Brown Vetoes Adult Day Health Bill; Future of Program Unknown

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There is a 45% increased risk of death in people who are lonely compared to not lonely, according to a UCSF study.
The state has tried to eliminate adult day health care in the past.  (Photo: Getty Images)

By David Gorn, California Healthline

On Monday, Gov. Jerry Brown vetoed a bill to codify Community Based Adult Services as a Medi-Cal benefit and continue offering it as a benefit into the future.

The state has attempted to eliminate adult day health care in the past. The CBAS program, serving some of the oldest, most frail Californians on Medi-Cal, is the result of a 2011 settlement of a lawsuit challenging the state the last time the state tried to cut the program.

The veto Monday of AB1552 by Assemblywoman Bonnie Lowenthal (D-Long Beach) leaves an uncertain future for CBAS. The agreement in the 2011 settlement expired at the end of August, but CBAS is included as a Medi-Cal benefit in a proposed amendment of the state's Medicaid waiver and is included in the Coordinated Care Intitiative. CMS is expected to approve the amendment by the end of this month.

"It seems like the governor is picking at a scab," said Gary Passmore, vice president at the California Congress of Seniors. "CBAS exists as a settlement, and we tried to establish that in law. And here we are again. … Without it existing in statute, it puts everything up for grabs. It's a real step backward."


Coincidentally yesterday, hundreds of senior care stakeholders, including Passmore, gathered in Sacramento for the annual SCAN Foundation conference on long-term care and services.

Lydia Missaelides, executive director of the California Association of Adult Day Services, also attended the conference and said the veto was troubling but does not spell elimination for the program.

"It doesn't mean the demise or defeat of CBAS as a [Medi-Cal] benefit," Missaelides said. "But it is a signal that the future of the benefit will be a deal between the state and CMS."

The veto raises questions, Missaelides said, such as whether the state and CMS might decide to change the benefit, or whether adult day health providers in counties not included in the Coordinated Care Initiative might be affected. Codifying current policy, she said, is not a big leap for the state to take.

"It seemed like a simple thing to ask for," Missaelides said.

In the long run, said Passmore, it leaves the door open for amending the benefit -- by CMS or by Medi-Cal managed care health insurers.

"I guess we're going to leave it up to the managed care plans," Passmore said. "What's going to happen is, plan by plan, those entities will decide what role CBAS plays in their range of services."