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Thursday, Mar 28, 2024

Adult Day Health Care Centers Without Backup Plan

Gregory Maltby, 62, of Burbank battles dementia, bipolar disorder, Alzheimer’s disease and other health conditions. Twice a week, he attends ONEgeneration, a Van Nuys nonprofit center that provides adult day care services. The schedule gives his wife Lucy time to take care of herself and her 98-year-old aunt. But a recent cut in state funding for adult day health care programs threatens to impact families, such as the Maltbys, and leaves local health care providers wondering if they will have to scale down operations or shut down altogether. The state of California cut its adult day health care program for Medi-Cal patients, under its newly approved budget. The legislature decided earlier this year to end the program on Sept. 1 and maintain $85 million, about half of its funding, for an alternative program. The state budget, which Gov. Jerry Brown approved on June 30, eliminated language that linked the funding to a proposed replacement program. There are more than 50 adult day health care centers in the San Fernando Valley Region and about 300 statewide, according to the California Department of Aging. Ending the adult day care program without a follow-up plan will be a major hit to for-profit and nonprofit centers across the state, said Lydia Missaelides, executive director of the California Association for Adult Day Services. Several facilities already have closed in the past several months, including Jubilee Adult Day Health Care Center in Glendale, according to data from the association. And on average centers get about 92 percent of their business from Medi-Cal patients, Missaelides said. “We’re going to see a significant number of additional closures as people assess their ability to sustain their operations (and) their facilities without the (state) Medicaid reimbursement,” Missaelides said. Program impact If the state fails to put an alternative adult day health care program in place, it also would be a blow to program participants and their caregivers, who often cannot afford more expensive alternatives such as nursing homes, Missaelides said. Lucy Maltby says if her husband were no longer eligible for some form of an adult day health care program, she doesn’t know how she would manage his health care needs. “This is just really scary,” she said. “We don’t have, financially, the means where I can provide any other services for him.” Anna Swift, program director for ONEgeneration’s adult day care and care management, said it will have to terminate enrollment for about 50 of its clients once the program ends. Unless the program’s end date is postponed, Swift said the organization likely will have to lay off at least seven employees. Those positions include physical therapists, occupational therapists, a language speech pathologist, a psychological consultant and a dietician, she said. The organization is securing contracts to generate funds to keep its adult day health care program running, Swift said. Tony DeLonay, administrator for the Center for Healthy Living in Van Nuys, said the center may be forced to close if a new program isn’t implemented in time to keep the necessary funds flowing. The center provides medical services for between 100 and 115 adults, and employs about 37 people, he said. “It could be a situation where we might have to lay everybody off and discharge everybody,” DeLonay said. “We’re just very wary of what we’re going to do.” Partners in Care, which runs the Santa Clarita Adult Day Health Care Center, is seeking private funding so it can provide scholarships for Medi-Cal patients, said Anwar Zoueihid, the center’s vice president of direct services. About 95 percent of the center’s clients are Medi-Cal patients, center officials said. “Having this law will be very devastating for the (Santa Clarita) Valley because there are not other types of services like this (here),” Zoueihid said. “Partners in care will fight to the end to make sure … this service is available to this community.” Missaelides said if an alternative program isn’t established the potential fallout could extend beyond adult day health care centers. Vendors and suppliers for the facilities also could see a drop in business, she said. “It’s a big deal,” Missaelides said. “It’s scaring a lot of folks.” The future When Gov. Brown initially proposed cutting state subsidies for Medi-Cal recipients in adult day health care program, Assemblyman Bob Blumenfield introduced Assembly Bill 96. The bill, which passed the Legislature, proposed replacing the existing adult day health care program with another one called Keeping Adults Free from Institutions (KAFI). The KAFI program would require a federal waiver in order to receive federal funds and begin operation. Blumenfield, who represents the San Fernando Valley and chairs the Assembly Budget Committee, said the program proposed to serve fewer patients who are more clinically ill in order to cut costs. But the governor vetoed part of a line item of the budget that linked the appropriated funding to KAFI. In addition, he has asked legislators not to send him AB 96 for approval, according to officials from Blumenfield’s office. “There is, unfortunately, a fair amount of uncertainty right now, and that is to some extent because of what the Legislature intended may or may not be what the administration intends and is pursuing,” Blumenfield said. “We haven’t necessarily gotten them to agree that there needs to be a follow-up program.” In his line-item veto statement, Gov. Brown wrote that the Department of Health Care Services will work with the Legislature to determine to what extent additional services are needed. He said the options could include seeking federal waiver services and developing alternative funding agreements to preserve services at existing centers. “While I am sustaining the funding, I am deleting (the provision) because it requires a specified spending level for the program that does not consider other services available to those individuals,” Gov. Brown said, in the line-item veto statement. Calls to the governor’s office were referred to the Department of Health Care Services. Norman Williams, spokesman for the state’s Department of Health Care Services, said the benefit is optional under Medi-Cal, which is the state’s second largest fund expense. “It is not one (benefit) that is required, so it’s one of the few ways that the state could immediately address the budget situation,” Williams said. He said his department is currently evaluating Medi-Cal patients who use adult day health care services to identify other options, such as in-home supportive services and managed care. Blumenfield said there is still time to work out a transition plan. His office is currently in talks with the governor’s office regarding what the next steps might be, he said. The issue is also tied up in federal court. Last month, seven plaintiffs represented by the Oakland-based organization Disability Rights California filed a class-action lawsuit against Toby Douglas, the director of the Department of Health Care Services, according to court documents. Documents show the plaintiffs claim that the department is violating the 14th Amendment and Medicaid law by failing to provide enough notice of termination and the opportunity for a hearing. They are asking that that the program not be eliminated until “adequate and appropriate” transition program services are in place. On July 26, a motion hearing on the lawsuit is scheduled.

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