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Governor Axes Adult Day Health Care Services
With the stroke of his veto pen, Governor Brown struck down a replacement program for Adult Day Health Care Services (ADHC) and upended the lives of about 35,000 Californians who depend on the services to meet their needs and stay out of nursing homes. The veto also threatens the survival of more than 300 ADHC centers and the jobs of their 7,000 workers.
The Legislature passed the Governor’s proposal to eliminate Medi-Cal’s ADHC benefit in March, but at the same time expressed its intent to enact a less expensive replacement program called Keeping Adults Free From Institutions. On July 25, however, this option vanished when Governor Brown vetoed the legislation (AB 96) establishing it. Medi-Cal funding of ADHC is now scheduled to end on December 1, 2011, with no real plan in place to replace the social and medical services ADHC participants require.
Medi-Cal officials insist otherwise, reporting they will soon enroll most ADHC participants in managed care programs that will be expected to assess and respond to their needs. It is hard to find anyone outside of Medi-Cal who expects this plan to work. Assemblymember Mariko Yamada issued a scathing release that describes the state’s plan as a “transition to nowhere.” Even the managed care companies are worried, noting they will receive about $60 per month to replace ADHC services that cost, on average, $900 per month.
Money is not the only problem. With the number of closed ADHC centers growing by the day, and few centers expected to survive, many communities will not have the type of services that participants need to live at home. A successful model of care that has operated in California for nearly 40 years will be wiped out within months unless immediate action is taken to reverse the Governor’s action.
On August 16th, Assemblymember Yamada chaired an emotional four-hour hearing to review the state’s plan and hear public concerns. Dozens of ADHC participants, family members, workers, advocates and experts expressed grief and shock about the human crisis unfolding in our communities. Several key legislators joined Assemblymember Yamada at the hearing, and almost all expressed distress about the unfolding developments.
State Controller John Chiang also weighed in on August 16. In a remarkable letter to Medi-Cal’s director, he urged him to recover $339 million in overpayments to SCAN (Senior Care Action Network), a Southern California managed care organization, before enrolling any ADHC participants in SCAN. In an earlier letter to SCAN, Controller Chiang expressed concern that it lined its pockets at taxpayer expense by reaping grossly unfair profits of more than 80 percent (20 times the industry average) on an earlier Medi-Cal contract. Despite the massive overpayments, Medi-Cal plans to enroll about 20 percent of ADHC participants in SCAN. If applied to ADHC, the disputed payments could fund the program for an entire year.The last hope for ADHC participants and workers may be a federal lawsuit brought by Disability Rights California and other advocacy organizations that seeks to block, at least temporarily, the elimination of ADHC on the grounds that it violates federal laws, including the Americans with Disabilities Act. Unfortunately, the federal district court in Oakland postponed a July hearing in the case until November 1. By then, more centers will have closed, and the cut-off date for ADHC funding will be just 30-days away.