Access, Capacity Concerns for CBAS

California’s Community Based Adult Services program officially launches today, the culmination of a long and contentious effort to first eliminate and then replace the Adult Day Health Care program.

There were roughly 36,000 recipients of ADHC services when the governor first proposed eliminating it as a Medi-Cal benefit in January, 2011. After a long budget fight, the Legislature voted to end ADHC in May, 2011, with the proviso that a stripped-down replacement program would take its place. That plan was vetoed by the governor in June 2011, prompting a legal challenge by Disability Rights California. The settlement of that lawsuit in December 2011 led to creation of the new CBAS program.

According to Department of Health Care Services officials, about 80% of former ADHC beneficiaries now can receive CBAS benefits, which mirror ADHC services. The remaining 20% are eligible for enhanced case management services.

The concern among advocates now is for former ADHC beneficiaries who have been denied CBAS eligibility — particularly the 2,431 people who are appealing those decisions. Advocates also have expressed concern that the new system won’t have the capacity to help everyone in the CBAS program, since a number of adult day centers have closed, and many more are on the verge of closure, according to Lydia Missaelides, executive director of the California Association for Adult Day Services.

“It is clear to me that neither the state nor the plans are ready to go Oct. 1 with a fully planned launch,” Missaelides said last week.

Some members of the Assembly Committee on Aging and Long-Term Care expressed similar concerns at an oversight hearing last Monday.

“Given the multiple changes we’re facing [in the CBAS transition], we need to know: How are we going to ensure that these fragile citizens are protected?” asked Assembly member Mariko Yamada (D-Davis.)

“We cannot leave dependent adults to fend for themselves at home,” she said, “just like we cannot leave dependent children home. We don’t want to make institutionalization the only alternative here.”

Several legislators at last week’s hearing proposed delaying the full launch of the CBAS program until some of those concerns might be addressed.

“It would make good sense,” said Assembly member Mike Eng (D-Monterey Park), “if we could push back the implementation by six months.”

DHCS director Toby Douglas said the state is completely ready now to handle the needs of CBAS beneficiaries.

On July 1, DHCS launched the first part of the CBAS program, Douglas said, with about 10% of recipients making the transition to Medi-Cal managed care to receive the services in County Organized Health Systems (COHS).

“So much of CBAS is focused on our transition into Medi-Cal managed care,” Douglas said at the oversight hearing. “I should note that, in the COHS counties, it has gone very smoothly.”

Douglas hopes today’s beginning for the rest of CBAS recipients goes just as well.

For the 6,000 participants who selected fee-for-service over managed care, the deadline to select a managed care plan was extended to Oct. 18, according to DHCS officials.

“If [the participants who chose fee-for-service] do not choose a plan by Oct. 18,” said Norman Williams, deputy director of public affairs for DHCS, “they will lose CBAS eligibility on Nov. 1, but may rejoin the program any time thereafter.”

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