California Settlement Preserves Access to Adult Day Health Care

On November 17, 2011, seven plaintiffs who represent a class of 35,000 low-income people with disabilities, including older adults, and the California Department of Health Care Services (DHCS) reached a settlement in a federal lawsuit that challenged the State’s planned elimination of Adult Day Health Care (ADHC) as a Medi-Cal benefit on December 1, 2011 (Darling et al. v Douglas C:09-03798 SBA ). The settlement ensures that even in these challenging economic times, critical community based services will be preserved and low income seniors and people with disabilities will avoid unnecessary hospitalization or institutionalization.

Plaintiffs are represented by Disability Rights California, the National Senior Citizens Law Center, the National Health Law Program, AARP Foundation Litigation, and the firm of Morrison & Foerster LLP (pro bono counsel).

After extensive negotiations, the Parties reached a compromise which preserves ADHC-like services for people who are at risk of institutionalization, in a new program called Community-Based Adult Services (CBAS).  Similar to ADHC, CBAS will offer center-based skilled health and nursing care, therapies, transportation and other services, to eligible low income seniors and people with disabilities.  Under the settlement, the planned December 1, 2011 ADHC elimination date will be moved to February 29, 2012 to ensure a seamless transition for eligible ADHC participants to the CBAS program, and provide time for the Court to review the settlement and give final approval of the Agreement.

Under the terms of the settlement, CBAS will be offered through Medi-Cal managed care plans in most parts of the State. CBAS will be part of the State’s 1115 Medicaid waiver, and will not cap enrollment, ensuring that all eligible beneficiaries are able to receive these vital services.  Current ADHC recipients who are not eligible for CBAS will receive enhanced case management to assist them to transition smoothly to other long-term care support and services in the community.  Many of the current ADHC providers will be able to provide CBAS services, thus ensuring continuity of care.

The settlement resolves the entire Darling v. Douglas lawsuit, which was filed over two years ago. Plaintiffs have argued that elimination of ADHC, without adequate and appropriate replacement services, would violate the ADA and other laws, by placing tens of thousands of ADHC participants at risk of institutionalization, hospitalization, injury or death. The Court issued two preliminary injunctions, stopping cutbacks in the ADHC program, and was set to hold a hearing on a third preliminary injunction motion the day the settlement was announced.  The State’s appeal of the second preliminary injunction is pending in the Ninth U.S. Circuit Court of Appeal and will be withdrawn pursuant to the settlement.  The United States Department of Justice participated in the lawsuit, by filing an amicus (friend of the court) brief in the appeal, and filing two Statements of Interest.

The Federal District Court has sent a Notice of Class Action Settlement to those who received Medi-Cal Adult Day Health Care at some point since July 1, 2011.

Download the Court’s Order Granting Preliminary Approval of Settlement Agreement.


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