SANTA ROSA  -- Santa Rosa Community Health Centers and several other similar providers  have recently expressed concern that the state may not be living up to terms of  a settlement reached over budget cuts that could eliminate services for low-income residents. 

In mid-July, the group of Santa Rosa health centers said it would close it Southwest Adult Day Services at Friends House, because of a lower reimbursement rates that the state said it would pay as a means of shoring up a nearly $16 billion budget deficit. Despite its best efforts, the federally qualified health center said it could not operate the Friend's House program at the lower Medi-Cal rate. The federal rate was between $150 and $170 per person, compared to the state rate of about $78 per person.

The lower rates stemmed from a settlement reached last summer after several health centers sought a preliminary injunction against the Legislature's intention to eliminate Adult Day Health Care as a Med-Cal benefit.  Eventually, the Legislature and the suing parties reached an agreement that said the services would be under a new program, called Community Based Adult Services, instead of being under Medi-Cal.

But because Santa Rosa Community Health Centers is an FQHC, the settlement meant that it would have to be paid a lesser rate -- and thus incur a loss of about $50,000 a month for services that affected about 40 people, according to Naomi Fuchs, chief executive officer of the health centers. In response, the California Primary Care Association, the  Santa Rosa health centers and other FQHCs sued the state.

But the court sided with the state this time, allowing the Department of Health Care Services to go forward with its plan to reimburse health centers at the lower rate. However, as part of the ruling, certain levels of care need to be maintained to satisfy federal requirements, according to Lydia Missaelide, executive director of the California Association of Adult Day Services.

As part of the settlement agreement, the state is supposed to be working to ensure that the patients from adult day programs are getting care somewhere, according to the Santa Rosa health centers. The lower reimbursement rate is prompting health centers across the state to shutter the programs, leaving some 35,000 older, frail and low income residents and their families with no alternative  service other than a nursing home. That may violate the terms of the settlement under the  Americans with Disabilities Act, according to the centers.

That's where the health centers and other advocates say the state might not be  living up to its end of the bargain, a notion the Department of Health Care Services disagrees with.

"I do feel that the terms of the settlement are not being upheld," Ms. Fuchs said. "People are losing access to care. There's a false assumption that there's a patchwork of  services that can make up for it. It's really a tragedy that the state was unwilling or unable to come up with a way to keep that center open," she said of the Friend's House program, which is in Rincon Valley.

For it's part, the Department of Health Care Services said it is committed to the settlement and that FQHCs are simply now receiving the same rate as other health centers.

"DHCS is committed to ensuring that individuals eligible for (Community-Based Adult Services) receive the services to which they are entitled," spokesman Anthony Cava said in a statement.  "DHCS is engaged in dialogue with those FQHC centers that have raised concerns both to ascertain the nature of the problem being attributed to the lower reimbursement rate and whether options are available to allow their program to function within the parameters of the revised rate."

Ms. Missaelide said the state is required to report on access to care to the federal government whenever any change increases or decreases by 5 percent. She pointed to a list of 34 health centers that have closed their adult day health care services since June 2011, including five this year. Santa Rosa will stop its services on Aug.10. Numerous other centers, including FQHCs, are contemplating the same.

This article has been corrected to reflect the proper name of Southwest Adult Day Services at Friends House.