Closed ADHC Centers Make State’s Exempt List

The state Department of Health Care Services recently released a list of 64 adult day health care centers among roughly 300 in the state that will be exempt from the recently approved 10% reduction in Medi-Cal reimbursements. Those centers will be not be charged retroactively to June as other proividers will be, nor will they be subject to the 10% cut going forward because they serve a mostly rural population that the federal government wants to make sure gets access to care.

“These are the centers that the state feels are critical to maintaining access, in order to follow federal law,” according to Norman Williams of DHCS.

But 13 of the 64 centers on the exempt list have already closed, some of them last year.

Given the severe financial stress at ADHC centers right now — in part because of the impending elimination of ADHC as a Medi-Cal benefit on Dec. 1, it is upsetting to see the state include shuttered centers on its list of places it considers vital to remain open, according to Lydia Missaelides, executive director of the California Association of Adult Day Services.

“That the state is calling these centers vital to maintain access and yet the department doesn’t even know which ones are open,” she said, “that’s pretty appalling to me.”

Missaelides said inclusion of so many closed centers — about 20% of the centers on the exempt list — is just one more sign to her that the state has been offhand in its handling of ADHC centers, and has consistently nudged all of them closer to insolvency.

“The department didn’t seem to care much about access when these [13] centers closed,” Missaelides said.

That’s not true, Williams said.

“The department is concerned about those areas where ADHC centers have closed,” Williams said. “In implementing this reduction, we looked at factors that would specifically target those areas that provide that kind of access.”

DHCS Director Toby Douglas said in an earlier stakeholder meeting that there are three factors to determine access: “The three areas we looked at were population, provider network capacity and utilization trends,” Douglas said.

Williams said the exempt list is being updated as part of the state’s regular monitoring policy. “It’s our priority to make sure we meet our requirement for access,” Williams said.

The debate over the state’s role in providing adequate care for Medi-Cal beneficiaries should come to a head tomorrow, one way or another. A lawsuit challenging the state’s ADHC transition plan may be settled out of court. If a settlement can’t be reached as expected, a federal judge will hear the case tomorrow.

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