ADHC Lawsuit Might Proceed, Regardless

The official acronym change is from ADHC to KAFI from the Adult Day Health Care program to Keeping Adults Free from Institutions.

The name change became official Friday with passage in the Senate of AB 96 (Bob Blumenfield, D-Woodland Hills). The bill would order the California Department of Health Care Services to file a federal waiver application for the new KAFI program “as soon as possible,” with an outside deadline of Sept. 1, 2011 — the same day the existing ADHC program is slated for elimination of its Medi-Cal benefit.

If the Assembly passes the budget as expected when it meets today, the package heads to Gov. Brown for his signature. Whether he signs it or not, senior and disability advocates plan to pursue the lawsuit filed last week against the planned elimination of Medi-Cal dollars from the current ADHC program.

“Just because the Legislature appropriates the money, that doesn’t mean they’re really going to do it,” Elissa Gershon of Disability Rights California said. “The legislature could pass it, the governor could sign it, but there’s still no guarantee it will happen.”

According to Gershon, putting together a federal waiver request in such a short time frame — especially given the administration’s previous reluctance to keep the program at all — is challenging all by itself. But when you talk about sustaining similar programs with half the money, that’s just unworkable, she said.

It’s possible that the KAFI program could get past all of the minefields still to come: getting Assembly approval of AB 96 and the budget today, getting the governor’s signature sometime next week, and then getting voter approval in September for tax extensions.

Even if all of that happened, Gershon said, “That wasn’t going to stop us from suing.”

The original program, along with the needs of seniors and the disabled who depend on it, cannot just be halted, Gershon said. The proposal for a half-the-price KAFI program still would result in droves of patients being dropped. At its root, that elimination of the Medi-Cal benefit for adult day health care, Gershon said, is illegal.

With the KAFI program only getting half the funding of ADHC, the directive from the state will most likely be to target those people who are most at-risk — and that means a small sector of patients with the most expensive treatment needs. So half the money doesn’t really mean treating half the patients, Gershon said. And if you only treat small number of patients, she asked, how can you keep a center alive and functioning?

“There isn’t a clear answer with the [new] waiver program, in terms of how do you make that waiver work. The [current] programs say they need a balance of participants to make it work, cost-wise. They’re not going to get that,” Gershon said. “As a practical matter, I don’t see how the centers are going to stay open.”

In fact, six ADHC centers have recently closed, and that number will increase, since no one knows what the new federal waiver guidelines might look like.

A September election complicates the timing even further. If the old program is eliminated in September, and the new program doesn’t even submit an application for a federal waiver until then, where does that leave existing programs for an undetermined amount of time? And if voters don’t approve tax extensions in a September election, then the whole waiver application becomes moot. It’s hard to operate a business in that kind of uncertain climate.

Ironically, Gershon said, adult day health care was designed as a cost-cutting strategy — by providing nursing home services and assistance during the day, and allowing people to return home at night, the state doesn’t need to spring for the 24-hour care of nursing homes.

“It’s really incomprehensible to me,” Gershon said. “The results are so clear. People are now dying, people are now losing their jobs, and at the same time, the state is giving the nursing homes a rate increase. That is astounding to me.”

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