San Francisco Marin Medical Society Blog

Victory For Seniors: Calif. Adult Day Health Care Center Lawsuit Resolved

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Really, it's all about Esther Darling. The 74-year-old is the poster child for adult day health care services. She had a stroke, deals with diabetes and congestive heart failure, takes multiple medications and receives care and treatment at a day center in Yolo County. "If it wasn’t for the [Adult Day Health Care (ADHC)] therapy, I wouldn’t be able to walk today," Darling said. "They said I wouldn't walk anymore, but I was determined to prove them wrong." Darling is the named plaintiff in a lawsuit against the Department of Health Care Services settled yesterday, just prior to a scheduled federal court hearing. She stands to benefit from the new program in that settlement, Community-Based Adult Services (CBAS), which is designed to provide "ADHC-like services" to current ADHC beneficiaries who are at risk for being institutionalized, such as Darling. The settlement has three main components:

• CBAS will provide services roughly equivalent to those currently offered at ADHC centers, and funded at the same rate, for patients who qualify. Eligibility is based on medical need, for those who are at risk for institutionalization. DHCS officials estimate about half of the current ADHC beneficiaries will be eligible, though that number could rise, based on assessments that still need to be conducted.
• CBAS will provide enhanced case management in an integrated managed care setting for those who are not in imminent danger of institutionalization. All patients who want to receive these benefits—whether it's CBAS-eligible patients or the ones who receive more intensive case management service—will need to enroll in a managed care plan.
• The settlement extends by three months the deadline for elimination of ADHC as a Medi-Cal benefit (also referred to as an optional Medicaid benefit), from December 1 to March 1.

The state Legislature, which voted to eliminate ADHC as a Medi-Cal benefit in March, allocated $85 million to a new program to be called Keeping Adults Free from Institutions. Gov. Jerry Brown (D) vetoed the ADHC replacement plan in July. The big difference between the Legislature-backed KAFI program and the current settlement CBAS program  is that the new program is not capped. The benefit will be available for those who qualify for it, not restricted by a hard cap upper limit for the program cost.