‘There is nothing else’: Californians face eviction as insurer cancels assisted living benefit
- Health Net plans to end its assisted living benefit for Medi-Cal members at the end of the year, affecting about 3,500 patients who rely on it to cover care costs.
- The benefit helps pay most of the 24-hour service costs at board-and-care homes, memory care facilities and similar settings, while residents still pay room and board.
- Families and senior advocates say the change could force some older adults, including people with dementia, into homelessness, hospitals or nursing facilities if they cannot find another placement.
- Health Net said affected members will be supported through their current authorization dates and may be transitioned to nursing homes, home-based care or other programs.
- The company said internal data showed the program did not improve outcomes such as emergency-room visits or hospital days, and it said state guideline changes raised concerns about the program’s long-term viability.
Health Net, one of the largest Medi-Cal insurers in the country, is ending an assisted living benefit for members at the end of the year. The change affects about 3,500 low-income Californians and people with disabilities who rely on the plan to help pay for care in board-and-care homes, memory care facilities and similar settings.
The decision has created immediate concern among families and senior advocates, who say some residents may not be able to afford the monthly cost of assisted living without the benefit. In the case described in the report, an 89-year-old man with dementia could not safely return home, and his family said they could not cover the roughly $6,000 monthly cost on their own.
Advocates say the state program was meant to keep high-need patients housed and reduce costly emergency-room and hospital use. They argue that California did not build enough protections to prevent people from losing housing when a plan exits the benefit. State regulators dispute that criticism and say they will work with Health Net to preserve continuity of care.
Health Net said members will be covered through their individual authorization dates and may be transitioned to nursing homes, back home with in-home supportive services, or other programs. The company also said its internal data did not show better outcomes from the benefit and said changes in state guidance affected the program’s viability.
“别无他法”：加州居民因保险公司取消辅助生活福利面临被驱逐
Health Net 是美国最大的 Medi-Cal 保险机构之一，现计划在今年年底前终止面向会员的辅助生活福利。这一变化将影响大约 3,500 名依赖该计划支付寄宿照护、记忆照护及类似机构费用的低收入加州居民和残障人士。
这一决定已引发家属和老年权益倡导者的担忧。他们表示，如果没有这项福利，一些住户可能无力承担辅助生活每月的费用。报道中的一位 89 岁老人患有痴呆症，无法安全回家，而他的家人称自己无法独自承担每月约 6,000 美元的开销。
倡导者认为，这项州级项目原本是为了让高需求患者保持有住所，并减少急诊和住院的高额成本。他们指出，加州并没有设置足够的保护措施，避免保险计划退出后患者失去安置。州监管机构不同意这一说法，并表示会与 Health Net 协调，尽量保持照护连续性。
Health Net 则表示，受影响会员会在各自的授权期限内继续获得服务，并可能转入养老院、回家接受居家支持服务，或进入其他项目。该公司还表示，内部数据并未显示该福利带来更好的结果，同时称州方指引的调整影响了项目的可行性。