A legislative hearing yesterday took on the task of unraveling the legal, administrative and medical tangles generated by the elimination of adult day health care as a Medi-Cal benefit in California.
The likely closure of up to 300 ADHC centers across the state on Dec. 1 — and what will happen to the medically fragile population of roughly 35,000 seniors and the disabled in California who use those centers — has produced a swell of deep worry and frustration in the ADHC community and in Sacramento.
Advocates have charged the Department of Health Care Services with ignoring the needs of the ADHC population and shunning the advice and input of center directors and experts associated with that program.
Committee members asked DHCS Director Toby Douglas to submit a detailed plan for the outreach effort of the department, and another report that outlines the effort to evaluate outcomes for ADHC patients.
“We’re more than happy to do it,” Douglas said. “But we have to remember we have limited resources.”
Those limited resources include $85 million appropriated by the Legislature for a scaled-down version of the ADHC program. That money has now become the fund for transition toward the Dec. 1 elimination date. About half  that money is funding ADHC services for the three-month extension from Sept. 1 to Dec. 1, Douglas said.
“Every month of delay costs us about $14 million,” Douglas said.
That leaves a relatively small pot of money to finance the outreach, administrative costs and extra incentives for managed care health plans that the department hopes to implement. Douglas said the plans would receive an extra capitated incentive of $60 per person per month to handle ADHC patients. That amount could change, depending on the care levels required for those patients, which can only be determined after they’re enrolled and assessed.
“We will provide the plans with whatever the appropriate rate is to provide the services needed for these people to remain in the community,” Douglas said. “[The timeline] is fast, and that underscores the importance of moving them into managed care quickly, so we can do an assessment, giving ample time over a two-month period to determine what’s needed after the benefit’s over.”
About one-fourth of ADHC patients have significant dementia, and almost two-thirds of them are non-English-speaking. That represents a significant barrier in terms of getting people to understand the myriad managed care choices in front of them, numerous legislators said.
Douglas said the department is sending out a letter next week to all ADHC recipients, explaining the choices. He said it is the beginning of an extensive outreach effort that will include existing ADHC centers, In-Home Supportive Services staff and others, he said.
“There is some concern about how we’re explaining this to everyone, beyond a letter,” Assembly member Mike Eng (D-Monterey Park) said. “Whose responsibility will it be to make sure people actually understand all of this?”
That led to the request for a more-detailed report on the outreach effort. Assembly member Richard Pan (D-Natomas) also suggested the committee needed more information on how these patients’ conditions and costs will be tracked.
“We’re starting off with best intentions here, but are we really saving money in the end? If people go into nursing homes, if we have higher hospitalization rates, we should know about that,” Pan said.
Beyond the peppering of questions about what will happen to ADHC patients and their families, the department took a large amount of heat based on its perceived lack of communication with ADHC centers.
“No one [from the department] has come to me and asked me a doggone thing,” said Micheal Pope, executive director of Alzheimer’s Services of the East Bay. From her point of view, lack of communication now will eventually mean lack of care for these patients. “We’re talking about people,” she said. “We have to have some heart here, and not make policies that could kill people.”
Lydia Missaelides, executive director of the California Association of Adult Day Services, said that ADHC patients are, by definition, on the verge of being sent to a nursing home, and she doesn’t see much in the department’s plan that will prevent that.
“A human disaster is about to unfold in our communities,” she said. “These individuals are the most high-cost and high-risk in the system. The state’s failure to involve stakeholders in this discussion demonstrates the extreme pressure the department is under to meet their budget numbers — and it shows a huge misunderstanding of this population’s needs.”
Douglas said the department’s plan makes good sense, given its resources and time frame.
“We care deeply about all of these people,” Douglas said. “Our goal is to implement a process and a plan so that these people can remain in the community.”
The state’s plan will be reviewed in court on Nov. 1, a month before the elimination date.
No deadlines were established for the DHCS reports to the committee.