When it became clear in January that California's adult day health care program was slated for budget elimination, people at the California Association of Adult Day Services got busy, cut to the bone, then came up with $28 million in cuts from their $160 million program.
Given the steep cuts the program had already made in previous years, they felt that was as low as they could possibly go.
Well, now they're going to need to go lower.
Last week, the Legislature's joint conference committee decided not to eliminate the adult day health care program -- but did cut its overall budget in half. Adult day health care officials are relieved to be making those cuts, given the alternative.
"This was definitely an attempt by leadership to maintain a form of this program going forward," Lydia Missaelides of CAADS said of last week's conference committee decision. "They wanted to craft a way to secure this service for the most medically needy individuals."
But like many Sacramento decisions, the actual cutting is more complicated than the decision to cut. Eliminating half the program is not a simple proposition.
The committee was worried about possible legal challenges to making such large cuts, so it decided to vote for elimination of the program, and then re-creation of the same program at half the price.
Which means, in theory, the program will be shut down, and then restarted with a federal waiver. But how can a program go unfunded for the months it would take to get that waiver and restart it?
"That’s the question of the day," Missaelides said. "How does one go about running the program while the criteria of waiver has to be changed?"
That's one of the things the Assembly and Senate will need to discuss in budget talks this week, she said -- how to come up with transitional funding to keep the program afloat while the federal waiver is secured. Getting a federal waiver takes some time.
"What they have to do is to direct the Department of Health [and Human] Services to craft a waiver," Missaelides said. "Then they'll submit that to CMS (the federal Centers for Medicare and Medicaid Services), then go back and forth to work it out, then have the program reborn as a waivered program."
But the goal, she said, is to keep adult day health care centers running without interruption in California.
"What I heard them say is, they do not want centers closing their doors," Missaelides said. "There will be a lot of misinformation out there because it's confusing. Clearly that's the intent, but technically I don't know yet how they do that."