replacement services would violate the Americans With Disabilities Act and other laws by placing beneficiaries at risk of hospitalization, injury, institutionalization or death (Sample, HealthyCal, 11/17).
Meanwhile, this year's budget package eliminated ADHC coverage as an optional Medi-Cal benefit, effective Dec. 1. The state spent about $169 million annually for ADHC services, with additional federal matching funds.
In July, Gov. Jerry Brown (D) vetoed a bill (AB 96) that would have created a program as an alternative to the ADHC program (California Healthline, 7/26).
Details of the Settlement
The settlement will allow ADHC centers to continue providing services through Feb. 29, 2012.
At that point, patients who are at risk of being institutionalized will be moved into the new Community-Based Adult Services program.
Under the new program, patients will be able to receive the same type of services they would under ADHC, such as health care, exercise, counseling, physical therapy and socialization.
State officials estimated that about half of those currently receiving services in ADHC centers would be eligible for the new program. Elissa Gershon, a lawyer for Disability Rights California, said there will not be an enrollment cap in the new program. The ADHC program serves about 35,000 Californians.
Those who are not eligible for CBAS will be placed into managed care plans and receive a case manager to help decide what care should be given (Lagos, San Francisco Chronicle, 11/18).
State officials said the settlement will save the state $28 million this fiscal year and $92 million next year (Gorman, Los Angeles Times, 11/18).
Gershon said it likely will take until the end of January for a federal court to finalize terms of the settlement (San Francisco Chronicle, 11/18).
In addition, the federal government must approve Medi-Cal funding for CBAS (Kisken, Ventura County Star, 11/17).
Reaction to the Settlement
Lydia Missaelides, executive director of the California Association for Adult Day Services, said the settlement is "complex, but I think it is doable, given how much work has already gone into preparing people for transition and elimination" (Tayefe Mohajer, AP/San Jose Mercury News, 11/17).
Missaelides added that many of the state's ADHC centers could qualify as CBAS centers. She noted that this year, 23 of the state's 300 ADHC centers have closed (Sacramento Bee, 11/18).
DHCS Director Toby Douglas said the agreement "upholds the state's commitment to provide essential care and services to those most in need efficiently and economically" (San Francisco Chronicle, 11/18).
For additional coverage of the ADHC settlement, see today's Capitol Desk post.