LOS ANGELES, CA — Health Net, a California-based insurer that serves Medi-Cal members, is ending assisted living coverage for about 3,500 low-income seniors in the state at the end of the year. Families and elder-care advocates say the change could disrupt housing and daily support for older adults who rely on board-and-care homes, memory care facilities and similar settings.
The decision has raised particular concern for people with dementia and other high care needs. Critics say losing the benefit could force residents into hospitals, nursing homes or other placements that may not match their needs, while some families warn they cannot absorb the monthly costs on their own.
What Health Net Said
According to CalMatters, Health Net said the assisted living benefit will end Dec. 31. CalViva Health and Community Health Plan of Imperial Valley, which contracted with Health Net, are also affected. The benefit helps pay for 24-hour services in assisted living and similar residences.
In an unsigned statement, the company said members would continue to receive care until their authorization periods end and could be moved to nursing homes, in-home care or other programs. Health Net also said it was working with members, providers and care management teams to build individualized transition plans tied to clinical needs and eligibility for other services.
Why Families Are Worried
Advocates say the move could hit some of California’s most vulnerable seniors hardest. The benefit is part of CalAIM, the state Medi-Cal overhaul meant to improve care and reduce repeat emergency room visits and expensive hospital stays. Health Net argued in filings to regulators that the program had not produced better care and was bringing more people from home into assisted living instead of moving nursing home residents into lower-cost settings.
Families told CalMatters the rollout has felt confusing and abrupt. Matt Johnstone said his 89-year-old father, who has dementia, lives in a North Hollywood home that may not be able to keep him there without insurance support. Jennifer Horcasitas-Glenn said she struggled to get clear answers about coverage for her 75-year-old mother-in-law, Jacqueline Glenn, who has dementia and Alzheimer’s.
What Happens Next
State regulators say members can keep services through Dec. 31 if the care remains clinically appropriate, and people whose approvals expire before then may ask for an extension. The California Department of Health Care Services said it will work with Health Net to ensure member protections and continuity of care. Patients are supposed to receive 30 days’ notice, can file grievances or appeals, and may qualify for other services.
Advocates say those safeguards may still leave families searching for new plans or placements, especially because some other Medi-Cal plans continue to offer the benefit while approval for long-term care can be difficult to secure. Health Net members and providers are watching Oct. 7 as well, when some provider contracts expire, even though the benefit is scheduled to continue through Dec. 31. Families can check directly with Health Net and the Department of Health Care Services for updates.
More on health, care, money and the people nearby, on Westlake Arrow.