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Budget impasse halts Medi-Cal payments
State's crisis threatens group homes for adults and the disabled
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Photo by Dana Rene Bowler
Linda Mendoza, caregiver at Horizon House in Ventura, hugs Krystal Concha before her nap. Krystal receives medical care and constant interaction at Horizon House, which is struggling to stay afloat.
Photo by Dana Rene Bowler
Horizon House caregiver Lily Rodriguez with Krystal. Says Krystal's mother: "I don't know where she would go."
Photo by Dana Rene Bowler
Caregiver Susanna Saucedo rubs Krystal Concha's legs with the help of caregiver-in-training Jennifer Villanova, right, at Horizon House. The owner of Horizon House, Wanda Kruft, has already borrowed $40,000 to keep her two homes for developmentally disabled children open.
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As healthcare providers take out mortgages and borrow from friends to help group homes for the developmentally disabled, nursing homes and senior day-care centers withstand California's mounting Medi-Cal crisis, April Wiseman worries about her 77-year-old mother.
Lena Avery has Alzheimer's disease and on occasion wanders through her Port Hueneme neighborhood, at least once escorted home by police. While her daughter works in a school cafeteria, Avery spends her days at an adult day healthcare center in Oxnard. But owners say their finances are running out, largely because Medi-Cal payments have been halted until the state breaks through its budget impasse.
If the center closes, Wiseman would have to try to explain to her mother, though she knows it's an impossible task. Her mom would just make a face and walk away frustrated and confused.
"She would think she'd be going every day and she's not," Wiseman said.
Like everything else involving the state's $15.2 billion budget deficit, the Medi-Cal crunch and its impact on the poor families, seniors and disabled people covered by the state insurance program are confusing. Reimbursements to doctors, pharmacists and other providers were cut 10 percent in July. Because the state is operating without a budget, payments to nursing homes, group homes for the developmentally disabled, hospitals and others have been stopped until there's a budget agreement.
A vote on a budget proposed by Democrats is scheduled in a special session of the Legislature today, but passage seems unlikely without support of Republican lawmakers and Gov. Arnold Schwarzenegger.
Even if the budget is resolved this month, community clinics, some hospitals, nursing homes and group homes still won't receive payments due in August until September. Earlier this year, the state announced that $600 million in payments due this month would be delayed to help the state avoid going deeper into debt.
Considering 30-day notices
The cuts and delays have affected virtually everyone in healthcare. But independent owners of homes for the developmentally disabled and adult day care centers believe they might be among the hardest hit because they make little money in the best of times and operate with limited reserves. Most of them say they can survive August but offer no guarantees if delays in payments stretch past Labor Day.
Wanda Kruft of Ventura owns two group homes for children who are developmentally disabled and have seizure disorders or other health problems. Some of her nine clients are on feeding tubes or need around-the-clock care.
All of Kruft's income comes from Medi-Cal. She has already borrowed $40,000 from a friend to stay afloat and used a chunk of that to meet her $25,000 payroll on Friday.
"I can't guarantee I'll have it after that," she said, referring to her next payroll. She'll meet with employees this week to discuss how to let families know the center could close if the budget isn't resolved.
Panicked family members
"We'll probably give everyone 30 days' notice because you can't wait until the last minute," she said, noting that her clients would probably end up at larger facilities that have deeper pockets. "What's it going to be like if they're sent some place where they're just another kid?"
The cuts and delays brought bills aimed at helping providers. They also spurred efforts to rescind cuts in reimbursements. Associations have set up emergency funds for providers. When Medi-Cal-funded homes for the developmentally disabled exhaust all other financing, they can request aid from the Tri-Counties Regional Center, said Jackson Wheeler, a manager for the state-contracted organization.
"What it means is our agency will look and see if we have the money to give them," he said on a Friday morning that began with three panicked phone calls about Medi-Cal.
Wheeler said the group homes have survived similar budget struggles before. But the nationwide economic uncertainty might make the current crisis seem worse.
"I think there's a heightened sense of vulnerability," he said. "It's like just one more thing. It just makes it, in people's minds, worse."
It's the threat of closure that panics family members. Rachel Snee's 9-year-old daughter, Krystal Concha, has brain malformations that keep her in a wheelchair and unable to talk.
At Kruft's Horizon House, she gets medical care and constant interaction.
"Placing her in a home was the best thing that could ever have been done," said Snee, who has her own disabilities and knows she can't provide the care her daughter needs.
The possibility of a 30-day notice is a nightmare.
"I don't know where she would go," Snee said, quietly repeating the words. "I don't know where she would go."
The payment delays are complicated by the state's 10 percent cut in Medi-Cal reimbursements. That means pharmacies are losing as much as $30 to $40 for each prescription for some brand-name drugs used after transplants or for HIV, said Ali Karandish, pharmacy manager for Stan's Drugs in south Oxnard.
"Since the beginning of the cuts, we've probably lost $10,000 to $20,000," he said, noting the pharmacy has stopped accepting new Medi-Cal customers.
Scrambling for medication
Some care providers are scrambling to find pharmacies that will fill prescriptions for patients with seizure disorders or psychiatric needs.
The Tri-Counties Regional Center is helping facilities for the developmentally disabled purchase medications. The pharmacy industry also is fighting the cuts in reimbursement in courts and in the Legislature.
If the cuts remain, small pharmacies will suffer the most, said Karandish.
"We'll probably go out of business. That's probably most of the independents in the area," he said.
Stan Rosenstein, a chief deputy director for the California Department of Health Care Services, said that while pharmacies lose money on some prescriptions, they make money on others and should still come out ahead.
He said the 10 percent cut is an unfortunate but unavoidable reality.
"We can't spend money we don't have," he said, referring to the state's gaping deficit.
Rosenstein said the biggest problems are coming from delays in Medi-Cal payments. He said most of that damage will be mitigated when the Legislature passes a budget.
But trying to predict when that will happen is like using a crystal ball to tell the future, said Assemblyman Pedro Nava, D-Santa Barbara. He believes the culprit is California's ranking as one of three states that require a two-thirds vote to approve the budget. The law allows a small minority of legislators to block the budget, he said.
Taking out a mortgage
"The tragic part of every budget delay is that the very first casualties are the poor, the infirm and the elderly," he said.
Assemblywoman Audra Strickland, R-Moorpark, believes the state insurance program is being used as a pawn to force legislators to vote for a bad budget. She thinks the state needs the kind of bill she once wrote that would create special funding to protect Medi-Cal patients when there is no budget.
The delays in payments are forcing some nursing homes to dig deep for credit.
Claude Linkous, administrator of the Los Robles Care Center in Ojai, said the facility's owner took out a $350,000 mortgage on a house.
"We didn't want to do it," he said. "We wanted to keep it and use it for a rainy day. I guess this is a rainy day."
Linkous said the nursing home will survive no matter how long the budget impasse lasts.
"Somehow or other, we would come through," he said.
Senior adult day healthcare centers are being hit both by the payment delays and the cuts in reimbursements, said Inna Berger of the Oxnard Family Circle center. Even if payments resume soon, she worries that the 10 percent cut could force centers like hers to close.
Most of the 140 clients at her center come from low-income families that have no way to provide care during the day. She worries about seniors being left alone with no one to administer their prescriptions.
"We're going to be left with a humanitarian tragedy," she said.
— The Associated Press contributed to this report.
Posted by opns on August 17, 2008 at 2:47 a.m. (Suggest removal)
And we need more Prison Hospitals? I know I'm not the only one who see's something wroung here. Prison inmates are being 'hand fed', treated like royalty - while our hardworking retired generation is taking a slap in the face. How dare Sacramento do this to our elder generation. The government offices are so good at frustrating the american people, they are doing a very good job at this. Lets see what else are they good for?
Posted by ironwoman on August 17, 2008 at 8:02 a.m. (Suggest removal)
opns- You took the words right out of my mouth....maybe the Federal Receiver can add these people to his list to help out and order Billions to provide them basic healthcare. I mean, these are just disabled people that need medical care... The system disgusts me knowing that Our State may give this Receiver this kind of money when the disabled are suffering and need help themselves. And what did they do wrong? Nothing. Yet, let's give CONVICTED FELONS gold-plated medical care....free of charge. YES, there is something wrong here.
Write to your legisture. Just think, the guy who killed the innocent man yesterday at the US Bank in Oxnard, when caught, he will be provided free medical care because it's his constitutional right.
Posted by filipaisa on August 17, 2008 at 8:48 a.m. (Suggest removal)
what i think should happen and pardon me if i am wrong here....is to START SCREENING everyone and ANYONE...who is applying for WIC..MEDICAL..FOODSTAMPS. If they dont have proper I.D then they shouldnt be allowed financial assistance. most of the families hit hardest are people who actually pay the taxes and pay there dues to this community and we cant even get assistance from the goverment. and if we cut out all the people who are recieveing it fraudulently then that would make more money and care avaiable to these group homes and the kids/adults with special needs will have a place and that wont get taken away.
Posted by filipaisa on August 17, 2008 at 10 a.m. (Suggest removal)
couldnt agree more patti!
Posted by THESILKY1 on August 17, 2008 at 10:22 a.m. (Suggest removal)
As I said before and I will say it again. 8 billion dollars does not grow on trees. 8 billion dollars comes from cutting Social Service Programs, Education, Higher Taxes. This is what Clark Kelso is costing the County Residents and the people of California.
Some Granny will loose her ride share program to the Dr's office. so Clark can build his prison playground, so corrections can play doctor.
Some Client with Disabilities who is in a program with the Department of Rehabilitation will loose funding for his/her Educational Program, Transportation, Retraining, Job Placement etc.
If Clark is so dedicated to the cause and not his salary, Clark can donate some of his $800,000 dollar salary to the cause, to include his so called bonus, and I think he should build one of his new facility's in his backyard.
How about it Clark are you up for that one?
The Hillbilly Prince.
Posted by THESILKY1 on August 17, 2008 at 11:19 a.m. (Suggest removal)
How about this,
The Federal Judge and Clark Kelso need to build a billion dollar Health Care Facility for our Senior Citizens and folks with Disabilities at the site of the Ventura Youth Correctional Facility.
What happened to their rights?
These folks have committed no crimes and have paid into the system their entire lives. Why don't they receive the special attention deserved and get the golden treatment.
I think California's priorities are headed in the wrong direction.
Why don't we take care of these folks, who need it the most, and who are the most deserving?
A billion dollar facility would house, all those in the county with needs. This would bring high paying jobs, and create employment for all, and be an asset to the community.
How about that Mr, Henderson and Mr. Kelso, where's the receivership for our Seniors and people with special needs?
Hillbilly Prince.........
Posted by insideedge on August 17, 2008 at 11:48 a.m. (Suggest removal)
Easy soultion...Cancel Medi-cal. make em all go get jobs, like me, and PAY for health insurance
Posted by HotModernMom on August 17, 2008 at 12:21 p.m. (Suggest removal)
I thought the Democrats were all for "helping" the average citizen (sarcasm).
If the budget passes as is the MIDDLE CLASS gets screwed with even HIGHER taxes.
If the budget does not pass then these poor folks who need Medical get screwed and of course the Dems will blame the "mean" Republicans (have you seen the lastest commercial by the Califoria Teachers UNION blaming Republicans for not passing the budget-----this union is obviously in bed with the tax and spend libs).
Spending as out of control - tax revenues have ACTUALLY INCREASED 24% in the past 5 years yet the liberals in Sacramento "have no money" to pay for their programs. Sickening. Just plain sickening.
Their is plenty of tax revenue, just quit spending like their is no tomorrow on all of these social do gooder programs for illegal aliens and these 8 billion dollar medical castles, ahem....prisons.
Take back our state of vote these liberal spenders out! They care more about illegals and "sick" (how about sicko) prisoners than they do about you!
Posted by HotModernMom on August 17, 2008 at 12:48 p.m. (Suggest removal)
The Alzheimer's patients in this article are getting screwed by the illegal aliens who receive SO MUCH of our tax revenue for their "free education" in k-12, in state tuition privledges at the universities (though out of state Americans pay LOTS MORE), and VERY EXPENSIVE emergency rooms visits for colds, ear infections and gas, yes gas (too much lard from Tres Sierras). Now theses Alzheimer's cannot receive care because the state is "out of money" (which is BS). If I spend all my savings away I cannot demand more from others! These Sacramento libs are just plain, greedy jerks who only care about a potential vote from illegals who may be given amnesty some day. Sick, sick, sick!!!!
P.S. Let's not forget about the A-1 healthcare for prisoners at the proposed Castle Camarillo Estates Healthcare for the "Mentally Insane".
Posted by caokie on August 17, 2008 at 2:32 p.m. (Suggest removal)
Any adult who came here and has no proper ID can not get medi-cal, they can only get emergency medi-cal, but VCMC MUST treat them. Even for the slightest cut or cough. But their kids who are born here get full scope medi-cal and their parents do not pay any taxes to help pay for them. Besides medi-cal they can get WIC,food stamps and they can get housing due to fact the kids has a social security card. Here a good one a kids who is here illegally can get health coverage from the county thur the ACE for kids program that program was set up for kids who are in violation od federal law. They can use any county clinic that's why it takes so long at VCMC, go to the urgent care at Las Islas and you are there all day nothing urgent about it at all. I agree that all members of the county board of supervisors should have to use medi-cal and use the county system. And the county also has a self-pay program where the patient pays only a part of the bill , guess who pays the rest.
Posted by Rocket81 on August 17, 2008 at 2:49 p.m. (Suggest removal)
Lock the SOB politicians in chambers and let them stay there until they get it done. Cut the pork and all the BS they wasted the millions of dollars the past few years. They wasted it and blew it for the whole state. This needs to be done at all levels of government.As for prison hospitals: Screw the prisoners, they got there by choice. And screw the lawyers for being lawyers.
Posted by tsetsaf on August 17, 2008 at 3:21 p.m. (Suggest removal)
Posting here does nothing. Contact your representative by finding them here: http://www.legislature.ca.gov/port-zi... (I just did)
Posted by mailo24 on August 17, 2008 at 4:09 p.m. (Suggest removal)
Well let the families members worry about there own it shouldn’t be put on hard working Americans. Sorry waste of ink and paper. I won’t loose sleep over this.
Posted by mailo24 on August 17, 2008 at 4:22 p.m. (Suggest removal)
their
Posted by THESILKY1 on August 17, 2008 at 8:53 p.m. (Suggest removal)
I'm sure you won't loose any sleep over this,until it happens to you. however your tax dollars will care.............
Posted by filipaisa on August 18, 2008 at 1:41 p.m. (Suggest removal)
i think that is all BS i have to admit i kno someone who is a immigrant and recieves healthcare and wic! and it jus really get me sick to my stomach at times knowing that they can recieve these things and get a free ride...while i have to work my way to take care of my special needs child
Posted by queenbsnee on September 2, 2008 at 1:43 p.m. (Suggest removal)
That is my daughter who is in the pictures. We all have our opinions and reasons for having those opinions. If I could take my daughter home and care for her like the people at Horizon House does then I would. I am disabled aswell because of an accident. I am having a fundraiser for the home this weekend, September 7 and 8 at Burger Barn in Camarillo. Please come and support the home or just come for burgers and football. Hope to see you there. Thank you
Posted by bartholomew1 on October 25, 2008 at 9:42 p.m. (Suggest removal)
insideedge you are very stupid i am on med i cal and i do have a full time job that i can get insurance through but if i can get it for free why not i have kids and it is tooooo expensive for me to pay for them with my work we on medi cal get treated very poorly it seems like no one cares that is not right health insurance should be free for everyone and get treated the same
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