Regardless of the outcome in the legal battle over cutbacks in Medi-Cal reimbursements, these are tough times for California's safety net for low-income people.
Two parts of the net are stretched particularly thin -- adult day health care centers, providing care for frail elderly, and Denti-Cal, providing dental services for Medi-Cal beneficiaries.
The statewide organizations advocating for these two programs -- the California Association for Adult Day Services and the California Dental Association -- are among seven plaintiffs in a lawsuit challenging California lawmakers' decision to reduce Medi-Cal reimbursements to health care providers by 10%.
Officials in both organizations say that even if the 10% cuts are prohibited in court, the statewide programs will have a hard time making ends meet.
We'll examine the adult day centers' predicament this week and Denti-Cal next week.
'Flurry' of Rural Centers Closing
California has about 300 Adult Day Health Care programs providing a variety of health, therapeutic and social services to frail elderly and disabled people. Most of these people would be in nursing homes if it weren't for ADHC programs in their area.
Licensed by the California Department of Health Care Services and administered by the state Department of Aging, day care services are considered an important quality-of-life enhancement for more than 37,000 patients and an important money-saver for the state. Without an AHDC center in the neighborhood, Medi-Cal beneficiaries, who account for about 90% of the patients at ADHC centers across the state, would be forced into more expensive 24-hour institutional care.
"We've seen this flurry recently of non-profit rural centers closing and many centers -- rural and urban but mostly rural -- are having a rough time," said Lydia Missaelides, executive director of the California Association for Adult Day Services.
"We're keeping our fingers crossed on the legal challenge to the 10% cut, but even if there's good news there eventually, our patient lists keep growing but our funding doesn't," Missaelides said.
One of four rural centers to close statewide over the past six months was the only facility of its kind in Placer County.
Sen. Sam Aanestad (R-Grass Valley) last week wrote a letter to California Health and Human Services Agency Secretary Kim Belshé seeking her help in quickly establishing a replacement.
The letter, in part, said:
"Health for All Auburn, the only Adult Day Health Care (ADHC) facility in Placer County, closed on 6/27/08. This left 100 participants and families without needed care. As you know, ADHC is a cost effective alternative to long-term care for Medi-Cal beneficiaries.
"The displacement of 100 beneficiaries in my district to Skilled Nursing and inpatient Psychiatric Facilities will significantly impact the Medi-Cal budget ... Loss of independence causes additional stress for beneficiaries and their families."
Aanestad asked Belshé to expedite the process for establishing a new not-for-profit center in Placer County.
Gas Prices Hit Rural Populations
A small satellite center closed recently in Oroville, Butte County. Patients did not lose services but now they have to drive to the Peg Taylor Center for Adult Day Health Care in Chico to get them.
"We thought we might be able to extend our services by opening a satellite in Oroville but I think we were a little ahead of the curve," said Diane Cooper-Puckett, executive director of the Peg Taylor Center.
"There's been no loss of services in our county but there are issues facing all of us, especially in programs serving rural areas," Cooper-Puckett said.
"I've been doing this for 22 years now, and I'd say this is the most difficult time I've seen. We are saving the state money, I'm convinced of that. More importantly, we're really improving the quality of life for our patients. But for a variety of reasons -- changes in the health care system as well as what's going on in society in general -- this is a very hard time," Cooper-Puckett said.
"Because of changes in the health care system, clients are at a much higher level of acuity of need, there are more of them, and reimbursement rates aren't keeping up with increases in the cost of living," Cooper-Puckett said.
For rural users of adult day centers, some of whom drive many miles to and from centers each day, higher gas prices are hitting hard, Cooper-Puckett said.
Bipartisan Support for Adult Day Health Care
Two of the Legislature's staunch supporters of ADHC and Medi-Cal in general are Republicans representing rural areas.
"The results of under-funding for Medi-Cal are particularly pronounced in rural health settings because we don't have economies of scale," said Cliff Wagner, chief of staff for Assembly member Rick Keene (R-Chico). Keene's Third Assembly District in the northeastern part of the state includes Quincy, Colfax, Gridley, Marysville, Nevada City, Oroville, Paradise and Truckee.
"When centers are already under-funded and then they're threatened with more cuts or with higher transportation costs or just sheer growth in the population they serve, it can lead to problems," Wagner said.
"If they close up shop, you can be pretty sure no one's going to step in and do what they did," Wagner said.
"It's not really a conservative or liberal issue," Wagner said. "The reality is that we as a state have determined -- at least in theory -- to set priorities so that we provide a safety net for our residents."
"There's an entirely real and legitimate concern that that safety net is in jeopardy," Wagner said.
Although he voted for the budget reduction package earlier this year, Sen. Aanestad said he was against reductions in Medi-Cal funding.
"California already ranks dead last among all states in Medi-Cal provider rates," Aanestad said. He said the 10% Medi-Cal cutback would cause doctors to "simply stop seeing those patients. I predict this will lead to the demise of the Medi-Cal program," Aanestad said.