SACRAMENTO – On Jan. 27, Assemblywoman Bonnie Lowenthal, D-Long Beach, introduced Assembly Bill 1552, which would continue Medi-Cal coverage for adult day health care services for frail seniors and adults with disabilities on a permanent basis.
Without the legislation, adult day health care services would expire as a Medi-Cal benefit at the end of August.
California has 270 adult day health care services centers that provide skilled nursing care, physical, occupational, speech therapy, social work services, transportation and other services to frail adults who are at risk of institutionalization.
According to a recent study by the California Medicaid Research Institute, the cost of caring for the average Medi-Cal or Medicare enrollee in a nursing home in California is $83,364, while the average cost per person in adult day health care services is $9,312.
Adult day health care enrollees and providers have encountered serious challenges in recent years. Due to California’s fiscal crisis and years of budget instability, adult day health care was eliminated as an optional Medi-Cal benefit in 2011. A class action lawsuit, Esther Darling, et al. v. Toby Douglas, et al., challenged the elimination of services as a violation of the U.S. Supreme Court decision in Olmstead v. L.C. California subsequently settled the lawsuit, agreeing to replace adult day health care services with a new program, Community-Based Adult Services, which will link enrollees to care through managed care and fee-for-service models. Community-Based Adult Services are offered through a federal Medicaid 1115 Waiver, which is set to expire on Aug. 31, 2014.
If signed into law, AB 1552 will extend access to ADHC services through the Community-Based Adult Services program on a permanent basis. In counties with Medi-Cal Managed Care, enrollees will see services as part of their overall package of benefits. In counties without Medi-Cal Managed Care, or for enrollees that are exempt from managed care enrollment, the benefit will be offered under the fee-for-service model. AB 1552 includes an urgency clause, allowing it to take effect immediately once signed into law by Gov. Jerry Brown in order to ensure a continuation of services beyond the current August expiration.