State Makes It Possible to Opt Back In to Managed Adult Day Services

Next week, the state’s new Community Based Adult Services program will be withdrawn from about 5,000 Californians who are eligible for the program  because those people chose to opt out of Medi-Cal managed care — which is a requirement for receiving CBAS services.

State officials said some of those 5,000 people, many of whom are eligible for Medicare, may have opted out under false assumptions about Medi-Cal managed care. Many physicians and beneficiaries are under the impression that beneficiaries would have to give up their doctor, or that their doctor would somehow lose out on Medicare payments — and those false assumptions have led to some of those opt-outs, state officials said.

“We are concerned that some people may not be fully aware of the ramifications of their decision to stay in fee-for-service,” said a DHCS press release. “We believe that some of them have received erroneous information that suggested their move to managed care would affect their ability to continue seeing their Medicare primary care physician.”

The Department of Health Care Services last week announced it would allow those 5,000 people to opt back in, for a limited amount of time.

DHCS calls it the “Easy-Way-Back” enrollment process. Anyone who is eligible for the CBAS program, has opted out of Medi-Cal managed care and now is currently in fee-for-service can make the switch to managed care by the end of December and have CBAS services reinstated.

Lydia Missaelides, executive director of the California Association of Adult Day Services, called it a good development, but one that comes late in the process.

“We were telling the department about this problem back in April, and now I’m afraid it’s too little, too late,” Missaelides said.

“Physicians are not understanding how Medi-Cal managed care works, or perhaps they’re having different experiences,” she said. “But many of them are telling [CBAS-eligible patients] not to sign up for it. We have physicians saying, ‘I can’t see you anymore,’ and there’s all kinds of confusion about the plans. And the department hasn’t done much about it till now.”

Missaelides said it didn’t make sense to launch the CBAS program on Oct. 1, before the administrative systems were in place to make the change. Adult day centers are having difficulty getting paid for services, she said, and there are a significant number of people who are appealing denials of eligibility. On top of that, to have 5,000 people lose services on what may be a misunderstanding, Missaelides said, makes for a confusing and chaotic transition.

The state said it has conducted three conference calls with 200 providers since Aug. 28, and it sent a follow-up letter to those providers to clear up misconceptions about Medi-Cal managed care. Notices also have gone out to beneficiaries, explaining the transition of CBAS to managed care and how to enroll in it. The state has conducted nine site visits to adult day care centers to meet with beneficiaries, and it plans another four visits over the next week. 

Missaelides said the issue is not just the state’s effort, but the scale of the task itself. “There are so many doctors to educate,” Missaelides said, “I just don’t know how they’re going to reach everyone about this.”

What will end up happening, she said, is that CBAS-eligible people are going to be discharged on Oct. 31, and that means more centers are going to close soon.

“It could be a pretty crazy month of November,” Missaelides said.

Related Topics

Capitol Desk