STATE

SAVE ADHCs

The budget conference committee voted to reject the Governor's proposal to eliminate ADHC as a Medi-Cal benefit. This should be considered a HUGE win in this environment of the worst budget deficit in decades....BUT the budget negotiations will next shift to the Governor and Legislative leaders.. (See local impact below)

SAVE ADCRCS

The budget conference committee voted to reject the Governor's proposal to eliminate funding to Alzheimer's Day Care Resource Centers with the compromise of reduced funding to approximately 30%.....BUT the budget negotiations will next shift to the Governor and Legislative leaders.....

The elimination of ADHC will throw 36,000 elderly and disabled Medi-Cal participants and their caregivers into absolute turmoil.

This proposal will cost the public more than it saves!

Only 11% or 3,700 participants going into a nursing home will wipe out the savings. The reality will be much higher.

Nursing facility beds for Medi-Cal are extremely limited and some counties have no bed capacity, which will require the cost of moving people to a facility in another county.

Working caregivers will be forced to choose between quitting their job and losing their income or placing their loved one in a nursing facility.

Caregivers' own physical and mental health will decline due to their inability to manage care without the support of ADHC, which in some cases will lead to increased neglect or abuse.

Others with no family support will sit at home alone without the nursing and therapy support they need as their health slowly deteriorates or they rapidly de-stabilize, leading to ER, hospital stays, psychiatric stays, overuse of emergency response, or incarceration, at an even greater cost to the public.

This makes no fiscal sense and is a cruel and harsh way to balance the budget - by excluding the most vulnerable members of our society -- frail elders ; those with Alzheimer's disease; mental illness; or developmental disabilities -- from accessing the care that ensures their place in the community while remaining in their home.

ECONOMIC IMPACT

*ADHCs are small businesses or non-profits. Closing programs requires breaking leases and vendor contracts, laying off staff, and removing a roughly $1 million local economic contribution of each center.
*Approximately 6, 500 workers will be laid off and qualify for unemployment benefits.
*A community resource will disappear and it is highly unlikely it will return.
" The state will suffer the loss of $238,076 million in federal funds.

Thirty years of progress in developing home and community-based alternatives will be wiped out for everyone as ADHC and other services are eliminated. Services will not quickly recover from this blow. As programs permanently close, institutional care will be the only option left just as the baby boomers reach retirement age and community options are needed more than ever in California's history.

*Click Here to Find your local legislators!

*Budget Committee Contact Info

*To find other legislators, go to http://www.legislature.ca.gov/

*Reject this harmful proposal that targets the neediest and most at risk individuals served in our ADHC programs and threatens to close centers across the state. Impact is nearly 1,800 San Francisco participants.The impact becomes greater when add in loss of jobs as well as financial and emotional stress on caregivers.

* This Governor's proposal will cost more than it saves as persons wtih chronic mental illness, and developmental disabilities destabilize and frail elders and persons with Alzheimer's disease, who are unsafe to be home alone, are placed into nursing facilities or hospitals. The Governor has not taken into consideration the shift cost to more expensive programs of care.

*Increase license fees to Adult Programs and elimination of funding for ACDRCs increases risk to participants and survival of these programs.

* Work with CAADS, the Alzheimer's Association and other stakeholders to find alternative savings while protecting the right care for the right people.

* Legislators are now considering eliminating all state funding for the ten Alzheimer's Research Centers (ARCCs) and 54 Alzheimer's Day Care Resource Centers. Click here for Fact Sheet.

Earlier Revision Proposals that could still occur:

* Limiting ADHC benefit to three days per week. Equivalent of permanently eliminating 7,000 participants from ADHC care, or approximately 20% of those currently served. (This can be extrapolated locally also). The participants approved for five days a week of care are the very ones whose next step in the continuum of care will be emergency care and a nursing facility. Centers will close if the total expected savings comes out of ADHC program, rather than from administrative dollars or a combination of both. Statewide, it would only take 2 people from each of the 327 centers to enter skilled nursing care as a direct result of this policy to wipe out the savings.

View the Governor's "2009-10 May Revision General Fund Proposal" at http://www.dof.ca.gov and the Legislative Analyst Office report at www.lao.ca.gov.

Cuts Already Taking Effect on July 1, 2009
he following Medi-Cal optional benefits will be permanently eliminated:
1. adult dental
2. acupuncture services
3. audiology and speech therapy services
4. chiropractic services
5. optometric and optician services including services provided by a fabricating optical laboratory
6. podiatric services
7. psychology services, and
8. incontinence creams and washes.

" Who Is Exempted By This Cut: medical and surgical services that may be provided by a doctor regardless of whether the service is actually provided by either a doctor or dentist, pregnancy-related services, and services for treating conditions that might complicate pregnancy. Also exempted for this specific cut are persons in the Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT) and long-term care in a skilled nursing facility or intermediate care facility.

LOCAL

Proposed State budget cuts impact on San Francisco programs:

Elimination of Medi-Cal funding to ADHCs:

12 ADHC centers serving more than 1,800 individuals.

If programs close, 20% and more of these individuals will require emergency room care, hospitalization or institutionalized care within 30 days. Each of these options are limited in capacity or have no capacity to receive this influx of individuals.

ADHCs average daily cost ranges between $80-$90 per day. Above options, if available, costs 4x-5x more!

Jobs lost!

Businesses impacted as caregivers will need to divert their time to increase care to loved ones. Vendors who provide services, equipment and materials to centers will have decreased business.

Elimination of funding to all Alzheimer's Day Care Resource Centers (ADCRC):

Three ADCRCs in San Francisco with 128 participants. Program closures. Where do these participants, with specialized needs now, and in the future, go?

HOLD THE DATE FOR WEDNESDAY, JUNE 10 AT 3 PM! The Budget Justice Coalition, which includes Human Services Network and about a dozen other coalitions and advocacy organizations, are planning a major rally on this date! We will need the commitment of every health and human service organization for a major turnout to stop cuts to vulnerable populations and to push for progressive revenue measures on the November ballot. More info coming soon!

OTHER ALLIES with updated city budget issues:

Planning for Elderss http://www.planningforelders.org/

Coalition of Agencies Serving the Elderly (CASE) www.sfseniors.org/

Human Services Network http://www.sfhsn.org

FEDERAL

The success achieved to date by California Association for Adult Day Services (CAADS), through legal action to stop the 10% ADHC Medi-Cal rate cut in August 2008 and the 5% rate cut in March 2009, has been nothing short of remarkable. This litigation activity has protected over $20 million in funding for ADHC services during one of the worst state budget deficits in decades. Because of these legal victories, the State of California at the end of March filed a petition with the United States Supreme Court to appeal the Ninth Circuit of Appeals published opinion that laid the legal groundwork for success.

We need to continue, along with our health care provider colleagues who joined in the lawsuit, to defend these hard fought legal battles. The next step is to hire a law firm specializing in U.S. Supreme Court cases. Our lawyers will argue that the Supreme Court does not need to hear the state's appeal. CAADS is seeking funding support for their legal fund to take this fight all the way to the Supreme Court. We need to stop this 5% cut. Click here for Pledge Form.

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No Federal Stimulus Grant Funds: CAADS examination of the federal stimulus grants leads us to conclude that adult day services programs are not eligible for either health program or health information technology grants at this time.

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Congress and President Obama have made health care reform (HCR) at the national level a top priority this year.
Two Senate committees have jurisdiction with Senator Baucus (D-MT) as Chair of the Senate Finance Committee taking the lead. Three committees will shape HCR in the House including the Energy and Commerce Committee chaired by Congressman Waxman (D-CA). The goal is to put a proposal on the floor of each house by July 31 and work on reconciling differences in August.

The stated goals for HCR are to improve patient care and reduce costs by “bending the curve” of health care spending, which consumes 17 percent of GDP today, and is projected to increase to 20 percent by
2017 ($4.3 trillion annually). The Senate has held a series of roundtable
discussions with stakeholders as they examine ways to improve the way health care is delivered in both the private and public sectors.

Industry groups that killed health care reform a decade ago are now negotiating to position themselves and shape their role. Market reforms such as eliminating insurance discrimination based on age and gender, individual mandate for purchase of health insurance and related government subsidies for low income individuals and families are being
discussed as well as the role of a public insurance option that would compete with private plans.

Some of the ideas being discussed include an increased emphasis on preventive services and wellness, health information technology, improving care coordination at the physician office level and at the time
of hospital discharge, with an emphasis on targeting chronically ill patients with the major chronic diseases that consume the greatest health care dollars:
.. Congestive Heart Failure
.. Chronic Obstructive Pulmonary Disease
.. Coronary Artery Disease
.. Asthma
.. Diabetes
.. Depression

Providing universal coverage is the foremost goal occupying Congress, but there is a growing realization that the current system of providing care for persons with chronic and disabling conditions is not working
nor financially sustainable over time. CAADS is working to position Adult Day Services to be a model of care and option within the changes that finally emerge. To view Senate health care reform documents go to
http://finance.senate.gov/.