Letter Out, Senate ADHC Hearing Set for Thursday

The Department of Health Care Services has sent 26,000 notification letters to adult day health care program participants in California, notifying them that ADHC no longer will be a Medi-Cal benefit as of Dec. 1.

Beneficiaries have until Oct. 1 to choose a managed care plan or opt to remain in a fee-for-service day center. Those who choose a managed care plan, according to DHCS, will be assessed and then receive services similar to what they get in ADHC centers.

Those who don’t make a choice by Oct. 1 will be automatically enrolled in a managed care plan, according to DHCS officials.

It’s a busy week in the ADHC world. DHCS has a Tuesday deadline to submit two reports to the Assembly Committee on Aging and Long-Term Care. On Thursday, a Senate budget subcommittee is holding a hearing on ADHC issues.

DHCS’ letter begins the state’s effort to transition 36,000 ADHC patients to other services. About 8,000 of those people already are enrolled in a managed care plan, so the letter went out to other dual eligibles — those who receive both Medicare and Medi-Cal — who live in two-plan areas, which covers the bulk of ADHC recipients.

At last week’s Assembly hearing, DHCS Director Toby Douglas said the letter would go out a week later, but it turned out that the letter was sent the day after the hearing.

The letter’s earlier-than-expected mailing caused consternation among ADHC providers, who said the medically fragile population — about one in four have dementia — could be confused and alarmed by the notice. Since patients were likely to contact their ADHC centers, providers felt they should have been informed that the letter was going out.

So did Assembly member Mariko Yamada (D-Davis), who chaired the legislative hearing on Tuesday.

“I find that particularly insulting,” Yamada said. “We asked about [the letter] on Tuesday and were told one thing — and then we found out they’ve been delivered. I don’t get that.”

Jane Ogle of the DHCS said the two reports requested by the committee — one that lays out the department’s outreach effort, and another that explains how the department plans to track outcomes of former ADHC patients — will be turned in early this week.

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