Transition of Adult Day Health Care program is 'down to the wire'

When I spent time at the Grace Adult Day Health Care Center in Sunnyvale last spring, the fate of California’s adult day health program – and of Grace itself – was unclear.

It’s one year later, and in some ways, the situation remains unsettled. Look no further than today’s federal court hearing on the issue. 

One year ago, proposed state budget cuts seemed so grim that Grace’s co-owners, Manooch and Suzanne Pouransari, were considering closing down their center and opening a nursing home instead.

Grace offers medical services, physical and speech therapy, meals and social stimulation to participants with medical and cognitive problems, from diabetes to Alzheimer’s disease. The majority are on Medi-Cal, the state’s health insurance program for low-income residents, meaning that the center – and others like it – are dependent on government funding.

In November, the state announced a compromise plan to transition the existing Adult Day Health Care program into a new program, called Community-Based Adult Services (CBAS). Under this plan, centers would offer similar services, but not all of the 37,000 adult day health participants would be eligible.

Because the state was no longer talking about eliminating the adult day health program, the Pouransaris scuttled the nursing home idea and decided to keep Grace open as a CBAS center.

The state pledged to assess each participant to determine eligibility, and CBAS was slated to begin April 1 – this Monday.

But the assessment process has spurred complaints and a legal challenge that will be heard in San Francisco today.

“The process didn’t happen very smoothly,” Manooch Pouransari said.

Nurses visited Grace earlier this year and met with its 210 participants. They deemed all but two of them eligible for the CBAS program, Pouransari said.

After the nurses left, however, the state made 35 more ineligible, he said.

“Someone out there, without even knowing our participants or visiting them, they made an ineligible list of their own,” he said. 

Those participants are contesting the findings, but won’t have their hearings before the program is supposed to transition into CBAS Monday.

“These people, they’re all going to be eligible. They have Alzheimer’s, they’re disabled, they use wheelchairs,” he said. “There’s no doubt they made a mistake.”

Elissa Gershon, attorney at Disability Rights California, said complaints such as these are widespread. Disability Rights has filed a contempt motion, arguing the state is not meeting the terms of the transition plan it agreed to. 

“It’s not clear on what basis the nurse is overturning these eligibility findings,” she said.

The state Department of Health Care Services (DHCS) counters that it has been in full compliance with the agreement.

“This filing by the plaintiffs is unnecessary. DHCS is disappointed that the plaintiffs have abandoned the well-intentioned and cooperative process that we have used successfully to this point,” said a department-issued statement.

The department says it intends to move forward with the transition Monday. But Gershon isn’t so sure. It depends on what happens in court today.

“It’s really down to the wire,” she said.

This blog was updated on March 29, 2012

UPDATE: There was no announcement today after the federal court hearing on the Adult Day Health Care transition. It seems that both sides are trying to work out their differences outside of the courtroom.

DHCS released this statement.

"Any complex settlement, as the adult day health care one is, has thousands of moving parts and hundreds of provisions, about which the parties may have disagreements about interpretation or implementation. DHCS and Disability Rights California have had these disagreements and are working things out. At today's federal district court hearing, by the request of both parties, the matters were taken off calendar to allow time for both parties to finalize the settlement agreement. DHCS is committed to working with the plaintiffs to resolve any outstanding issues. This does not affect DHCS' April 1 launch of the Community-Based Adult Services program."

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