A change in the federal budget that Congress will likely pass in the coming weeks is prompting one local business to worry that it may be the beginning of the end for adult day health care in California. President Bush has been advancing his plan to cut expenditures at the Center for Medicaid and Medicare Services, and Kelly Bruno, vice president of ONEgeneration in Van Nuys and Reseda, says a new change may affect the non-profit business’ ability to provide adult day care services that support more than 28,000 families. “Many clients currently in the (adult day care) program may no longer be eligible, and that poses a huge problem. Where are our clients going to go?” Bruno said. “The care we provide helps family members and community members at home as long as possible to avoid have to place them in long-term-care facilities until they absolutely have to.” The CMS requires states to provide certain services in order to receive federal funding, other services, like adult day care are optional. For years, said Lydia Missaelides, executive director of the California Association for Adult Day Services, California paid businesses like ONEgeneration for services through Medi-Cal, and the federal government matched the state’s budget through Medicaid. California has been using this method, which Missaelides calls the “state plan,” for over 28 years. “The federal government has been scrutinizing Medicaid expenditures very closely, and in an unrelated request to the CMS a couple of years ago, noticed that adult day health care was in the state plan,” said Missaelides. The state was told it would have to receive reimbursement for adult day health care through a federal waiver program. Switching to a waiver system will be incredibly complex, said Missaelides. She said that adult day care providers will have to differentiate between skilled and unskilled services and any waiver system will bring changes in what services can be claimed as medically necessary. Missaelides and other CAADS staff members with be meeting on a regular basis with state officials to try to understand the waiver requirements but the governor’s office has already said it expects its budget for adult day care reimbursement to drop by about $9.8 million. Considering that federal matching funds would be reduced by the same amount, meaning the $440 million budget used for reimbursing adult day care programs will be reduced by about $20 million. Under a waiver system, adult day care will have to show that clients are 30 days away from being admitted into a nursing home before Medicaid will authorize any treatment. Bruno said that ONEgeneration, which provides adult day health care and other services to seniors, may be forced to turn away some of its clients. “This is ultimately going to cost Medi-Cal,” Bruno said. “The cost of adult day health care is roughly one third of what a nursing home will cost.” “Our clients are not going to disappear,” Bruno added. “Our clients cannot be left at home. We have someone working for a local business who has a mom who can’t stay at home because she’ll turn the stove on or she’s impaired, or she’s diabetic and needs insulin shots.” Families of ONEgeneration’s 120 adult day health care clients could find themselves having to miss work or cost the government more money by placing family members in homes, Bruno said. ONEgeneration provides more than a social setting for senior citizens; clients receive physical therapy, occupational therapy and speech therapy as needed. They can also speak with staff social workers. For all her fears, Bruno says it’s much too early to talk with any certainty about the future of adult day health care in the Valley. Missaelides, who said that state officials have been working hard to find a way for adult day health care to continue, is giving Bruno and CAADS’ 140 other member organizations as much information as she can gather in the coming weeks. Meanwhile, Bruno says she hopes that the federal government understands the value of adult day health care. “We’re keeping people functioning at the highest level for as long as possible,” said Bruno. “That’s just the right thing to do and aside from that it’s beneficial to the community.”
