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Brantley v. Maxwell-Jolly

California's Attempt to Cut Adult Day Health Care Services is Blocked by Court

The U.S. District Court for the Northern District of California prohibited California from implementing its proposed cuts to Adult Day Health Care Services (ADHC).

Responding to a state budget crisis, the California Legislature made devastating cuts to Medicaid and a variety of health programs, including Adult Day Health Care. In conjunction with AARP California's earlier efforts to limit the cuts, AARP attorneys, in conjunction with attorneys from Disability Rights California and the National Senior Citizens Law Center, filed a class action lawsuit on behalf of older plaintiffs with disabilities to block the cuts in ADHC services.

ADHC provides daytime health and nursing care and other services to low-income people with disabilities, enabling them to remain in their homes and communities. The 35,000 Californians who participate in ADHC have an average age of 78 years and take six or more medications per day, requiring supervision or assistance, nursing and related services. More than two-thirds of the recipients also face at least three serious medical challenges (such as cardiovascular disease, dementia or diabetes), and 92 percent of the recipients are entirely dependent on Medi-Cal funding for their care and cannot afford to pay for these lifesaving services themselves.

The California Legislature, in action opposed by AARP California, made substantial cuts to the state's Medicaid program, including cuts to the ADHC program. The cuts would result in individuals, who have been assessed by the state and their treating professionals to medically need four or five days of ADHC a week, receiving this vital service no more than three days per week. According to the statute that implements the cuts, the state could also by written declaration implement eligibility restrictions that could result in complete termination of services to some individuals. Services that are provided by ADHC include professional nursing services, personal care services, medication management, meals and physical therapy.

California's Medicaid program, also known as Medi-Cal, is the main source of health care insurance for 6.6 million Californians. As with all Medicaid programs, once enrolled in the federal-state partnership, the state agrees to provide a basic array of and level of services to its lowest-income residents. One bedrock principle is that medical services must be provided to beneficiaries at least to the extent that those services are available to the general population living in the same geographic area, and that the amount, duration and scope of each covered service sufficiently or reasonably achieves its purposes. In exchange for this commitment, the federal government pays a significant share of the costs of the health insurance program.

Plaintiffs' Arguments

The plaintiffs in Brantley v. Maxwell-Jolly (also referred to as Cota v. Maxwell-Jolly, and now Darling v. Douglas) argue that California's enacted cuts violate federal Medicaid law and the Americans with Disabilities Act (ADA). The cuts subject class members to unnecessary institutionalization by failing to provide health services in the most integrated setting appropriate to an individual's need — which would thus enable class members to remain in their communities. California admits that the proposed cuts in services and benefits and changes affect as many as 8,000 individuals currently receiving five-day-a-week ADHC care.

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