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By the end of August, 35,000 low-income elders and people with disabilities will have received notification that Medi-Cal, California’s Medicaid program, will no longer cover adult day health care (ADHC) beginning December 1.

Adult day health programs provide health, therapeutic, and social services to those at risk of being placed in a nursing home, the California Department of Aging explains.

In California, there are 300 ADHC programs. According to the California Disability Action Network, they employ 7,000 people.

Eliminating the Medi-Cal benefit for ADHC was proposed by Governor Jerry Brown last January to help close the state’s budget gap.

Class Action Suit Filed

Advocates, including the AARP California Foundation, Disability Rights California, National Senior Citizens Law Center, and National Health Law Program, filed a federal class action suit on behalf of the ADHC consumers.

The organizations charge that the elimination of the Medi-Cal ADHC benefit violates federal disability law, and are trying to stop it, “unless the state can provide adequate and appropriate replacement services.”

“Adult day health care has been a cost-effective means to keep thousands of people out of nursing homes and other institutionalized care,” said Barbara Jones, senior attorney, with the AARP Foundation.

“Estimates of the increased annual cost of premature institutionalization to California, if adult day health care is eliminated by year’s end, have topped $50 million. California still has not found alternate services for the thousands of low-income and elderly people dependent on this program,” Jones said.

Managed Care Plans to Coordinate Services

The state’s plan — just released on August 5 — is to mandatorily enroll the ADHC clients in Medi-Cal managed care plans, with an “opt-out option.”

The managed care plans will be responsible for coordinating services for the ADHC clients, including additional in-home supportive services, physical and occupational therapy, and social services, a Los Angeles Times article explains.

“State health care officials know they have 35,000 medically needy elderly and disabled patients whose lives clearly depend on what they do in finding coordinated care for these patients’ complex medical needs in a matter of weeks or face disastrous legal consequences in court,” said California Association for Adult Day Services Executive Director Lydia Missaelides, in a media statement (pdf).

“Pressed for time, they had to produce something, and the result is now a plan and strategy that is nothing more than a list of existing health care services for ADHC patients to be plugged into like widgets or lumped together in managed care plans that the patient may not accept or that may not be able to provide for the patient’s specific needs because the services simply don’t exist,” Missaelides said.

Strong Attachments

California’s required ratio of direct-care workers to clients in ADHC programs is 1:16, but many programs have higher worker staffing, Missaelides told PHI.

“Despite their strong attachments to clients, some of the ADHC staff is starting to look elsewhere for employment because of the uncertainty of the program’s future. It’s a very emotional time: the workers are attached to clients but they have their own families to feed,” Missaelides added.

A hearing is scheduled for November 1 to determine if California’s scheduled elimination of ADHC is in compliance with federal disability law.

– by Deane Beebe

Several dozen Tennesseans with disabilities sued the state’s Department of Intellectual and Developmental Disabilities (DIDD) for eliminating funding for critical home care and personal assistance services.

The lawsuit was filed in a Nashville federal court on July 11. It alleges that DIDD’s budget cuts violate the Supreme Court’s Olmstead decision, which requires states to place people with mental disabilities in home- and community-based settings whenever appropriate.

The plaintiffs, who range in age from 7 to 52 years old, say that the cuts would require them to move into group care homes.

They are joined in the lawsuit by People First, a nonprofit group that advocates for people with disabilities, and by the Legal Aid Society.

DIDD Cuts Reduce Hours

In June, the DIDD, tasked with trimming millions of dollars in spending as part of statewide budget cuts, imposed a cap on the number of hours that individuals with disabilities can receive certain types of in-home care.

One-on-one nursing services are now limited to 12 hours a day under the DIDD’s new plan, while personal assistance services are capped at 215 hours a month, or approximately 7 hours a day.

These cuts affect an estimated 680 Tennesseans, many of whom say that their disabilities are so severe they essentially require round-the-clock services.

For example, Christopher Hughes, a 34-year-old Campbell County resident with cerebral palsy, had for years relied on the care of two personal assistants, who provide more than 300 hours of care a month.

Because of the cuts, his mother says, Christopher will be forced to move into a group home, an hour’s drive from his family.

Lenny Croce, a Legal Aid attorney, told The Tennessean that the cuts will be responsible for “segregating individuals” with disabilities by removing them from their communities and placing them in group homes.

– by Matthew Ozga

California’s 2011-12 state budget, signed by Governor Jerry Brown (D) on June 30, contains a provision that could automatically trigger a $100 million cut to the In-Home Supportive Services (IHSS) program at the start of 2012.

The final $86 billion budget projects that the state will receive an additional $4 billion in revenue by mid-December. If the anticipated revenue falls short — only $2 billion to $3 billion is realized — then the IHSS program cuts will take effect, according to the Sacramento Bee.

“IHSS advocates fear the revenue projections will not be met and that the likely impact on consumers will be severe,” said Donna Calame, executive director of the San Francisco IHSS Public Authority and PHI board member.

“Consumers have already sustained cuts in Medi-Cal and an increase in co-pays. About 85 percent have seen their Supplemental Security Income/State Supplementary Payment cut from $904 to $830 a month,” Calame said.

Services and Wages Would Be Cut

Services provided by IHSS would be reduced by 20 percent should the cuts be triggered, reports the Associated Press.

“Workers could experience up to a 20 percent pay cut,” Calame said, “and with a drop in work hours, lose their health care coverage.”

The IHSS program was already scaled back last February with a 3.6 percent cut in hours.

If there is a revenue shortfall at the end of the year, budgets will also be slashed at several other state-funded programs and services, including the California Department of Developmental Services, the state university and college system, and child care assistance.

California’s adult day health care program has already been slated for elimination by September 1.

– by Deane Beebe

Florida State Capitol in Tallahassee

Florida direct-care workers and nursing home residents will feel the effects of the dramatic budget cuts passed by the state legislature late last week.

The budget calls for a 6.5 percent cut to Medicaid reimbursement rates, which amounts to approximately $187 million in cuts to Medicaid-funded nursing homes.

Florida’s Republican-dominated legislature passed the budget bill in the early-morning hours of May 7.

Staffing Requirements Lowered

To offset the budget cuts, state staffing requirements for nursing homes will be lowered.

The minimum number of daily hours of care provided by certified nursing assistants (CNAs) will be lowered to 2.7 hours, from 2.9.

Overall, nursing home residents will be required to receive a minimum of 3.6 hours of daily direct care from nurses and CNAs combined, down from 3.9 hours.

In the past, Florida had “stood out as one of the few states that made a commitment to staffing its nursing homes near the level we know is necessary to provide basic care and services — 4.13 hours per resident day,” said Janet Wells, director of public policy at the National Consumer Voice for Quality Long-Term Care.

Wells continued:

It is devastating that the legislature has gone back on that commitment on the false premise that reducing staff will save the state money. Hospitalization to treat pressure sores, dehydration, broken bones, and other medical conditions related to understaffing will offset any savings gained from firing nurse aides who make $11 an hour.

Staffing Reductions and Budget Cuts Criticized

The reduction in state-mandated staffing hours means that nursing home residents will get “less assistance with their basic living activities,” thus degrading the quality of care they receive, said Terry Bucher, the director of education at the Florida Professional Association of Care Givers.

The 6.5 percent budget cut will also likely require nursing homes to cut direct-care workers’ hours — or lay them off entirely — just to stay afloat economically, Bucher added.

“Many of these direct-care workers are single heads of household; thus the [economic] ripple effect is difficult for them…in an economic time that has already left their families struggling,” she said.

Governor Expected to Sign

Gov. Rick Scott (R) is expected to sign off on the legislature’s budget within the next several weeks, observers say.

The Florida budget will also cut Medicaid support for hospitals by a larger-than-expected 12 percent, or $510 million.

– by Matthew Ozga

Washington State Capitol building in Olympia

Home care workers were among the more than a dozen people arrested at the Washington state capitol on April 7 while protesting the proposed 16 percent state budget cut to home care services.

The home care workers recommend that the state fill the $5.1 billion budget gap over the next two years by closing tax loopholes and corporate subsidies instead of making more cuts to home care.

Seattle Post-Intelligencer political columnist Joel Connelly penned a column featuring three home care workers who were arrested at the demonstration. The workers explain what the cuts in hours will mean to their clients who are elderly or living with disabilities and in need of services to continue living in their homes.

Though the arrested workers expressed more concern about their clients than themselves in the column, as many as 6,000 home care workers who make an average of $10 per hour would see a reduction in the number of hours they work as a result of the proposed cuts, according to SEIU 775NW. They will also be asked to pay more for their health coverage, putting affordable coverage out of reach, the union says.

It is expected that the state House and Senate will not be able to reconcile the differences in their budget-slashing proposals — $4.4 billion and $4.8 billion, respectively — by the Easter Sunday deadline and will have to call a special overtime session to reach a budget agreement.

A national analysis of home care workers and health care coverage is available in PHI Facts 4: Health Care Coverage for Direct Care Workers, 2009 Data Update (pdf).

– by Deane Beebe

The Friday Morning Collaborative is hosting the second webinar in its series to provide information and resources that may assist state advocates in preventing cuts to home and community-based services (HCBS), while promoting the adoption of new options in the Affordable Care Act.

“Cost Effectiveness of Home and Community Based Services” will take place on March 25 from 2:00 to 3:30 PM EST.

Speakers will include:

• Stephen Kaye, Center for Personal Assistance Services, University of California San Francisco;
• Lisa Alecxih, The Lewin Group;
• K. Charlie Lakin, Research and Training Center on Community Living, University of Minnesota; and
• Dee Mahan, Families USA.

Due to limited space, anyone interested in participating should register early and share lines when possible. The webinar will also be recorded and made available for viewing following the event.

A recent AARP Public Policy Institute report documents how state budget cuts caused by the economic recession pose a serious threat to long-term care services for elders and individuals with physical disabilities.

The webinar series was kicked off in February with “State Budgets: Challenges and Opportunities for Home and Community Based Services.” The series is made possible with support from The Scan Foundation.

The Friday Morning Collaborative — of which PHI is a member — is a national coalition of aging and disability organizations working together to protect and strengthen Medicaid Home and Community Based Services (HCBS).

– by Deane Beebe