San Francisco Adult Day Centers Get Reprieve From 10% Medi-Cal Rate Cut

The state Department of Health Care Services has granted an exemption from a Medi-Cal reduction to nine San Francisco adult day health care facilities catering to a frail and elderly patient population.

Officials hope the move will help all nine Community-Based Adult Services centers stay in business — particularly four of them that were planning to shut down in July for financial reasons.

“This is a huge victory against the odds,” said Moli Steinert, executive director of the four Stepping Stone CBAS centers. “We were on the edge here in San Francisco of losing our centers.”

At the core of the decision was access, according to Mari Cantwell, chief deputy director of DHCS. If those four centers closed, she said, the 291 people who get services every month at Stepping Stone would not have been able to get those services anywhere within a reasonable geographic area.   

“This is part of our ongoing responsibility to monitor access,” Cantwell said. “We need to be monitoring access, and taking action if necessary. They were planning to close their centers July 1, and if that happened there would have been insufficient capacity [elsewhere].”

According to Steinert, the turning point came when the centers contacted state Sen. Mark Leno (D-San Francisco), who brought the details of the potential access problem to DHCS officials.

“We had requested a restoration of the 10% cut and DHCS looked at it, and in the first round denied it. Senator Leno stepped in and asked them to look at it again more closely,” Steinert said. “I doubt we could’ve done it without him.”

“I had little option,” Leno said. “I had some very concerned constituents, and … access was becoming a serious concern. They were doing everything within their power to stay afloat, and they weren’t making it, in part because of that 10% cut.”

Leno said he recently ran into DHCS director Toby Douglas, and let him know how pleased he was with both the decision and the process.

“I told Toby the other day, this is the way the system should work,” Leno said. “Constituents come to my office and make their case that doors in fact will close, I bring the information to you, people do their due diligence and reach the same conclusion.”

DHCS did a financial audit and, along with the Department of Aging, reviewed the centers’ capacity. State officials determined the centers’ service numbers should be based on functional capacity, rather than licensing capacity. According to Cantwell, that was roughly an 11% difference, and it helped make the decision to reverse the cut a little simpler.

“When our auditors went out, they determined Stepping Stone did everything they could to continue to operate. Just understanding the financial situation helped,” Cantwell said. “Our access monitoring isn’t about keeping specific providers open … but would there be actual capacity in the remaining centers to handle that. We determined [the remaining centers] could only absorb about 80 people. That was the crux of the decision here.”