Federal MSSP Waiver Expansion Cut From Transition Plan

by David Gorn

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In its transition plan for eliminating the adult day health care benefit, the California Department of Health Care Services had been planning to expand the Multipurpose Senior Services Program, a federal waiver program aimed primarily at case management. The state planned to expand that program by 1,000 slots.

Yesterday it abandoned that idea in part because of the long waiting list that currently exists within that program, according to Norman Williams of DHCS. The state couldn't offer new slots to current ADHC patients, he said, not with 1,400 people already waiting long periods of time to join the MSSP program. So the state will move on without it, Williams said.

"The MSSP was an important consideration, a building block of the transition plan," Williams said. "But we do believe we have the capacity and the resources to provide services for these people, without the MSSP piece."

The dismantling of a piece of the transition plan might have an effect on the pending court case challenging the adequacy of the capacity and resources in the transition, according to Elissa Gershon, a senior attorney with Disability Rights California, which brought the lawsuit.

"I think it's an omen, a sign that the services they're offering are inadequate," Gershon said. "It's showing that they're already dismantling the program they've been relying on for months. At this late date, the rest of their plan is likely to fall apart in the same way."

The court date to review and judge the merits of the transition plan is set for Nov. 1. Elimination of ADHC as a Medi-Cal benefit is set for Dec. 1.

Gershon said MSSP is not the only program that has issues with limited enrollment.

"The Nursing Facility/Acute Hospital waiver, that's for people who need in-home nursing, that waiting list is about 700 people. And they’re on it for an average of 19 months," Gershon said. "PACE [the Program of All-Inclusive Care For The Elderly], there's only about 1,000 slots open in the entire state. And they've talked about expanding PACE, but that's a long process."

The MSSP program provides care coordination, which is a function the state expects managed care plans to provide.

Debbie Toth, who runs an MSSP program in the East Bay, said if the state's objective is to find alternative services for ADHC patients, that's what MSSP does best -- from services provided by a local church to utilizing some small grant to help provide services, she said.

"Of all the programs and all pieces of this transition, MSSP is the program that best knows the needs of ADHC patients. It knows the clientele the best."

Toth also said the MSSP waiver has "a pot of money of waiver service dollars" that can be used to purchase alternative services.

According to a letter sent by the state Department of Health Care Services to ADHC stakeholders and the media yesterday, the state is comfortable that its transition plan without the MSSP waiver will be adequate.

"DHCS believes that even without MSSP as a current option, the IHO (In-Home Operations) Waiver, expanded IHSS (In-Home Supportive Services) hours, and the case management and care coordination provided by managed care plans and APS (APS Healthcare) will provide sufficient community resources for the transitioning beneficiaries to ensure they can remain independent in the community," the letter said.

Lupe Feldhaus
Adult Day Health Care provides a "bundled service" type package. Why un-ravel something that works? The current ADHC patient benefit here is huge, whereas the patient benefit with the "unknown" as we see is already beginning to fail. We are dealing with the most vulnerable. ADHC's are vital to the patient, family and the community.
Kathy Sowers
The state is trying to pretend they're really NOT throwing the ADHC clients out on the street with no services. But the emperor has no clothes and we're not blind. I hope the court steps up and pushes back on this ill-advised non-plan.
Lois Knowlton
When is the Department of Health Care Services going to be honest and just admit that there are NO services that can replace ADHC??? With the exception of PACE, which is very small and slow to implement, none of the services provide medical care. None of the services provide the therapeutic socialization activities that are desperately needed by dementia patients and the mentally ill. Referrals and managed care doctor visits do not replace the comprehensive, integrated services of adult day health care. Lois Knowlton Friends of Adult Day Health Care Centers

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