Time Running Out To Opt Back In to Adult Day Program

by David Gorn

TOPIC ALERT:

About 4,400 frail and elderly Californians who qualified for Community Based Adult Services opted out of the managed care program to remain in traditional fee-for-service care.  Less than three weeks remain for them to change their minds.

On Dec. 31, the state Easy-Way-Back program will close, and those "opt-outs" who declined Medi-Cal managed care will officially forfeit their CBAS benefits, according to Norman Williams, director of public affairs for the Department of Health Care Services.

The opt-outs -- or the providers who are advising them to opt out -- may be operating on false assumptions, Williams said in a written statement.

"[They] may have a misunderstanding that entering Medi-Cal managed care would negatively affect their Medicare options, including which providers they may visit," Williams wrote.

"It appears that some physicians and other providers are still misinformed about the transition, are not providing complete or accurate information to their patients and, in some instances, apparently have violated Medi-Cal program rules," he said.

Roughly 5,000 CBAS beneficiaries originally opted out so they could remain in the fee-for-service model. About 600 of those people have opted back in, Williams said. That leaves approximately 4,400 beneficiaries who stand to lose their CBAS benefit on Dec. 31.

The department has instituted an expedited enrollment process for those who are CBAS-eligible, "which allows anyone to be assessed quickly for CBAS eligibility through a managed care plan in the future," Williams said.

Lupe Feldhaus
Mr. Gorn, There are many elderly and frail individuals who are not able to attend the CBAS program because their personal physician(s)do not belong to the managed care group plan that provides the CBAS program. It is not a matter of opting out. These folks want to attend the CBAS program just as they have attended the ADHC for the past years. This transition, as I see it is not working as smooth as we had all hoped for.

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