Doriah Chung smiles as she gives adult day healthcare employee Hoa Ta a neck… (Genaro Molina / Los Angeles…)
Just weeks before the planned closure of adult day healthcare centers throughout California, state officials and disability rights attorneys reached a legal settlement Thursday that preserves services for those low-income seniors and disabled residents most at risk of being institutionalized.
The state, which faces a $3.7-billion revenue shortfall, had targeted the centers as part of a plan to reduce spending on Medi-Cal, the government health program for the poor and disabled. Adult day healthcare centers provide nursing care, occupational therapy, physical therapy, meals and exercise to people with serious disabilities, brain injuries and chronic illnesses.
Center care is an optional Medi-Cal benefit, and its elimination would have resulted in the closure of many of the roughly 275 centers.
After the discussion of cuts began, lawyers filed a federal class-action lawsuit in 2009 on behalf of 35,000 benefit recipients. The suit alleged that many would have nowhere else to go for care, except to hospitals and nursing homes.
"We are very, very relieved," Elissa Gershon, senior attorney with Disability Rights California, told reporters. "In this fiscal crisis, some cuts are just not OK."
The settlement allows the adult day healthcare program to operate in its current form until Feb. 29 and creates a new program that will provide similar, center-based services for many benefit recipients after that date. The new program will be called Community-Based Adult Services.
State officials said roughly half of the current participants will be eligible for the new program and will be required to obtain the benefits through managed-care health plans. The eligible would include those with complex medical conditions, chronic mental illnesses, developmental disabilities and cognitive impairments like Alzheimer's disease.
The other half of benefit recipients would receive intensive case management to help them remain in their homes, state officials said.
"We are very pleased with the settlement," said Toby Douglas, director of California's Department of Health Care Services. It ensures that there is a program for "the most vulnerable participants."
State officials estimate a savings of about $28 million this fiscal year and $92 million next year. The adult day healthcare program currently costs the state $169 million, officials said.
Lydia Missaelides, executive director of the California Assn. for Adult Day Services, said she was thrilled with the settlement because it means patients will be able to stay at home and in their communities.
But over the last year, she said, more than 20 centers have closed in anticipation of the cuts. "It has just been a huge chaotic mess for our patients, families and staff," she said.
The lead plaintiff in the lawsuit, 74-year-old Esther Darling, attends a center in Northern California. She started going to the center 10 years ago after a stroke and suffers from congestive heart failure, diabetes and high blood pressure. Darling said Thursday that she was glad she would be able to keep going to the center. "This is my home away from home," she said. "Everybody here at the center is my family."
Nina Nolcox, program director at Graceful Senescence Adult Day Health Care Center in South Los Angeles, said cutting off the benefit would have been devastating because about 80% of the 230 participants at her center receive Medi-Cal.
Nolcox said she was grateful that the state committed to continuing care for the most needy patients. But, she said, the settlement is just the first step.
"Moving forward, the devil is in the details," she said.