Motion Could Delay Implementation

by David Gorn

TOPIC ALERT:

A court motion filed Saturday challenging the state's implementation of a new program for adult day services raises a number of concerns about how the new legal hurdle may affect timing and appeals in the new Community Based Adult Services program.

One of the main issues revolves around the fate of approximately 2,400 former Medi-Cal beneficiaries of Adult Day Health Care services. Those frail, elderly and disabled people had been denied eligibility to the replacement CBAS program. Many of them had been denied eligibility after earlier being approved for it.

According to Elissa Gershon, attorney for Disability Rights California which filed the motion Saturday in U.S. District Court in San Francisco, there are approximately 2,200 appeals of eligibility still outstanding, and roughly another 200 who have had a hearing but are still awaiting a decision.

Department of Health Care Services officials were unavailable for comment Monday.

Gershon said she hopes some of the issues can be resolved with DHCS officials, but said some of them clearly need judicial intervention.

"We had to put the whole thing before the court at this point," Gershon said. "But we are still hoping to approach some of these issues in a more collaborative way."

Disability Rights and DHCS settled a lawsuit eight months ago that challenged the state's plans to eliminate the Adult Day Health Care benefit for Medi-Cal beneficiaries. The new CBAS program developed in part from that settlement agreement. But implementation of that agreement has not always been followed by DHCS officials, according to Gershon.

"We bargained for CBAS converting to a Medi-Cal managed care benefit, there are any number of things we bargained for," Gershon said. "We don't have buyer's remorse about that bargain."

But, she said, the department needs to follow the details of that agreement.

"Bottom line, we bargained for something that's a pretty big change from the way we were doing things before, so we know there are going to be bumps," Gershon said. "We were struggling to handle those bumps. But all of the unresolved problems need to be resolved, they need clarification."

Disability Rights California is asking U.S. District Court judge Jacqueline Scott Corley to appoint a special master to facilitate the settlement agreement.

Since many of those unresolved issues can't be fixed by Oct. 1, when implementation of CBAS is set to begin in many counties, Disability Rights would also like a delay in that launch.

"On some of the issues, having some more time would be helpful," Gershon said. "But really, you just can't put people [who may qualify] in a position of losing services."

George Lauer
In response to Monday questions, Norman Williams, director of communications for the Department of Health Care Services, provided a written response Tuesday which said in part: "We have been working with plans closely over the past several months to ensure the state and plans are ready for the Oct 1 transition. We were recently able to confirm the plans' readiness for the October 1 date." The editors

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