State Plans To Provide Managed Care for Adult Day Health Care Users

California health officials have released a plan they say will help keep thousands of Californians out of institutions when Medi-Cal stops offering adult day health care services as a benefit in December, the Los Angeles Times reports. Medi-Cal is California's Medicaid program.

Later this month, ADHC beneficiaries will start receiving notification that the program will be eliminated, and they will receive forms to enroll in managed care plans (Zavis, Los Angeles Times, 8/7).

Background

About 300 ADHC centers provide health care, physical therapy, counseling, socialization and other services for about 37,000 elderly individuals and residents with disabilities. The state paid $169 million annually for the program.

Gov. Jerry Brown (D) recently vetoed a bill (AB 96) that would have set up an alternative to the ADHC program that lost funding in this year's state budget (California Healthline, 7/27).

Details of the Plan

The plan heavily relies on Medi-Cal managed care plans to find alternatives for ADHC beneficiaries. The alternatives could include more hours of care from In-Home Supportive Services, social services, and physical and occupational therapy programs.

Managed care is required only for the 18% of ADHC beneficiaries who are not also covered by Medicare.

Toby Douglas, director of the state Department of Health Care Services, said that those who opt out or who are in counties that do not offer the plans can receive the same care coordination through a state contractor.

Advocates' Response

ADHC advocates argue that the dependence on managed care plans could fail because appropriate alternatives are not always available.

They also said the state's plan could force families to transport patients to different locations to obtain the services that now are offered at ADHC centers (Los Angeles Times, 8/7).

For additional coverage on the state's ADHC transition plan, see today's Capitol Desk post.