The state's move on Friday to shift the transition date for Adult Day Health Care elimination by a month was borne of a request by CMS, according to officials from the Department of Health Care Services.
Advocates say the delay may be due to the scattered nature of the state's transition so far.
"It's been a royal mess," Corinne Jan of the Family Bridges ADHC in Oakland said. "Lots of duplications on the lists. Some people got a notice they were eligible [for the alternate program], then another saying they're not. Lots of confusion."
DHCS has been busy implementing the conditions of its lawsuit settlement over eliminating ADHC as a Medi-Cal benefit. The state agreed to create a new program, Community Based Adult Services, which will provide many of the same services. The optional ADHC benefit had been slated for elimination on Feb. 29. That date has now been moved to Mar. 31.
The CBAS program is expected to launch Apr. 1.
The smooth transition of one program into the other is dependent, in part, on the assessments of 35,000 current ADHC beneficiaries -- a group of mostly elderly Californians who generally have multiple medical conditions, numerous medications and are at-risk of admission to a nursing home.
Those assessments are going well, according to Norman Williams of the DHCS, though he could not say how many of the assessments have been completed.
"We've done well over 10,000 of them, well over that," Williams said. "It's a very significant number. We've assessed more than we haven't assessed. But I can't quantify it yet. We don’t have a complete data set, so we can't make an estimate yet."
DHCS has been working on the assessments for the past two months, and will keep to its timeline of completing all of the assessments by the original deadline of Feb. 29, Williams said.
That means the rest of the assessments should be finished by a week from tomorrow.
There has been some concern raised about the assessments themselves. The nurses who conduct the in-person interviews use a questionnaire to ask ADHC beneficiaries if they can care for themselves.
But since many of these patients have dementia or Alzheimer's, they can't really be trusted to convey the reality of their care, according to Jan.
"When they ask, 'Do you need help taking medications?' The patients say, 'No, I can do that.' They ask if they need help getting dressed, and they say, 'No, I can do that,'" Jan said. "But that's their answer for everything. Some people present well, but the truth is very different for them."
The state has sent thousands of letters to beneficiaries -- to confirm eligibility in the CBAS program, or to inform current ADHC beneficiaries that they're not eligible for CBAS and will instead receive enhanced case management.
Williams could not immediately say how many letters have been sent.
The one-month delay in implementing the new CBAS program was a federal choice, he said.
"It was a CMS request," Williams said. "They needed more time to process the waiver application."