State Opens Adult Day Services Dialogue

A new chapter starts tomorrow in the long saga of the Community Based Adult Services program.

Two state agencies — the Department of Health Care Services and the Department of Aging — tomorrow will convene the first stakeholder meeting in a new process designed to extend the CBAS program beyond the expiration date of the legal precedent that established it.

The Darling v. Douglas settlement officially ends in August 2014. The state is exploring the idea of reworking its federal 1115 Medicaid waiver to include CBAS care as a Medi-Cal managed care benefit. That means altering the transitional terms and conditions created when the program changed from Adult Day Health Care to the CBAS program.

“Now that CBAS is established as a managed care benefit, many of these terms and conditions must be reviewed and updated,” said Norman Williams, deputy director of public affairs for DHCS.

In addition to five planned public monthly stakeholder meetings, a stakeholder workgroup will be set up to work out some of the finer details, Williams said. 

“The CBAS stakeholder workgroup will help further define CBAS as a Long-Term Supports and Services (LTSS) managed care benefit,” he said, “beyond the context of the settlement agreement.”

Lydia Missaelides, executive director of the California Association of Adult Day Services, welcomed the new process and said the state clearly would like to renew the waiver with CBAS in it.

“The 1115 waiver would need to be submitted to [federal CMS officials] sometime this spring,” Missaelides said.

According to Missaelides, 51 adult day health care centers shut down in the past 21 months, in part because of the long struggle over reimbursement for those services. Modifying the 1115 waiver should help stabilize these centers that care for seniors and the disabled, Missaelides said.

There are a couple of unresolved issues, including not-for-profit status for care centers. When the state first established the CBAS program, it insisted all centers needed not-for-profit status, but that may have shifted a little over time, Missaelides said.

“I think they’re beginning to rethink that,” she said, “just because of the complexity of moving from for-profit corporate status to not-for-profit corporate status.”

Williams said that will be part of the stakeholder discussion.

“We will explore this issue, in the context of the managed care setting, during our upcoming stakeholder workgroup process,” Williams said.

The adult day care discussion will be conducted against the backdrop of the state’s Coordinated Care Initiative, a pilot project in eight counties aimed at integrating delivery of medical, behavioral, and long-term care services for Californians eligible for both Medicare and Medi-Cal.

Williams said all counties with CBAS services — not just the eight in the pilot project — will be included in the adult day care discussion.

“An amendment to the current 1115 waiver for CBAS will include all counties where the CBAS program exists,” he said, “not just the eight CCI counties.”

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