The Avenidas Rose Kleiner Senior Day Health Center — which serves adults who have difficulty caring for themselves — would have to turn away about half of the men and women that currently depend on its services if California halts Medi-Cal reimbursements to adult day health care centers, as the governor has proposed, said John Sink, vice president of programs for Avenidas.
Medi-Cal pays more than half the cost associated with attending the center, Sink said, and about 50 percent of the center's disabled and elderly are on Medi-Cal.
"The people that get squeezed out are those folks who are least capable financially of coming up with other alternatives," Sink said. "People who are relatively well off will continue to attend. For them, it's a good deal."
Currently, Medi-Cal enrollees get a free ride at the center, while it costs about $125 a day to take care of one senior at Rose Kleiner, Sink said. Medi-Cal — the state- and federally funded health insurance service for the needy — pays about $76 of that. Avenidas raises money to make up the difference.
However, if Gov. Jerry Brown's proposal to strip adult day care centers of their ability to collect Medi-Cal reimbursements goes forward, that would all come to an end. Sink said that Avenidas would not be able to cover the entire cost of care for its patrons.
"Without a payment source for the Medi-Cal-eligible individuals, those folks will no longer be able to attend," Sink said. "Family members may need to move home to take care of them, or move them to a skilled nursing facility," which on average, costs about $164 per day.
Unlike some adult day health care centers across the state, Avenidas Rose Kleiner will remain up and running no matter what California legislators decide about the governor's proposal, Sink said. Similar centers in other parts of the state would certainly close, however, as they would lose the vast majority of their clientele as a result of the elimination of the Medi-Cal benefit.
On the campaign trail to Sacramento, Brown promised to leave no stone unturned when considering which state programs would need to be downsized or dumped to address the state's $25.4 billion budget shortfall. Brown has proposed cuts to a wide swath of services, including the elimination of adult day health care as a MediCal benefit.
In an e-mail defending the governor's proposal, Anthony Cava, a spokesman for the California Department of Health Care Services, cited California's financial issues, saying that the $25.4 billion hole has to be filled somehow. "The state is facing a severe fiscal crisis. ... Making reductions or eliminating programs requires tough decisions, but those decisions are necessary in the context of the fiscal situation."
The proposal has also drawn fire from the California Association of Adult Day Services, or CAADS.
According to CAADS estimates, there are currently 37,000 Californians that depend on some form of adult day care. The average age of these men and women — who may suffer from cardiovascular problems, dementia or the aftermath of a stroke, among other chronic conditions — is 78. About 92 percent of them are on Medi-Cal.
The association has said in a statement that it does not make sense to take away the Medi-Cal eligibility of adult day health care for a number of reasons.
According to CAADS, Medi-Cal will still have to cover the cost of treatment for those who currently rely on facilities like the Rose Kleiner center, it will just end up paying more in the long run as seniors move to more expensive privately run care.
Furthermore, about 7,000 jobs would be lost across the state, leading to more unemployment claims.
Finally, if funding were restored it would prove very difficult and costly to restart the system of 310 care facilities and return them to their current operational capacity, the association predicts.
In response to these critiques, Cava wrote that California was one of only nine states that currently offered a similar benefit and that adult day health care was one of only a few Medi-Cal benefits that the state has the ability to legally reduce. The state could potentially save $176 million annually by cutting the program.
"We understand that this reduction will likely have health impacts," he wrote. "However, the state must live within its means and available fiscal resources."
Sink, like the association, acknowledged that California is in a dire financial situation. However, cutting spending in this area is not prudent, he said.
"It's a swing and a miss," Sink said. "It's not going to have the intended results. It's a step backwards."