Health Net is moving to cancel assisted living benefits for approximately 3,500 low-income seniors enrolled in Medi-Cal by the end of the year. This shift affects residents in 10 California counties who rely on these payments to stay in board-and-care facilities. Many of these patients live with dementia or other complex health conditions that require 24-hour support. Families say the insurer has provided little to no clear communication about what comes next.
Advocates fear the loss of coverage will lead to a spike in homelessness and overcrowded emergency rooms. While the state government considers this an optional service that health plans may choose to discontinue, residents and their families argue the transition plans are non-existent. Most families cannot afford the costs out of pocket and lack the ability to provide intensive care at home.
Health Net claims the program failed to reduce hospitalizations or improve overall patient outcomes. They maintain that members will receive assistance to transition to other settings. However, providers report that they are receiving conflicting information about contract end dates and patient eligibility. Some families report that customer service representatives appear unaware that the program even exists.
Regulators state that members are entitled to services until December 31 provided the care remains medically necessary. Still, families describe a sense of panic as they face the potential for sudden eviction. With few alternative options available, many seniors and their caregivers remain in limbo while they wait for concrete answers from the insurer and the state.