Assisted living
California insurer's cut to an assisted living Medicaid benefit could push 3,500 seniors toward nursing homes
Health Net is ending a Medi-Cal benefit that pays for 24-hour care in board-and-care and memory care homes for about 3,500 low-income seniors, and nursing home leaders expect some to land in nursing homes or hospitals instead.
Key facts
- Skilled Nursing News reported on August 24 that Health Net, a California Medicaid health plan, announced a cut to assisted living benefits for about 3,500 low-income seniors.
- The benefit pays for 24-hour services in board-and-care homes, memory care homes and similar residences, and is part of the state's Medicaid overhaul meant to reduce repeat emergency visits and hospital stays.
- The latest extensions run through December 31.
What happened
Skilled Nursing News reported on August 24 that Health Net, a California Medicaid health plan, announced a cut to assisted living benefits for about 3,500 low-income seniors. The benefit pays for 24-hour services in board-and-care homes, memory care homes and similar residences, and is part of the state's Medicaid overhaul meant to reduce repeat emergency visits and hospital stays. The latest extensions run through December 31.
Health Net argued the program moved people from home into assisted living rather than out of nursing homes, and had not led to better care. Many people using the benefit have dementia or similarly high care needs. Some provider contracts expire October 7, though benefits are supposed to continue through the end of the year. A deputy director at California Advocates for Nursing Home Reform told CalMatters the fallout is "going to be a disaster."
What it means for families
When a payer stops covering assisted living, residents with high needs do not stop needing care. Families may be asked to pay privately, bring a parent home, or look for a nursing home bed, and nursing homes in many areas are already limiting admissions.
For example: a mother with dementia in a memory care home paid through this benefit could get a notice that coverage ends at year-end. Her family would need a plan before then, not after.
What this means in New York: this is a California plan decision. New York's assisted living Medicaid program works differently, but the same question applies: ask how your parent's assisted living stay is paid for and what happens if that payment changes.
Quick answers
Who is affected by the Health Net assisted living cut?
Skilled Nursing News reported on August 24 that Health Net, a California Medicaid health plan, announced a cut to assisted living benefits for about 3,500 low-income seniors. The benefit pays for 24-hour services in board-and-care homes, memory care homes and similar residences, and is part of the state's Medicaid overhaul meant to reduce repeat emergency visits and hospital stays. The latest extensions run through December 31.
What to do this week
- If a parent's assisted living is paid by a Medicaid health plan, call the plan and ask in writing whether the benefit is changing and when.
- Ask the residence what happens to residents if the plan stops paying, and how much notice they give.
- Keep copies of every notice and write down who you spoke to and when.
Sources
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