California orders Health Net to extend assisted living coverage through year-end

California health regulators have ordered Health Net to maintain assisted living coverage for its low-income Medi-Cal members through the end of the year. The directive follows an abrupt decision by the insurer to terminate these contracts, which left thousands of patients and care providers scrambling for alternatives.

The state’s Department of Health Care Services (DHCS) issued a corrective action plan requiring Health Net to extend services for all affected members until December 31. Previously, the insurer had notified providers several months ago that it was ending its assisted living and home care contracts, with some terminations scheduled to begin as early as October.

In an August letter to the company, DHCS cited eight specific deficiencies in how Health Net handled the transition. These failures included not submitting transition plans for members, failing to move patients to other appropriate medical care, and denying services to those who needed them. Regulators stated that these violations jeopardized member safety and disrupted continuity of care.

Advocates and providers estimate that approximately 3,500 Medi-Cal patients rely on Health Net for assisted living costs. Most of these individuals are elderly, with many suffering from cognitive issues such as dementia. Health Net operates Medi-Cal plans across ten counties: Amador, Calaveras, Fresno, Inyo, Los Angeles, Mono, Sacramento, San Joaquin, Stanislaus, and Tulare.

If the insurer fails to extend benefits and create individualized transition plans for each member, the state may impose fines of $25,000 per member for every day the violation continues. Providers have confirmed that their contracts will now run through the end of the year.

Health Net spokesperson Beatriz Lopez stated that the company still intends to end the assisted living service next year but will cover all current members through December. "Health Net and DHCS share a commitment to advancing the health and well-being of Medi-Cal members," Lopez said.

The insurer previously told CalMatters that the assisted living benefit had not resulted in better care, citing no reduction in emergency room visits or hospital days. The program is part of CalAIM, a state initiative aimed at stabilizing high-cost users to save money. Lopez added that Health Net would continue analyzing data to support services that improve health outcomes.

Despite the immediate extension, advocates warn that long-term housing insecurity remains. Hagar Dickman of Justice In Aging noted that thousands of older Californians are still set to lose their housing on January 1st. She explained that most assisted living residents have no other home to return to if coverage ends.

Dickman also pointed out that if a member moves to another insurer that still covers assisted living, continuity of care protections would not apply. This means the new insurer might not approve the costs, leaving residents with only skilled nursing or homelessness as options.

Pauline Shatara, deputy director of California Advocates for Nursing Home Reform, agreed that state protections are inadequate. "It doesn’t sound like we found a solution to help pay for these people to remain where they are," she said.

Source: Pleasanton Weekly.

Sources

pleasantonweekly.com