Think Seniors Blog

Forum on Integrating Health & Long Term Services for Dually Eligible Seniors and People with Disabilities in Alameda

WHEN:
Monday, February 6, 2012, from 10:00 to Noon

WHERE:
Ed Roberts Campus
3075 Adeline Street, Berkeley
(across from Ashby BART station)
in the 1st Floor Conference Room

The state is moving forward to select at least 4 (and likely 10) counties to pilot Managed Care Integration for Dual Eligibles. Alameda Alliance for Health is spearheading a collaborative effort to develop Alameda County’s application. February 6 is a unique opportunity for service providers and consumers to give feedback regarding key aspects of the plan.

Who should attend? Dually eligible (Medicare+Medi-Cal) seniors and people with disabilities, their caregivers, and service providers. Alliance needs to hear from all of us.

What does “Integration” mean? The State’s plan is to enroll all Duals into a Managed Care model that includes MSSP, IHSS and other Long Term Services and Supports. Click here to view the state’s Request for Solutions (this is the request that describes what the state wants). In Alameda County we have an opportunity to design this new system so that it works for people. Your input is vital to this planning process!

Please contact me if you have any questions or need a ride to the meeting.

- Wendy

On January 5, Governor Brown released a budget proposal for California’s 2012-13 fiscal year. His plan addresses a $9.2 billion deficit (a combination of a current fiscal year shortfall of $4.1 billion and a projected $5.1 billion deficit for the year beginning July 1, 2012). The plan calls for $10.3 billion in cuts and revenue (leaving a $1.1 billion reserve fund). The plan includes:

• $6.9 billion in additional revenues from a ballot measure asking voters to increase the sales tax by ½ percent and impose higher income tax rates on high-income Californians.
• $5.4 billion in “triggered” ballot spending cuts to take affect on January 1, 2013 if voters don’t approve the November measure.
• $4.2 billion in cuts to CalWORKs, child care, Cal Grants, Medi-Cal, In-Home Supportive Services and other programs.

Terribly deep cuts to senior services enacted in the 2011-12 Budget remain in place, and have seriously damaged remaining life-line programs for seniors – In-Home Supportive Services, Supplemental Security Income cash grants for indigent elderly and disabled, Multi-purpose Senior Services Program case management, and Medi-Cal health care coverage. A negotiated settlement stopped the elimination of Medi-Cal coverage for Adult Day Health Care, but it remains unclear just how many current ADHC patients will be able to access the service once it is reconstituted under Medi-Cal Managed Care.

The following describes the Governor’s new budget proposals that would directly impact seniors and senior services in Alameda County.

MEDI-CAL PROPOSALS

Expand Dual Integration to More Counties. The Governor proposes to launch integrated managed care for dually eligible seniors and people with disabilities starting in January 2013. Essentially, the Governor proposes to extend the four Dual Integration Demonstration Pilots to ten counties. The state is currently preparing to receive applications from counties seeking to launch Pilots that will integrate managed care with long term supports and services (including IHSS, ADHC, MSSP), nursing homes, and ultimately with behavioral health care. Alameda County, with about 45,000 “duals,” is one of the counties preparing to apply.

This proposal assumes that all duals in the ten Integration Project counties would be enrolled into Managed Care Plans; that authorization for IHSS, MSSP, and Medi-Cal coverage of ADHC would be the responsibility of the Managed Care Plans; and that this change would phase-in over 12 months. The Governor’s proposal acknowledges challenges that include consumer protections, uniform assessment tools and consumer choice, but anticipates that the “single point of accountability for services” will result in cost savings and increased quality.

Launch Managed Care in Rural Counties. The Governor also proposes to launch Medi-Cal Managed Care in the rural counties that are currently fee-for-service. The Governor’s plan indicates a start date of June 2012 for this change, but does not provide dates or details for what would presumably be mandatory enrollment in Medi-Cal Managed Care Plans. This proposal does not affect Alameda County.

Institute Open Enrollment Period for Medi-Cal Managed Care. Currently Medi-Cal beneficiaries – including seniors and people with disabilities who are Medi-Cal only and those who have dual coverage – are able to enroll in or switch to a Medi-Cal Managed Care Plan throughout the year. The Governor expects that this will create better continuity and realize savings to the General Fund ($3.6 million in FY 2012-13 and $6 million the following year). There is no discussion in the Governor’s proposal about how this restriction would apply to people who have been “defaulted” into a Plan and may not even realize this until they seek care.

IN-HOME SUPPORTIVE SERVICES PROPOSALS

Assume the 20% “Trigger” cut. The Governor’s budget proposal assumes that the court action to block this year’s enacted 20% reduction in IHSS hours will be lifted, and anticipates the cut will go into effect on April 1, 2012. The Governor recommends a set-aside in the budget in case the injunction stands.

If the cut goes forward in April and the Governor proposes, only some will be exempt – those who receive the maximum of 283 hours per month, those who receive Protective Supervision, and those who receive services under a Home and Community Based Services Waiver.

Limit Domestic and Related Services. The Governor’s proposed budget would eliminate IHSS domestic services for recipients who live with other household members. The elimination would cut $163.8 million from the 2012-13 IHSS program, and would affect about 254,000 seniors, children and adults with disabilities. Domestic and related services include meal preparation and cleanup, housework, shopping, and laundry.

Repeal the Medication Dispensing Machine Project. The Governor’s proposal accepts that this project failed, assumes the savings will not be achieved, and eliminates it from FY 2012-13. The project was supposed to save $140 million for this year’s General Fund.

In Alameda County, almost 18,000 seniors and adults and children with disabilities rely on IHSS. The majority of them rely on a caregiver to provide personal, domestic and related services. Over 14,000 cannot perform housework without help; Over 11,000 cannot prepare meals without help; Over 15,000 cannot shop for food without help. Over 11,000 live in a shared living arrangement and most of these would lose their domestic and related services under the Governor’s proposal.

CAREGIVER RESOURCE CENTER PROPOSAL
The Governor proposes to eliminate funding for the eleven Caregiver Resource Centers in California. In 2009 Governor Schwarzenegger used his line item veto to cut 70% of state funding for Family Caregiver Alliance and the other ten Alzheimer’s Resource Centers in California. This cut has had a significant impact on these organizations, yet they continue to provide information, education, respite, care planning and support for families and friends who are caring for adults with chronic disabling health conditions. If California eliminates it’s funding, CRCs will lose the match they need to draw down federal dollars, and California’s 5 million family caregivers who provide $47 billion in “free” care may be without support.

California’s Department of Health Care Services is moving rapidly forward to launch demonstration projects in four to ten counties in January 2013. The intent is to enroll duals (seniors and people with disabilities who are covered by both Medicare and Medi-Cal) into managed care plans that integrate medical, long term care and home- and community-based supports and services (including In-Home Supportive Services). Plans from all over the state are gearing up to apply, including in Alameda County where we have about 45,000 Duals (more on this next week).

Here is a time line:

> DHCS released a draft of the Criteria/Request for Solutions last week.
> Comments on this draft are due January 9, 2012.
> Release of final criteria will be mid to late January.
> Applications will be due mid to late February.
> Selected counties will be announced in March.
> DHCS releases draft of proposal that will go to Center for Medicare and Medicaid Services (CMS) in March.
> Comment period on DHCS proposal will close in April.
> DHCS submits draft proposal to CMS and federal comment period opens in late April or early May 2012.
> Once the state proposal is approved, the demonstration pilots will begin working towards a launch date of January 1, 2013.

This is a tall order, even before considering the multiple independent systems and organizations that would need to coordinate and repurpose, and the very real disruptive impact such a change could have on the vulnerable population in the spotlight.

The first step to ensure a positive outcome is a close examination of the Draft Criteria and clear feedback to DHCS by email to OMCPRFP9@dhcs.ca.gov by 5 p.m. on January 9. If you can carve out the time, do it!

- Wendy

P.S. Today the Governor released his proposed budget for 2012/13, which included launching Duals Managed Care in 8 to 10 counties, and making these permanent rather than demonstrations. These are proposals, and won’t be incorporated into DHCS’s plans until they are legislated.

On January 10 the Governor is expected to release his proposed budget for 2012. In anticipation of this announcement, advocates are coming together at five rallies across the state on January 10th to call for a “California Budget for the 99%” – a budget that prioritizes the needs of our state’s residents. The rallies will take place in Fresno, Los Angeles, Sacramento, San Bernardino, and San Francisco. Here is contact information for the two closest to Alameda County:

Sacramento: 11am/ North Steps of the Capitol Building, Sacramento. Contact: Evan LeVang at Evan.Levang@ilsnc.org (530) 893-8527

San Francisco/ 3pm/ State Building, 350 McAllister Street, San Francisco, CA 94102. Contact: Pete Woiwode at pwoiwode@communitychange.org (510) 504-9552

Today US District Court Judge Claudia Wilken issued a temporary restraining order that requires the Brown Administration to halt all actions to implement the 20% across-the-board cut in service hours for hundreds of thousands of elderly and disabled Californians who rely on the In-Home Supportive Services (IHSS) program. The judge’s order also requires the State to rescind any notices of action to the counties and any IHSS recipients that it has sent out.

In Alameda County, over 17,600 people receive the in-home care. While many are eligible for nursing home placement today, others are able to avoid serious medical complications thanks to the supportive care they receive.

The RO is in response to a law suit filed by Disability Rights California on behalf of IHSS consumers who stand to lose essential services if the trigger cut goes forward. A hearing is scheduled for December 15 in Oakland to determine whether a temporary injunction should be issued to block the cuts.

The IHSS cut was part of two “triggers” in the state’s FY 2011-12 budget that will engage automatically in January 2012 if the Department of Finance determines that revenues are not meeting expectations. Now that figures for October are in, it is becoming clear that both triggers will be hit.

The first trigger is set to cut $600 million from the budget, mid-year, including the $100 million across-the-board cut to IHSS and a $15 million cut in Medi-Cal, targeting the Program of All-Inclusive Care for the Elderly (PACE), the SCAN Health Plan, and the Aids HealthCare Foundation.

The second trigger is set to cut up to $1.9 billion in order to balance the budget. Most of these cuts would come from K-12 Education, but could also include deeper cuts to Community Colleges and the elimination of home-to-school transportation.

- Wendy

Here is CARA’s announcement:

STOP THE CUTS – RALLY AND MARCH
FRIDAY, DECEMBER 2ND AT 2PM
FEDERAL BUILDING, 90 7TH STREET AT MISSION ST.
SAN FRANCISCO
(MUNI/BART to Civic Center – 1 block south on 8th street to Mission, 1 block to 7th)

For more information, call CARA (California Alliance of Retired Americans) at 510-663-4086.

DAY OF ACTION IN SFTO STOP THE CUTS
The 1% Got BailedOut & The 99% Got Sold Out!
Expand Social Security!
No Cuts to Medicaid!
Medicare for All!
Jobs for All & Economic Fairness!

2:00 PM OCCUPY THE FEDERAL BUILDING PLAZA (7th & Mission St./Civic Center Bart/Muni).
Assemble at the SF Federal Building where hundreds of us will peacefully deliver our strong message to government representatives of No Cuts to Medicaid; Expand Social Security and Medicare for All while a rally is held outside in the Federal Building Plaza. We will then march to the Financial District.

3:30 PM OCCUPY WALL STREET WEST
We will march to several wretched symbols of corporate and financial corruption .— Westfield Plaza (to support SEIU Local 87), Wells Fargo Bank (to demand cancellation of student debt), and Verizon (to
demand end to attacks on 45,000 union workers) .— then to the Occupy SF area at the foot of Market St.

4:30 HYATT REGENCY
5:00 PM INTO THE NIGHT CELCEBRATE & DEFEND OCCUPY SF
We will gather for a protest action at Hyatt Regency Hotel (foot of Market St.), a notorious symbolof corporate greed, to express our solidarity with Hotel Workers Local 2 before assembling for a rally/
concert in Justin Herman Plaza to support Occupy SF. This is a peaceful & family-friendly day of protest.

We still have a lot of details to discover, and Judge Armstrong has to approve the settlement (probably in January), but the settlement in the long battle to preserve Adult Day Health Care in California was announced yesterday.

Here is a link to Marisa Lagos’ Chronicle article.

Here is a link to a Summary of the Settlement Agreement by Disability Rights California, the lead on the federal class action lawsuit.

Stay tuned for more.

- Wendy

Rallies in Oakland, San Francisco and Los Angeles have brought together people who want Adult Day Health Care to continue to be a part of their communities. Their message is singular: Tell Governor Brown to stop the December 1 elimination of Adult Day Health Care as a Medi-Cal benefit.

Please spread the word. Here’s how:
1. View these videos from the Alameda County Rally and the San Francisco Rally.
2. Call the Governor at (916) 445-2841.
3. Share both videos with your network.

With a hearing scheduled for November 15, we await the judge’s decision on granting an injunction to stop the state from eliminating Adult Day Health Care. Whichever way the judge rules, we need our Governor to understand that Adult Day Health Care is a necessary part of the continuum of care for older adults and people with disabilities.

-Wendy

Starting in January, counties will be able to utilize Social Security information to streamline the enrollment of eligible seniors into CalFresh. Alameda County’s Social Services Agency and Board of Supervisors endorsed AB 69 in June, and we are looking forward to working with them on implementation. An estimated 90% of seniors who are eligible for CalFresh don’t have it. The new law could help a significant number of seniors who are struggling to make ends meet.

AB 69 does not help seniors and people with disabilities who receive Supplemental Security Income – this group remains categorically ineligible for CalFresh, and this is a problem that still needs a solution.

A new report summarizes the impact of the state’s budget decisions and recent developments on senior services in Alameda County gathered at a September 7, 2011 convening of Senior Services Coalition stakeholders.