CDCAN REPORT #190-2011: Adult Day Health Care Medi-Cal optional benefit will continue until February 29, 2012

ELIMINATION OF ADULT DAY HEALTH CARE AS MEDI-CAL BENEFIT DELAYED UNTIL FEBRUARY 29TH

Settlement of Federal Lawsuit Reached Today Between Recipients and Brown Administration - Agreement Calls For Creation Of New "Community-Based Adult Services" Program To Transition People In Existing Adult Day Health Care - Over 35,000 People With Disabilities and Seniors, Over 7,000 Workers and Over 300 Adult Day Health Care Centers Impacted By Settlement

SACRAMENTO, CA (CDCAN)  [Last updated 11/17/2011 01:55 PM] - The scheduled elimination date of Adult Day Health Care as a Medi-Cal "optional" benefit will be delayed from December 1, 2011 to February 29, 2012 under a settlement announced today of a federal lawsuit between recipients in the program and the California Department of Health Care Services.

Under the settlement, the existing Adult Day Health Care Medi-Cal optional benefit will be phased out and replaced on March 1, 2012 with a new program called "Community-Based Adult Services" (CBAS) that will provide necessary medical and social services to those with the greatest need.  The Department of Health Care Services, the state agency that oversees statewide the Medi-Cal program, estimated that roughly half of current Adult Day Health Care receipients will qualify for the new program. Eligibility to participate in the new program will be determined by state medical professionals on the basis of medical need, and the benefits provided will be coordinated with Medi-Cal managed care plans.

The settlement - and the delay in the elimination - impacts over 35,000 people with disabilities - including those with developmental disabilities and low income seniors in the program, over 7,000 people who are workers and staff in the Adult Day Health Care program and the over 300 centers across the State.  Many of the centers and thousands of workers faced imminent closure and loss of jobs and benefits in a matter of weeks before the settlement was reached.

The lawsuit, Darling et al v. Toby Douglas (C:09-03798 SBA) filed by Disability Rights California  and other disability and senior advocacy organizations on behalf of 7 named recipients who represent the over 35,000 people with disabilities and seniors who use Medi-Cal Adult Day Health Care benefit . ["Darling" is the named of one of the 7 persons with disabilities and seniors in the Adult Day Health Care program and "Toby Douglas" is the name of the director of the Department of Health Care Services, the state agency that oversees statewide the Medicaid program (called "Medi-Cal" in California)

It is not clear if additional legislation would be needed to help implement the provisions of the settlement agreement [CDCAN will issue a later report with more details on the settlement agreement].  The settlement does not impact the 10% Medi-Cal rate reduction to many Medi-Cal providers including Adult Day Health centers - though that reduction has been delayed until after a December 19th federal court hearing in Los Angeles on a separate lawsuit that was filed by the Medicaid Defense Fund to top those rate cuts.

Advocates and Recipients Praise Settlement

Esther Darling, age 74, who lives alone with the help of Adult Day Health Care, said after the settlement was announced that "...there are lot of people who really need this program.  I have fought to stay out of a nursing home and have been able to with ADHC (Adult Day Health Care)."

California Association for Adult Day Services Executive Director Lydia Missaelides  said the settlement was a "huge comfort" to thousands of Californians and that "...this decision means those in the care of our centers will be able to stay at home and in their communities and receive necessary medical and therapeutic services without interruption.  We are grateful that the nearly 300 ADHC [Adult Day Health Care] centers statewide have been given a reprieve to stay open past the planned December 1 closure, resulting in 7,000 jobs being saved and vendors being spared further cuts to their local businesses."

Missaelides noted that the settlement "...makes it clear that the services provided by center-based adult day health programs are irreplaceable in preventing or reducing use of higher-cost institutional services such as nursing homes and hospital emergency rooms, and honors patient dignity and the Americans with Disabilities Act," but expressed caution saying that "...we see many challenges ahead as the details of implementation of the settlement are finalized and put in place.  We are committed to working in partnership with the state and DRC [Disability Rights California]  to make this settlement agreement a success for all parties.

Elissa Gershon, senior attorney for Disability Rights California (DRC) said that the settlement preserves the rights of people with disabilities and seniors in the program under the federal Americans with Disabilities Act (ADA, "to continue to live in their own homes and communities, and receive the health care services and supports needed to remain independent."

Gershon said that advocates and those people served in the Adult Day Health Care program were ..."pleased that we were able to work with the state to maintain critical benefits for some of California's most vulnerable citizens."

Toby Douglas, Director of the Department of Health Care Services said that he was pleased "...that we were able to come to an agreement that settles the legal dispute over the elimination of the Adult Day Health Care benefit. This agreement upholds the state’s commitment to provide essential care and services to those most in need efficiently and economically."

Ken Kuwayti, partner with Morrison and Foerster, one of the legal firms working with Disability Rights California in representing the people with disabilities and seniors in the Adult Day Health Care program, said that the settlement was "a victory"  for those people noting that with the settlement, "...California remains in step with nearly every other state in the country which offer this type oof program because it is uniquely beneficial and cost-effective, providing a bundle of healthcare services in a supportive, community environment."

Settlement Would Create New Program

• The settlement would preserve Adult Day Health Care-like services for people who are at risk of institutionalization in a new program called "Community-Based  Adult Services" (CBSAS).
• The new program would be similar to Adult Day Health Care and offer center-based skilled health and nursing care, therapies, transportation and other services to eligible people with disabilities and low income seniors.
• The Community-Based Adult Services will be offered under Medi-Cal managed care plans in most parts of the State.
• The new program will be part of the State's Medicaid Section 1115 Waiver, and will not cap enrollment, ensuring that all persons eligible will be able to receive the new service.
• According to the settlement announcement, many - though not all - of the current Adult Day Health Care centers will be able to provide the new Community-Based Adult Services.  It is not clear how many of the over 300 or so Adult Day Health Care centers who employ over 7,000 staff and workers across the State will be able to remain open under the new program.  At least 18 centers have closed their doors this past year since the elimination of Adult Day Health Care as a Medi-Cal optional benefit was passed and  enacted last March as part of the 2011-2012 State Budget.
• Current persons in the existing Adult Day Health Care Medi-Cal optional benefit who are not - or would not be eligible for the new Community-Based Adult Services, will receive, according  to the settlement announcement, be able to receive "enhanced case management" to assist them to transition "smoothly" to other long-term care services in the community.
• The delay in the effective date of the elimination of the current Adult Day Health Care as a Medi-Cal "optional benefit" from December 1, 2011 to February 29, 2012 to "...ensure a seamless transition" for those people currently in the existing Adult Day Health Care program to the new Community-Based Adult Services program.  The delay also would provide time for the federal district court to review the settlement and give final approval of the agreement reached by both parties.

Organizations Representing Those Filing Lawsuit

Those filing the lawsuit are represented by Disability Rights California (DRC), the National Senior Citizens Law Center, the National Health Law Program, AARP Foundation Litigation, and the firm of Morrison & Foerster LLP (pro bono counsel - meaning they are providing their services without charges)