More than expected qualify for adult day health program San Diego Union Tribune
February 15, 2012
Far more low-income ailing seniors and disabled adults than
expected will be eligible to stay in California’s revamped Adult
Day Health Centers program, offering relief to participants
worried they could be dropped from the rolls by March 1.
But the numbers also indicate the program overhaul, meant to save
the state $28 million this year and $90 million next year in
Medi-Cal costs, could have far less budget-cutting punch.
One thing is clear: State officials overestimated when they
predicted last summer that half of the 35,000 people attending
270 centers statewide — and 22 centers in San Diego County —
would be disqualified as not medically precarious enough for the
“We’re thinking it will be closer to 75 percent” remaining in the
program this year, Jane Ogle, deputy director for health care
delivery systems in the state Department of Health Care Services,
But by next year, she said she expects the numbers to drop to
20,000 participants — low enough so the $85 million budgeted will
cover the program that has cost $171 million a year, she said.
Adult Day Health Centers provide medical and social services to
help participants living at home to avoid hospitalizations or the
costly option of a nursing home.
The state had originally planned to eliminate Medi-Cal funding to
the centers. But in November, a settlement in a lawsuit over the
issue called for creating a new system by March 1. Under the new
program, called Community-Based Adult Services or CBAS, the same
services will be provided to Medi-Cal recipients who meet
specific criteria. In the last month, 200 state nurses have
visited the centers to evaluate all Medi-Cal participants.
Many center operators worry that in the scramble, needy people
are being dropped from the new program.
“I think this has been a complete waste of money and time,” she
said. “It just goes to show this is a real need in the
Most San Diego centers are still awaiting final tallies, but the
half dozen centers with the results say 80 percent to 90 percent
of participants qualify for continued care.
At Glenner Alzheimer’s Family Centers in Chula Vista and
Encinitas, all Medi-Cal recipients were approved, program
director Dawn DeStefani said.
At Neighborhood House Adult Day Health Care Center in southeast
San Diego, about 90 percent qualified, director Jennifer
That pattern held true among Medi-Cal recipients at Redwood
Elderlink in Escondido, director Kurt Norden said.
At Loving Care, Kintz said all but 14 of the 140 Medi-Cal
participants in her program are eligible to stay.
To be sure, the future is uncertain for those who will be dropped
from the program in two weeks.
“I was destroyed,” said Boris Flitsian, weeping as he described
the letter delivered Friday informing him that Medi-Cal won’t pay
for him and his wife, Solomeya, to come to the center after Feb.
“This country that opened its arms to us, this place that takes
care of us and helps us to be independent — why are they taking
this away?” he asked, speaking in the careful English he’s
learned since the frail couple emigrated from Russia in 1991
after the collapse of the Soviet Union and a new rise of
anti-Semitism in their native Romania.
Both now 84 and dealing with numerous ailments, the Flitsians go
every weekday to the center, where they get check-ups, physical
therapy, two nutritious meals and a social connection that keeps
them from drowning in the painful memories that have haunted them
for much of their lives.
Boris Flitsian said they may forget their house keys, they may
forget their birthdays, but they never forget every detail of the
deprivation and deaths of loved ones during World War II, the
post-war Stalinist purges that sent a pregnant Solomeya to a
Siberian labor camp, or a subsequent hospitalization for
“I have a lot of physical problems, I have a lot of psychological
problems,” Solomeya said. “When I came here I felt safe. And I
saw other people have problems and I’m not alone in the world.
When I see they care about me, I feel that I’m a human being.”
The Flitsians and others ineligible for the new program will be
contacted by Feb. 28 and referred to other community programs and
resources, Ogle said.
The state nurses used criteria including whether participants
could handle daily activities such personal hygiene, making meals
and taking their medications. Conditions such as dementia and
serious mental illness generally automatically qualified
At Loving Care, co-founder Helen Kaminsky promised to appeal the
Flitsians could have been disqualified and promised to help
appeal the decision.
“We really believe we are helping them to stay alive,” she said.
“If we let them go, they really have nothing else. So we will
hold on for them.”
By July 1, participants in the new Community-Based Adult Services
will be moved into Medi-Cal managed care programs that will
reimburse the centers.
Meanwhile, center operators feel a sense of seige. They’ve been
hit already with a 10 percent cut in Medi-Cal rates. Under the
new program they’ve had to apply to become CBAS sites. And by
July 1, all for-profit centers must become nonprofits to stay in
the program. Right now, only about a third of the centers are
“We believe nonprofit centers represent a higher level of service
delivery and accountability,” said Norman Williams, a state
Department of Health Care Services spokesman.
A Medi-Cal Payment Error Study in 2009 found unnecessary medical
services accounted for the largest category of possible fraud and
more than 70 percent came from adult day health centers,
according to the study.
But a switch to nonprofit status may be the tipping point for
At the Poway Adult Day Health Care Center, director Kathryn Holt
said she had considered becoming a nonprofit when she opened 10
years ago. But “you can’t get a Small Business Administration
loan,” she said.
SBA loans have allowed her to buy a building and renovate it, so
she can provide programs for 104 participants.
“With the 10 percent Medi-Cal cut we’re getting the same
reimbursement as 10 years ago,” she said. “And the nonprofit
requirement is a huge issue for providers. It really feels like
there’s an agenda to pull the rug out from under the whole adult
day health care industry.”