The fate of the Adult Day Health Care (ADHC) program in California remains uncertain as earlier this week Governor Brown vetoed a bill that would have replaced it with the similar, less-costly Keeping Adults Free from Institutions (KAFI) program. Following the elimination of ADHC as an optional Medi-Cal benefit to save the state approximately $170 million annually, the legislature passed AB 96 to create KAFI and continue to provide services to roughly 35,000 Californians. After issuing the veto, Gov. Brown said while he supports the goal of the bill, “creating a new ADHC look-alike program at this juncture is unnecessary and untimely” (Sacramento Bee, 7/26). Gov. Brown extended the elimination of the ADHC program until December 1, but at least a dozen of the 300 ADHC centers throughout the state have already begun closing. Robertson Adult Day Health Center in East Sacramento closed its doors in June.
Designed as a means to save money, ADHC provides nursing-home type services during the day, allowing seniors and the disabled to live and remain functional at home, keeping them out of more-costly nursing homes and hospitals. ADHC supporters say that cutting the program will end up costing the state money because it will mean more trips to the emergency department, more use of adult protective services, and many more people moving out of their homes and into expensive nursing homes (Gorn, California Healthline, 7/28). Officials say concern over the program has been growing for some time and a “culture of distrust” sprang up over suspicion of fraud. Stan Rosenstein, former chief deputy director of Medicaid services of DHCS said “At one point, they tried to limit services to three days a week, and they couldn’t do it. That led them to believe that, if they can’t put on limits, they can eliminate it as an optional benefit.”
Meanwhile, a lawsuit challenging the elimination of the ADHC program as a Medi-Cal benefit will be heard on November 1. A hearing originally scheduled for September 1 was pushed back at the request of the Department of Health Care Services, to allow more time to prepare a transition plan. DHCS spokesman Norman Williams has said the state is working on several possible alternatives, including an expansion of the existing In Home Support Services program and use of the existing In-Home Operations waiver. Advocates for ADHC are concerned because none of the alternative programs offer the same type of services currently offered through ADHC. For example, IHSS does not include a medical component, which is a key aspect of ADHC.
While many in the ADHC community hope the lawsuit will reverse the state’s move, the majority of the centers will close in advance of the December 1 deadline. Lydia Missaelides, executive director of the California Association of Adult Day Services, estimates 5%, or about 15 centers, will be able to remain open, but will operate on a fee-for-service basis. Concerns over communication and transition plans add to the uncertainty. Missaelides and other ADHC center directors say there has been almost no contact from DHCS so far. But DHCS officials say they have conducted 8,000 reviews of ADHC cases and have been in constant contact with agencies. “The centers are a part of the plan, in that we’re working with and communicating with the beneficiaries,” Williams said. Letters will begin going out to beneficiaries in the coming weeks, informing them of the decision to eliminate the program.
Despite the demise of KAFI, ADHC advocates and patients will continue to hope for the best, but already the effects are being felt. Sue Barnett, a patient of an ADHC center in Sonora that closed in April, says “Without their help, I wouldn’t be where I am,” she said. “And really, there’s nothing to replace ADHC” (Gorn, California Healthline, 6/30).