State settles suit over adult day health care

On the eve of a hearing in federal court, California officials and advocates for disabled and low-income seniors have agreed to a brief delay in the elimination of the state Adult Day Health Care program while a replacement service can be implemented.

The settlement of a lawsuit challenging the demise of ADHC, originally filed two years ago, requires the state to establish a new program called Community-Based Adult Services by February 29, 2012. Much like ADHC, the CBAS program will offer center-based skilled health and nursing care, therapy, transportation and other services. The state agreed to delay ADHC’s demise from the planned termination date, Dec. 1, until Feb. 29.

But there’s some disagreement between state officials and ADHC supporters over predictions of how many of the program’s approximately 35,000 current participants will end up in CBAS – and thus, how much the state will wind up saving by eliminating ADHC.

Still, the settlement was applauded by both sides.

“There are a lot of people who really need this program; I have fought to stay out of a nursing home and have been able to with ADHC,” Esther Darling, the lead plaintiff in the case, said in a statement. The 74-year-old Darling, who lives in Yolo County, currently receives ADHC services and expects to transition to the CBAS program.

Toby Douglas, director of the state Department of Health Care Services, said in a statement, “I am pleased that we were able to come to an agreement that settles the legal dispute over the elimination of the adult day health care benefit. This agreement upholds the state’s commitment to provide essential care and services to those most in need efficiently and economically.”

The ADHC program began in the late 1970s and grew to include some 280 existing centers around the state. Beneficiaries — mostly seniors but also younger patients suffering from traumatic brain injuries and cognitive diseases – obtain health-related services at the centers, such as physical, occupational and speech therapy, and blood pressure and blood sugar monitoring. Group activities at the centers provide social interaction and physical exercise that leads to healthier emotional lives, advocates have said.

State officials tried to eliminate ADHC in recent years, the result of severe budget woes and the program’s status as an optional benefit under federal Medicaid rules. Though officials said they cherished the program, it again was targeted earlier this year by the Brown administration and legislators in a bid to save $169 million in annual state general fund money. (The program’s total cost was about $340 million a year, and the federal government provided the balance.)

Disability Rights California, the National Senior Citizens Law Center, the National Health Law Program and other supporters began pressing for an injunction against the state’s latest attempt to kill ADHC. They contended that without adequate services for beneficiaries to fall back on, ADHC’s termination would violate the federal Americans with Disabilities Act and other laws by placing participants at risk of institutionalization, hospitalization, injury or death.

An Oakland-based federal judge was to hear arguments on the proposed injunction on Wednesday. But pending the judge’s concurrence, the settlement will resolve the entire lawsuit, titled Darling et al. v Douglas.

What remains to be resolved is the settlement’s long-term impact.

After current ADHC beneficiaries are assessed, the state expects about half will be judged eligible to continue receiving those services, and they will seamlessly transfer into CBAS, said Norman Williams, spokesman for the Department of Health Care Services. In many cases, existing ADHC centers will offer CBAS services.

The other half will obtain the services they need through managed care plans, but won’t be provided at CBAS centers, Williams said. Because the state will adopt stricter eligibility requirements and will have more control over those qualifications, general fund savings will hit $28 million in the current fiscal year that ends June 30, and $92 million in the 2012-13 fiscal year, he added.

“What this means is that the appropriate people who should be (CBAS centers) will get the appropriate services,” Williams said.

But Lydia Missaelides, executive director of the California Association for Adult Day Services, said she and other advocates expect a larger percentage of existing ADHC participants will end up in CBAS.

The 50% estimate “seems very low…based on my experience for all these years working with these folks,” she said. “All of the people currently in (ADHC) have been assessed by a professional team at the center and approved by a state nurse through the Medi-Cal field office….They’ve already gone through that.” Further, she stressed, there is no cap on the number of participants in the new CBAS program.

But, she added, “We’re all speculating at this point based on our best information.”

Though the new deadline for ADHC’s demise is a bit more than three months away, state officials say CBAS will be ready. Much of its planning was already in the works as the state prepared to eliminate ADHC on Dec. 1, Williams said.

“We’re confident we’ll be able to get that done by the beginning of the (CBAS) program on March 1,” he added.

Herbert A. Sample is a freelance writer in Los Angeles. He can be reached at

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