Tying Up the Last Loose End of the Budget

The state Department of Health Care Services has completed its first set of evaluations in the ongoing process to eliminate the adult day health care program in California, according to a state official. Now it will begin the effort to move the 35,000 ADHC participants to other state programs.

Meanwhile, the central topic of conversation among some legislators this week will be the governor’s veto of a budget provision that tied appropriated funding to a new version of the ADHC program.

The negotiation for some kind of new ADHC program “is not over,” Sen. Mark Leno (D-San Francisco) said. “That is yet to be determined.”

The state Legislature passed AB 96, by Assembly member Bob Blumenfield (D-Woodland Hills), which would create an $85 million program called Keeping Adults Free from Institutions (KAFI). But as part of a last-minute deal with the governor, the trailer language for that bill was not sent to the governor with the budget. Instead, there was one provision in the budget that tied that money to the new program, and the governor vetoed that provision.

The good news is, Leno said, that the governor did approve the $85 million and now the details of spending that money have to be worked out.

“We’ll be meeting with the administration this week to clarify what our position is, what the position of the Legislature has been, what the position of the committees has been,” Leno said. “We will make all of that very clear.”

The tricky part to establishing any new ADHC program is time, since CMS recently approved a Sept. 1 elimination date for it. That leaves less than two months to design, approve and implement a new program.

According to Norman Williams of the DHCS, the state is working on the assumption of elimination, and plans to move people out of ADHC and into other state programs, such as In-Home Supportive Services or the case management services in Medi-Cal managed care plans.

DHCS already has completed its review of patients who spend four to five days at ADHC centers, Williams said. And the department is now beginning the process of assessing the other ADHC recipients.

“What we’re working on now is putting in place the transition plan,” Williams said. “It does not include KAFI. It is an effort by the state to make sure that everything is done so people can remain free from institutionalization. And we are working aggressively to figure out the best methods for delivery of care.”

Williams is not yet sure how the $85 million in the budget will be spent, but said the department has to operate on the assumption that it will be spent on patient transitions out of ADHC, not necessarily for any new type of adult day health program.

“We will be working through the ADHC centers, and a notice will go out from my department, informing people the benefit has been eliminated, and to make them aware that they have other resources available,” Williams said.

“The $85 million is dedicated to actively working with ADHC centers to help with placement,” he said. “Some of that $85 million would go to transitional services. I can’t speak to how the dollars will be distributed. But we’ll be looking first at those who are most at-risk of institutionalization.”

Leno hopes to spend that money a different way, on creation of a new program. “That’s our intent,” he said, “and that’s always been our intent.”

Leno hopes details can be decided quickly, and that there will be enough time to launch a new program.

“It’s not only my hope, but intention,” Leno said. “It is our collective hope that we’ll be able to make this work.”

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