Adult Health Services Eligibility Questioned by Patient Advocates

Patient advocates and family members of low-income adults with health problems say that state officials are rejecting adults for the Community-Based Adult Services program without clear explanations, the San Francisco Chronicle reports.

Background

On March 1, CBAS replaced the Adult Day Health Care program, which offered health care, physical therapy, exercise and counseling for low-income adults.

The new program was created as part of a legal settlement between state officials and patient advocates who sued over Gov. Jerry Brown's (D) plan to eliminate ADHC.

According to the settlement, the state is required to accept adults who qualified for ADHC and who are considered at risk of institutionalization.

State officials estimated that half of the 35,000 ADHC beneficiaries would qualify for CBAS (Lagos, San Francisco Chronicle, 7/9).

Determining Eligibility

When the state launched the CBAS program and started assessments to determine eligibility, some beneficiaries were grouped as categorically eligible or presumptively eligible.

The state estimates there are more than 9,000 residents in those two groups, which generally are comprised of the sickest and frailest of the ADHC population.

The roughly 5,900 categorically eligible beneficiaries automatically get into the CBAS program. The remaining 3,500 presumptively eligible beneficiaries still need to be assessed.

In recent months, state-employed nurses have been determining which patients still qualify for services.

According to the California Department of Health Care Services, about 1,800 patients have been determined ineligible for services and have appealed the decision.

Many patients will have to wait months for a hearing (California Healthline, 7/3).

Details of Concerns

Elissa Gershon -- a Disability Rights California attorney -- said state officials have been rejecting many individuals who are at risk of institutionalization on the basis that they do not meet ADHC requirements.

Patient advocates say there have been several cases across the state where people deemed ineligible have been left alone, hurt themselves or placed in psychiatric hospitals or nursing homes.

Lydia Missaelides -- executive director of the California Association for Adult Day Services -- said the denials have financial implications as well. She said, "The consequence is that people are going to hospitals and now nursing homes." She added, "It's costing us money."

State Response

State officials have said that the process for determining eligibility for CBAS is progressing as agreed upon in the settlement.

Jane Ogle -- a deputy director at the state Department of Health Care Services -- said the process would become more efficient after the state completes 100 test cases.

Ogle added that people should be safe at home if they have been denied access to CBAS.

She said that, in general, the transition is "moving in the right direction, but it is a process, and things do take time" (San Francisco Chronicle, 7/9).