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Medi-Cal Coverage for Adult Day Care

Can a state eliminate services for Medicaid beneficiaries with disabilities?

Esther Darling hugs physical therapist Yolanda Azevedo.

Photo by Jake Stangel

Esther Darling, left, with therapist Yolanda Azevedo.

Esther Darling can relax. Now 74 and a stroke survivor dealing with diabetes and heart disease and in need of daily medication, she was worried that her daily visits to the Yolo Adult Day Health Center in Woodland, Calif., were in jeopardy. But a settlement with the state, reached last fall and affirmed in January, ends a two-year-old case and means that services for Darling and 35,000 other low-income Californians will continue. "I'm very happy about this," said Darling, who worked in a toy factory before suffering a stroke 17 years ago. "I'm so glad they didn't close the centers down, because then a lot of people would end up in a rest home. I don't want to ever end up there."

Darling was the lead plaintiff in a class action suit filed after the California Department of Health Care Services decided to reduce its budget by $340 million by terminating care at 300 day centers covered by Medi-Cal, the state Medicaid program. The average annual cost of $20,020 for each patient is far less than the $77,745 average cost for a patient in a nursing home, according to the state Association for Adult Day Services.

For more than 30 years, the California centers, called Adult Day Health Care (ADHC), have offered skilled health and nursing care therapies, transportation and other services to eligible low-income older people and people with disabilities. Darling and six other plaintiffs argued that eliminating ADHC centers without replacement services would violate the federal Americans With Disabilities Act and other laws by placing tens of thousands of ADHC participants at risk of institutionalization, hospitalization, injury or death.

Federal courts issued two preliminary injunctions stopping cutbacks in the ADHC program, and had scheduled a hearing on the third preliminary injunction when the parties agreed to settle.

Under the settlement, the centers will remain open and will be funded by a new program called Community-Based Adult Services (CBAS).

"The settlement ensures that critical community-based services will be preserved and low-income seniors and people with disabilities will avoid unnecessary and expensive hospitalization or institutionalization," said Kelly Bagby, senior attorney for AARP Foundation Litigation, which along with Disability Rights California in Oakland, the National Health Law Program, the law firm Morrison & Foerster LLP and the National Senior Citizens Law Center was cocounsel on the case. The U.S. Department of Justice also filed a friend-of-the-court brief in the suit supporting Darling.

The new CBAS program's enrollment will not be capped, ensuring that all eligible beneficiaries are able to receive services. Current ADHC recipients who are not eligible for CBAS will receive enhanced case management to help them transition to other long-term care services in the community, Bagby said. Many of the current ADHC providers will be able to provide CBAS services, thus ensuring continuity of care.

What it means to you: There are strong legal precedents protecting adult health care even as states continue balancing their budgets by trimming home- and community-based health, transportation and senior services.

Also of interest: Exploring adult day care options. »

Emily Sachar is a journalist and author based in Brooklyn, N.Y.

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