A legislative oversight hearing last week on the transition of about 37,000 frail and elderly enrollees from the Adult Day Health Care program, which was eliminated by the state, into the Community Based Adult Services managed care program was marked by skepticism and criticism.
One year after the settlement of a lawsuit led to the creation of the CBAS program, legislators and advocates for the elderly questioned the state's handling of the transition at a hearing of the Assembly Budget Subcommittee on Health and Human Services.
Department of Health Care Services Director Toby Douglas testified that 80% of the ADHC enrollees were found eligible for CBAS. Douglas' statement that "about 80% of the class members from the settlement transitioned" into the CBAS program elicited skepticism at the hearing and questions about the department's math.
Assembly member Holly Mitchell, referring to Douglas' testimony before the committee last year, said "You talked about an 80% transfer rate and back then we couldn't quite figure out your math. And now I hear you say again today that 80% have transitioned."
Mitchell and other legislators believe fewer than 80% made the move from ADHC to CBAS.
Douglas said CBAS had more than 27,000 current enrollees, which stirred up more questions.
"We were at a high of 37,000 ADHC enrollees," said Assembly member Mariko Yamada (D-Davis), "and you say there are about 27,000 enrolled now. So there's kind of a gap number of 10,000 people."
Other testimony pegged the original number of ADHC beneficiaries at 38,000 but Douglas said the starting number may not be that high.
"In terms of the 37,000 or 38,000," Douglas said, "I think it was around 35,000."
Douglas said several thousand participants chose to remain in fee-for-service rather than enroll in a Medi-Cal managed care plan to get CBAS care.
Douglas was asked how many adult day services centers have closed, since access to care is one of the concerns of the oversight committee. He said he thought it was about 20 to 30 closures. Yamada later said she was told 48 centers have closed.
Attorney Elissa Gershon of Disability Rights California said the appeals process for those denied eligibility for CBAS was flawed.
"We understand about 2,400 people filed for Medi-Cal hearings to challenge their denial of CBAS," Gershon said. "Those hearings took place largely during the summer and fall of 2012. We are still waiting for data on the outcome of those hearings, and that is long overdue -- including a specific number for how many hearing requests were, in fact, filed."
She said not all of the hearings had been completed by the end of 2012.
"It's an extraordinary delay," Gershon said. "Most people filed for hearings in February or March of last year, so they waited a good nine or 10 months from when they filed to get results."
Douglas said DHCS has done a good job with the transition process.
"Through that process, it has been not without challenges," he said. "We have been monitoring grievances and appeals, and we've seen a very low number of grievances and appeals. … From an access standpoint, we continue to monitor capacity within the system."