A “Small” Loser in the Battle for a Balanced Budget—Adult Day Care

Thursday, June 13, 2013

There are a lot of losers in a state budget process like California’s that allocates more than $96 billion. Some are big, like environmentalists who didn’t expect the state to redirect $500 million to the general fund from the new cap-and-trade energy auctions— money that was earmarked for battling climate change.

Other losers are small, if measured by the size of the allocation rather than its impact on those at the receiving end, like adults with physical and mental disabilities who need Medi-Cal funds to attend daycare centers.  

Funding for Adult Day Health Care (ADHC), a 30-year-old, cost-effective program, was eliminated in 2011 when the state eviscerated the social safety net to save money. But the state was sued and agreed to keep a replacement program temporarily going as part of a legal settlement.

Democratic Assembly members Mariko Yamada and Bob Blumenfield introduced Assembly Bill 518 in February to restore permanent funding to the program and last month the Assembly unanimously approved it. But Yamada refused to sign off on a Senate Health Committee amendment that would allow more for-profit companies to provide the care and the bill died without a vote this week, according to Dan Walters at the Sacramento Bee, after an “awkward conversation” with Democratic members of the panel.

When the state settled the class-action lawsuit, Esther Darling, et al. v. Toby Douglas, et al., two years ago, it agreed to replace ADHC with a new program, Community-Based Adult Services (CBAS) that would operate until June 2014. AB 518 would have made the program permanent and provided funding for the 32,000 of the former 40,000 ADHC beneficiaries who remained eligible for assistance.

Participation of for-profit organizations in CBAS had been an issue since before the bill was introduced. Last December, California’s Department of Aging announced the Department of Health Care Services would not implement restrictions on for-profits until January 1, 2014. As of May, 62 of the CBAS centers were non-profits and 183 were for-profit.

Staff analysis of the bill indicated that amendments in support of for-profit participation were expected. When they surfaced, the reception from Yamada was chilly. Walters said Yamada had a philosophical objection to someone “making a profit off the public dollar.”

–Ken Broder


To Learn More:

Adult Day Care Legislation Dies after “Awkward Conversation” (by Dan Walters, Sacramento Bee)

Out with ADHC, in with CBAS (by David Gorn, California Healthline)

Assembly Bill 518 (California Legislative Information)

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