On November 17, 2011, the State of California reached a settlement in the lawsuit (Esther Darling, et al. v. Toby Douglas, et al.) challenging the elimination of Adult Day Health Care (ADHC) as a Medi-Cal benefit. ONEgeneration is extremely thankful to the legal team that fought for the preservation of benefits for our participants(Disability Rights California, National Senior Citizens Law Center, National Health Law Program, Morrison & Foerster LLP, and AARP Foundation Litigation). While there will be changes under the settlement agreement, we anticipate that services will be maintained for most of our participants.
Under the settlement, ADHC will become a new program called Community Based Adult Services (CBAS) on March 1, 2012. CBAS will have some different rules for participant and provider eligibility. Eventually, CBAS will be offered primarily through Medi-Cal managed care plans. CBAS will be substantially similar to ADHC services and will be available at licensed ADHC centers. Some ADHC clients will be considered “categorically” eligible for CBAS and some others will be “presumptively eligible.” Those “categorically” eligible are individuals who are: 1) Regional Center clients; 2) Multi-Purpose Senior Services Program (MSSP) clients; 3) eligible for Specialty Mental Health services; and/or 4) eligible to receive 195 or more hours of In-Home Supportive Services (IHSS) per month. In determining those who are “presumptively” eligible, the Department of Health Care Services (DHC) will be looking at the level of need based upon existing care plans. Individuals not in the “categorically” or “presumptively” eligible categories will be assessed by DHCS nurses before January 20, 2012. These assessments will occur at the ADHC centers in collaboration with ADHC center staff. Any individuals deemed ineligible for CBAS will receive enhanced case management services, likely through a Medi-Cal managed care plan.
At ONEgeneration, we are already in the process of becoming a CBAS provider and will work closely with DHCS to ensure that as many of our participants as possible are able to transition smoothly from ADHC to CBAS.