What is CBAS?
CBAS, or Community-Based Adult Services is an essential Medi-Cal funded program that provides daytime support to older adults and people with disabilities so they can remain safely in their homes. CBAS enables family caregivers to work while still supporting their loved ones. For tens of thousands of Californians, CBAS is the difference between aging in place and being forced into a nursing facility.
Who Does CBAS Serve?
Eligibility for CBAS is based on functional and care needs, not diagnosis. While many participants have conditions such as Alzheimer’s disease, dementia, Parkinson’s disease, or mental health disabilities, the program serves individuals with a wide range of needs.
Most participants:
- Require assistance with mobility, bathing, medication management, and meal preparation
- Are at high risk of falls
- Have cognitive impairments, such as dementia or Alzheimer’s Disease
- Have vision or hearing disabilities
What Services Does CBAS Provide?
CBAS offers a comprehensive package of medical, therapeutic, and supportive services in a single adult day health setting, including:
- Nursing services
- Physical, occupational and speech therapies
- Mental health services
- Therapeutic activities
- Social services
- Personal care
- Hot meals and nutritional counseling
- Transportation to and from home
CBAS Meets People Where They Are
To meet the needs of participants, CBAS centers provide on-site skilled nursing care, personal care, rehabilitative therapies, specialized meals, and psychiatric and social work services. Many centers offer art, music and games, as well as socializing opportunities. Centers also offer transportation to and from the center, an essential service used by nearly 87% of CBAS participants.
Carol’s Story
When Carol, a military veteran, began experiencing dementia-related cognitive decline, she moved in with her daughter, Danielle. Around the same time, Danielle became a new mother. Although Carol received 20 hours of caregiving support through the VA, it was not enough to ensure her safety while Danielle was at work.
Enrollment in a nearby CBAS center changed everything. With Carol attending CBAS during the day, Danielle—now caring for two young children—was able to return to full-time work, knowing her mother was safe, engaged, and supported. At the center, Carol thrived. She participated in music therapy, art activities, and social events, and built meaningful connections with other participants. “My mom would light up when she went there,” Danielle shared. “The social interaction, the music, the art—the sky was the limit.”
In late 2024, the CBAS center closed because, according to the provider, low reimbursement rates failed to keep pace with rising operational and real estate costs. With no other CBAS option nearby, Carol now spends her days at home, isolated and without the stimulation that once brought her joy.
Without CBAS, Danielle has been forced to reduce her work hours and is considering leaving her job entirely to care for her mother full time. “I feel sad because I like my job and what I do,” she said. “But when I think long-term, being with my family has to come first.”
CBAS is Always Under Threat
Despite its important role in supporting adults with disabilities, Medi-Cal’s adult day health service has repeatedly been targeted for cuts or elimination during state budget shortfalls.
Darling v. Douglas
During the 2009 budget crisis, California attempted to eliminate the service as a Medi-Cal benefit entirely. This action prompted the class action lawsuit Darling et al. v. Douglas, led by Justice in Aging and partners on behalf of approximately 35,000 low-income adults, including older adults with disabilities. The case settled at the end of 2011, preserving the program. As part of the settlement, adult day health services were shifted from a state plan benefit to delivery predominately through managed care plans. The Governor’s 2020 revised budget also proposed eliminating CBAS entirely, but the proposal was not included in the final budget that year due to opposition by advocates.
Gaps in Services Across the State
Access to CBAS today depends largely on geography rather than need, leaving many eligible individuals without access to care solely because of where they live.
The Darling settlement made CBAS a managed care benefit in only the 28 counties where the service existed in April 2012. In the remaining 30 counties, CBAS is an optional benefit that may be offered if a CBAS center is available. As of this writing, Tulare County is the only non-mandatory county where CBAS is available.
Stagnant reimbursement rates—largely unchanged since 2009—combined with the financial strain of the COVID-19 pandemic have led to widespread center closures and service reductions in many counties.
After center closures in Marin and Sonoma counties, CBAS is currently available in only 26 of the 28 mandatory counties. Despite the growing need for services and the increase in overall capacity following the transition to managed care, the services are not distributed across the state equitably. For example, Los Angeles County accounts for 63% of the total increase in CBAS capacity since 2013.
** Figure showing the number of adult-day health centers by county. Mathematica, California Statewide Non-Medi-Cal Home and Community-Based Services Gap Analysis Report, (June 2025) at 76.
CBAS By the Numbers
- CBAS offers 40,000 low-income older adults and adults with significant disabilities an alternative to institutionalization.
- 80% of participants are older adults and 24% are 85 and older.
- 20% of program participants have a dementia diagnosis.
- 48% have a mental disorder diagnosis.
- 5% have an intellectual or developmental disability.
- 318 licensed centers operate in 26 counties.
- Linguistically diverse participants (78% speak a language other than English).
- The majority (63%) are women.
- The racial breakdown is 33% Asian, 37% white, 3.5% Black.
Lawmakers can support the desires of older Californians to remain at home and living in dignity in their communities, support family caregivers, invest in equity, and address the long-term sustainability of Medi-Cal by prioritizing funding for this vital and cost-effective program.
Sources
California Department of Aging, CBAS Participant Characteristics
CA Health Advocates, “Governor Proposes $9 Billion in New Massive Cuts, Entire Programs Targeted for Elimination,” (Jun3 9, 2009)
Darling et. al. v. Douglas, No.: C-09-03798 SBA (N.D. Cal., Dec. 1, 2011) (settlement agreement)
Darling v. Douglas, 4:09-cv-03798 (N.D. Cal. Jan. 25, 2012); DHCS, CalAIM Demonstration Special Terms and Conditions, Section 5.1(a)(iv) and 5.1(b), (Nov. 7, 2025), (page 22)
CA Association for Adult Day Services, “Stronger Together,” (Jan. 20, 2026)
