State Reaches Settlement in Lawsuit over Adult Day Health Care
November 18, 2011
By Vincent Lim:
Mere weeks before the scheduled Dec. 1 closure of adult day health care centers in California, state officials reached a settlement with advocates for the elderly and the disabled to move the elimination date to February of next year and establish a new version of the state's adult day health care (ADHC) program.
The settlement finally resolves a two-year-long class action lawsuit originally filed in 2009 against the California Department of Health Care Services (DHCS), which challenged ADHC funding cuts. The suit's plaintiffs expanded their grievances when the state decided to completely eliminate ADHC as a Medi-Cal benefit altogether in 2010. Medi-Cal is California's version of the Medicaid program, which serves low-income older adults, persons with disabilities and families.
The name of the case changed a few times over the course of the last two years. After the death of Lillie Brantley, the original named plaintiff, Harry Cota took her place. After Cota's death in March 7, 2011, Esther Darling took his place. Toby Douglas also replaced David Maxwell-Jolly as the director of the DHCS in the same time period.
"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," said 74-year-old Esther Darling, the lead plaintiff in Darling v. Douglas, in a statement.
Under the new program called Community-Based Adult Services (CBAS) patients will receive the same type of health care, physical therapy and counseling services that they would under ADHC. Over 35,000 low-income older adults and individuals with disabilities receive care at the over 300 adult day health care centers across California, which allow them to remain living independently in their homes and out of full-time care facilities. Over 7,000 people also work at the centers and were faced with the probability of losing of their jobs.
ADHC centers will continue to provide services through Feb. 29, 2012. State officials estimated that around half of the current beneficiaries receiving services at ADHC centers will be eligible for the new program, which will not have an enrollment cap. Those ineligible for CBAS will be put into managed care plans, where a case manager will help decide what care should be provided.
The settlement is expected to save the state $28 million this fiscal year and $92 million next year, according to state officials. The federal government must approve Medi-Cal funding for CBAS. California spends about $169 million each year for ADHC services and is provided with additional federal matching funds.
Rallies were held in Los Angeles and San Francisco in the recent weeks leading up to the Dec. 1 closure date for ADHC centers. Approximately 22,000 elderly and disabled individuals would have been impacted by the state's decision to close the centers. The centers serve around 1,500 older adults and persons with disabilities in San Francisco.
Advocates for the elderly and the disabled organized protests throughout California. Photo by Vincent Lim.
Efforts by the Los Angeles Aging Advocacy Coalition and the California Senior Partnership saved ADHC from imminent elimination earlier in 2011. The California State Legislature allocated $85 million for a new program that would have been called Keeping Adults Free from Institutions (KAFI). However, Governor Jerry Brown vetoed the KAFI plan as a replacement for ADHC, and his revised budget proposal put the program at risk again. It provided only $25 million for adult day health care services, which was to be used to transition ADHC beneficiaries into In-Home Support Services and other state programs. The new CBAS program is estimated to cost the state the same $85 million per year that KAFI would have cost.
Some ADHC advocates have voiced that it remains unclear how existing program providers will operate under CBAS. In addition, a new round of funding cuts to programs may be looming with the projected state budget revenue shortfall. They nevertheless welcomed the news.
"This settlement preserves the rights of plaintiffs and class members under the Americans with Disabilities Act (ADA) to continue to live in their own homes and communities, and receive the healthcare services and supports needed to remain independent," said Elissa Gershon, senior attorney for Disability Rights California, one of the plaintiffs in the suit, in a statement. "We are pleased that we were able to work with the state to maintain critical benefits for some of California's most vulnerable citizens."