State Lambasted Over Transition Plan, Lack of Communication

Jill Yungling was trying to hold in her exasperation yesterday, but it just kept spilling over.

“It is appalling to me how they can sit up there and say all of these things, and it’s all so full of holes,” Yungling said, “and we’re just supposed to sit down here and believe them.”

Yungling came from Carmichael to attend yesterday’s adult day health care stakeholder meeting in Sacramento. The California Department of Health Care Services convened the session to discuss the elimination of ADHC as a Medi-Cal benefit, a move that is likely to shutter most of the 300 ADHC centers across the state.

Yungling runs one of those ADHC centers. Her question was the same as almost everyone’s at the meeting: What will happen to the roughly 35,000 senior and disabled Californians who count on ADHC services to keep them out of nursing homes and emergency rooms?

DHCS Director Toby Douglas and his staff laid out their plan for a transition to other services, primarily by enrolling each of the ADHC patients in a managed care program. DHCS also is exploring several other options, including amending a federal waiver program, expanding the In-Home Supportive Services program or contracting for some services with current ADHC centers.

“The department is dedicated to doing this transition right,” Douglas said. “We want to do it in a way that’s thoughtful and responsible. We’ve now developed a comprehensive plan that can …. allow these individuals to avoid institutionalization and remain in the community.”

Many in the audience weren’t fully buying it, Yungling included.

“What you’re saying sounds lovely, but it’s not functional,” she said to Douglas from the audience microphone. “I don’t know about all of this supposed coordination that’s been going on, no one has contacted me. How are we going to meet the needs of these people?”

Organizers of the meeting used the “1-1-1” rule for the meeting — one person speaks at a time, you get one question, and you have one minute to ask it. That rankled Debbie Toth, who runs an ADHC in the Mt. Diablo area.

“To me, a stakeholder meeting is when you bring experts together to share what they know, so you can incorporate it,” Toth told DHCS officials. “I’m really annoyed that you can say whatever you want, and we get no time, one minute, to try to refute it.”

That level of frustration surfaced often throughout the meeting. Douglas attributed it to the enormity of the change being undertaken.

“We want to stress how difficult all of this is,” Douglas said. “This is a big change, and it’s hard for everyone. But I want you to know, we would love additional comments. This is not the only venue. Written comments and e-mail comments can be sent to us.”

All of this angst and bitterness could have been avoided — and still could be, according to Stan Rosenstein, the former chief deputy director of Medicaid services for the DHCS.

“If ever there was a time for the governor’s  leadership, this is it,” Rosenstein said. “People need to be brought together, and work something out. I’ve seen it before and been a part of it before — that’s how the original Medicaid waiver got worked out, sitting in a room until there’s resolution.”

If a small group of stakeholders could be brought together, he suggested, the state could save money by working out a compromise. Otherwise, he said, it will all be up to a judge.

“The court still hasn’t spoken on this,” Rosenstein said. “It would need to be at the Secretary level, at least. Say to a small group of people, look, we have $85 million to spend, and then come up with an agreement. Otherwise, people’s lives get disrupted, and the state could end up losing in court, and not saving any money here.”

John Ramey of the Local Health Plans of California tried to sum it all up.

“We as health plans are going to do everything we can to facilitate this transition,” Ramey said. “But we also need to understand together that there are not the same amount of resources now as we had in the past.”

Ramey estimated that the $60 per person per month enhanced capitated benefit that will go to health plans is about 15 times lower than the money currently spent on ADHC patients. “And they weren’t doing nothing with that money,” he said.

“There needs to be more acknowledgement,” Ramey said, “that we’re not going to be able to deliver the same level of services, and we need to lower expectations with regard to that.”

Douglas responded: “The resources are more limited, but the goal is the same,” Douglas said. “Our plans must provide the same service with fewer resources. It might not be at the exact same level of services, but there is the same goal and the same expectation of outcome.”

“You’re making decisions that are not based not on reality,” Toth said in response. “It’s not too late to develop a plan, to work with us and talk to us, and develop a plan that works.”

Assembly member Mariko Yamada (D — Davis), chair of the Assembly Committee on Aging & Long-Term Care, scheduled a committee hearing next week to discuss the state’s next steps.

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