First of all, Assembly member Bob Blumenfield (D-Woodland Hills) wants to make it clear there is reason to be hopeful.
"We have had multiple meetings with the governor's office, making it clear what the legislative intent is," Blumenfield said. "There is light at the end of the tunnel."
The Legislature passed Blumenfield's bill, AB 96, which would set up the Keeping Adults Free from Institutions program, at about half the cost of the previous adult day health care program. If Gov. Jerry Brown (D) signs it this week, $85 million would be spent trying to keep a good number of the 300 ADHC centers across the state open, and could keep thousands of seniors out of nursing homes.
If Brown doesn't sign it, and if the courts don't reverse the elimination, almost all the ADHC centers will close and about 35,000 seniors and the disabled will need to find other services.
The state's Department of Health Care Services has suggested that some of the gap could be filled by In-Home Supportive Services and case management. To Blumenfield, that doesn't sound like a reasonable plan to care for 35,000 people, an estimated one-fourth of whom are at risk of almost-immediate admission to nursing homes.
"You can't just transfer everyone to IHSS," he said, "it's not a medical program. And it doesn't have that kind of capacity, anyway."
The talks with Brown give him hope that the KAFI program will become reality, Blumenfield said.
"There is still time for them to figure out a modified program," he said. "And we're making it clear there's an opportunity here to make that program work."
Launching the KAFI program requires a federal waiver, which can be a long and involved process. Blumenfield said there has been talk of including KAFI within an existing waiver, which could streamline the process.
The big question is: What is pushing Brown to eliminate ADHC and veto KAFI? The $85 million for it is a drop in the legislative bucket. The governor's office has been quiet on the subject, but there has been talk of a desire to integrate those services within DHCS, so that there isn't one standalone program that's separate from DHCS.
Whatever the motivation, Blumenfield said, the saving-money factor actually falls on his side of the ledger, he said, since nursing homes are so much more expensive than ADHC.
"If just 20% of those people [in ADHC] end up in a nursing home, you've lost all the money you saved," Blumenfield said.
If the governor vetoes the bill, the pressure will be on DHCS to roll out a public plan for dealing with all of these people. All by itself, that would be a useful development, Blumenfield said.
"The governor has some choices in front of him. He has the KAFI bill on his desk, and he can sign it or not," he said.
"I just don't know how you transition out of ADHC without something else in place. So he can either sign it or figure out another plan. And we have yet to see that [plan]."