Health Net ends assisted living benefit for 3,500 California Medi-Cal patients

Families of dementia patients fear homelessness and hospital cycling

Health Net, one of the largest Medi-Cal insurers in California, will end its assisted living benefit at the end of the year, according to documents obtained by CalMatters and interviews with providers. Approximately 3,500 Medi-Cal patients rely on the insurer to pay for assisted living costs.

Most of the affected members are elderly. Many have cognitive issues such as dementia, according to senior advocates. The decision could leave vulnerable people who need around-the-clock care without a way to pay for the facilities that provide it.

Matt Johnstone, whose 89-year-old father lives in a board-and-care facility in North Hollywood, learned of the change about four weeks ago when the facility called to inform him. His father has dementia and needs constant care.

The facility costs roughly $6,000 per month, a sum Johnstone and his brother cannot afford. Both brothers have health problems of their own and cannot safely meet their father’s needs at home, Johnstone said.

“He’s declining, and I just don’t know what’s going to happen if the program ends,” Johnstone said. Without insurance coverage, his father could end up on the streets, he said. CalMatters is not publishing the father’s name because Johnstone fears the plan will target him for speaking with media.

Two other insurers that contract with Health Net — CalViva Health and Community Health Plan of Imperial Valley — have also notified the state of their intent to discontinue assisted living benefits.

Health Net’s decision has been surrounded by confusion, with little public information released. Senior advocates and family members of assisted living residents fear people will become homeless, or that patients could be shuffled between hospitals and skilled nursing facilities.

Medi-Cal is California’s public insurance program for low-income residents and people with disabilities. The assisted living benefit the insurers are ending is what pays for the residential care that enrollees like Johnstone’s father receive.