Assembly Budget Subcommittee No. 2 on Human Services, Wednesday, April 15, 2026
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Assembly Budget Subcommittee No. 2 on Human Services California State Assembly
Follow its sittingsSpeaker 2
As always, comprehensive, thorough, somewhat abbreviated, no offense. But there's lots of detail and nuance here as well. I wanna also appreciate colleagues from Department of Social Services on the first couple panels with me today. Very quick overview of the budget. I'm not gonna tell you a whole bunch.
The bottom of page seven really sums it up. We have a current year budget of 18,700,000,000, and it grows in our proposal to $21,100,000,000 in the budget year. That's an increase of $2,400,000,000 year over year. We're also expecting to see nearly 38,000 individuals join our caseload. And we were pretty close last year when we estimated we'd add about 30,000 this year.
We added about 28,000 this year. So just phenomenal growth in our system. That's the equivalent of adding a single regional center every single year the last couple years. And we still, yes, have 21 of them. I'm really proud of the the work that it represents.
You know, there are ongoing there are many things here. I know you noted a variety of trailer bill proposals. We do consider them budget proposals, although, of course, policy is made in the budget as well. The objections we have heard across all the issues from stakeholders have not heard a single thing that's insurmountable with perhaps one exception at the end that we can talk about when we get there. If the legislature is interested in consensus language, we would appreciate as an administration and Department of Finance being clear on that expectation so that we bring back a revised version, but always happy to pursue what we've historically done, which is work through legislative staff to achieve that consensus.
So a direction there is helpful. Obviously, lots to be proud of. The bottom of page six in the agenda lists four basic budget adjustments for the department, ongoing commitment to IT, implementation of a federal mandate, redirection of existing resources, recognizing we don't have a lot of money to throw around. We've taken a really hard look at our state operations and redirected some funding. And I also wanna take a moment and acknowledge both the individuals and families, but also the staff from the department who for years took care of people while they lived at Fairview Developmental Center in Southern California.
We have shut down that property now. The last residents moved out several years ago, but it's a major milestone in California history. Only Porterville Developmental Center remains, and people go there because they're forensically committed, not because there are no other places for them. So just wanna mark that point in history, but no longer staffing that, running the diesel boiler for the facilities. There's some savings achieved to the state as a result of that proposal.
Beyond that, obviously, we have state chronic fiscal situations, structural deficit to address, And we also have a variety of federal activities, both past and feared upcoming based on the president's proposed budget. So we continue to watch federal happenings, and I'll make that my transition then into HR one conversations. We are continuing sorry. Flip to the right page for those questions. The first question asked in the agenda, foreseeable impacts of h HR one on the DDS system and the IDD community.
So there are a number of things here. The first thing that I would say, the numbers that I presented to you in the overall budget, we also include there 37% our total funding coming from federal Medicaid match. So things that happen in Medicaid are of significant interest to us as we operate the HCBS program. We serve roughly, give or take, year you're looking at half a million people in California in the IDD system. As you said in your opening remarks, six two thirds of them receive Medi Cal.
The Medi Cal work requirement changes and the redetermination of eligibility will clearly impose barriers on individuals and families trying to maintain their Medi Cal coverage. Having said that, the federal law does exempt people with disabilities and their caregivers from the work requirements in HR one. And we continue to work diligently with both Department of Social Services and Department of Health Care Services on the best way to automatically exempt folks by transferring data into the county operated SAWS system. We are confident that those activities will be successful. We are, of course, still planning for failure, if you will.
If it doesn't work, the community still needs to know what they need to know and what they need to say and be prepared for and potentially bring with them if it doesn't work. However, you know, we are planning for that but expecting success with our data automation efforts. We are also working on a cross programmatic data matching effort that will elucidate more information about the number of people served by regional centers who receive CalFresh benefits. So we ourselves are seeking that information, But I would also like to point out if we transfer our file up into SAWS, then we've captured 100% of our population whether they have CalFresh or not. So it it's of interest to us, but not a obstacle or a barrier into our auto exemption policy.
I think I answered the first two here. The Medi Cal changes, clearly, people are losing Medi Cal either because of the six month redetermination policy or or because of some failure in our auto exemption effort, that is an impact to people in terms of their available health care coverage. Some of them may need to turn to the health benefit exchange to maintain that. There are certain services that regional centers can cover, but it's not health insurance writ large. So it is definitely an impact on regional center families, but somewhat outside of our control.
The bigger impact for regional centers will will likely be seen in the fund source payment for the services delivered through regional centers. In other words, if that two thirds number getting Medi Cal goes to 60%, that's 6% of the caseload that we would no longer be able to claim the federal match for, and they would become state only cost. So there's that impact as well. We don't anticipate in either case much, if anything, in the way of eligibility. People who need regional center services generally have already come to a regional center and said they want services.
They're already eligible. Losing Medi Cal is not gonna drive a flood of people for eligibility processing at regional centers as we understand it. There's a question in the sub of the fourth bullet about potential codification of the exemption process. We don't believe that it's necessary, but we are of course happy to receive language if the legislature wants to ask for technical assistance with that. I don't see any harm in doing so either as an administration.
Impacts expected for the UIS community who are regional center served. Within the regional center system, we are blind to immigration status. If you are a resident of the state of California and you are eligible and you have a substantial disability, then we provide services regardless of your immigration status with the caveat, of course, of all the medical impacts that that community may experience based on changes in other programs. The budget does not assume a significant transfer from the loss of generic services. I will this will be covered in, I think, the next panel when we talk about in home supportive services.
But it's my understanding that those proposals don't reduce hours for individuals, but rather limit the number of hours that providers can work. We don't envision that the assessment will drop for an individual such that there would need to be a replacement of some of the services, for example, personal assistance. Generic services and the work required by SB 138, this is another opportunity to express appreciation. We asked and received within the last month input from Department of Social Services, Health Care Services, Department of Education, State Council on Developmental Disabilities, the County Welfare Directors Association, and the Association of Regional Center Agencies. Input on a preliminary list of generic services.
We're looking both, did we miss something, but also ask them in their own words to define what those programs are and also to do that in plain language for the public. So we believe in the last month, we've made significant progress in defining those generic services pursuant to that bill. It was a 2023 trailer bill. The the final question in the agenda is what product is expected from Annette Phelps and Phillips pursuant to the contract we executed with them regarding HR one impacts. And they're doing more for us with that 3,770,000 than than just this analysis.
The analysis that they prepared, they I would say, did as much as they could given what we had. And the additional that we had originally asked them for is dependent on the results of some of the data matching that I just talked about earlier. The product that they did provide to us was eight to 10 page report, and it was provided to legislative staff in our quarterly ledge briefing in September, I believe was the month. So at the moment, that's the only work product from Mennat again because we haven't been able to give them more data than that. So I believe everything's been shared.
I think we could probably benefit from providing a little more information to you about CalFresh impacts. And for that, I'm gonna turn to my colleague from Department of Social Services. Thank you.
Speaker 3
Alright. Good afternoon. My name is Alexis Fernandez Garcia, deputy director with the Department of Social Services. Thank you for the opportunity to discuss the impacts of HR one, particularly, for people with intellectual and developmental disabilities. CalFresh provides an essential safety net to millions of Californians, and our priority continues to be to protect benefits for those who are eligible.
Via my remarks, I will outline the CalFresh time limit rules for able-bodied adults without dependents or ABODS, that is the federal term, and how we are approaching implementation of HR one. The federal time limit rules have existed since 1996 welfare reform and generally restrict Calfresh eligibility to three months in any thirty six month period unless an individual is exempt, is meeting the work or community engagement requirements, or is living in a area that is eligible for a waiver of the rules. HR one keeps the basic structure of these rules but significantly expands who is subject to them by narrowing exemptions. For example, it raises the age of an ABOD from 54 to 64 and lowers the dependent child threshold from 18 to age 14. Exemptions remain for people who live with a disability, are pregnant, have a child under 14, are unfit to work, and that is a federal, term, or are American Indian.
All individuals served under the Lacherman Act would qualify for an exemption based on the federal definition of a disability that is used for this purpose. HR one also changes the criteria for statewide or regional waivers, limiting them to areas with unemployment above 10%. Taken together, the results are more Californians subject to the time limit sooner than under pre HR one rules. Today, we've provided a handout that should be in front of you to help us walk through some of the estimates, that we've shared prior. So roughly two point seven million adults age 18 to 64 receive CalFresh.
Speaker 41
We estimate that about two thirds or 1,800,000 of those people are already exempt from the ABOD time limit based on administrative data that exists within our eligibility system. That leaves roughly 950,000 adults whose exemption status is not yet known and who may be newly subject to the time limit because of HR one. Of these, we anticipate about a 110,000 would be found exempt, once counties collect additional information about them, and about 179,000 will meet the work or community engagement requirements through a qualifying activity. That leaves us with approximately 665,000 individuals who may lose eligibility, either because they're not exempt or not meeting the work requirement or because of, administrative burden. California will begin implementation on 06/01/2026, allowing time to align policy, update our eligibility system, and train county staff.
Speaker 3
For ongoing households, screening for exemptions will occur at application or recertification, which spreads implementation and the related workload over roughly twelve months. To mitigate harm, we are maximizing the use of existing data to identify exemptions, pursuing additional automation opportunities, including the use of data sources such as those from DDS, and strengthening county training and engagement. We are also expanding employment and training opportunities and additional, workforce, development opportunities. Even with these efforts, many Californians may face increased food insecurity if they lose benefits, and we remain committed to implementing HR one accurately, transparently, and with a focus on minimizing harm whenever possible. Thank you.
Speaker 5
How are you doing? Good afternoon. My name is Joe Meders. Today, I received services from my regional center. That is Alta Regional Center in Sacramento.
For the last twenty years, Alta has helped me to have a quality of life that I'm proud of. And and if we make any cuts, who knows what will happen to me and my friends out in the community? Yes. I am scared that cut any cuts to services system would send me back to an assisted living home or in a state hospital. We believe that that is not a quality of life that we want.
Many many are very scared. We are thankful for the lantern man act. Without that, we probably will not be here or would be on the waiting list to get services. For example, anyone else would be on the waiting list for services I hope that the number will be called soon. I want to I work hard to keep my services.
I I need also, I'm also a voter and a taxpayer. It makes me feel good when I'm able to do that. Medi Cal has helped me to stay healthy since I since I have a lot I take a lot a number of medications. It helps me to pay for them. Calfour's has helped me because I am someone who has diabetes, and I need to eat things that are good for me.
The regional center has helped me to get the support and the sup supplies I need to live in the community. Medicare helps me to work on my health needs. IHS helps me to be safe and clean and cleans my house. I also receive independent living services. Helps me by having someone text me to my medical appointments and explains things so I can understand them.
With these services, I am able to do things I like. I like for example, I like to go to the farmer's market and baseball games. When I didn't have these services set up, the this this happens. My health was not so hard. I have high blood pressure, and high blood sugar was out of control.
Speaker 42
I'm working I'm more I'm worried that cuts to any of these services will set me back. H o one in the state budget could mean I no longer live a quality life in the community. Today, I help people look at my ability and gifts, not just my disability. Today, I may be retired, but I I still help my peers out by helping them to advocate to have a quality life. Again, thank you for letting me share my story with you today.
Speaker 1
Thank you very much, Joe. I'll tell you, I enjoy the farmer's market too, but I can't go because I buy too much kettle corn every time. And my my blood sugar just goes, oh, So I banned myself from Farmer's Market. But thank you for being here. Appreciate it.
Speaker 6
Good afternoon. My name is Sabrina Epstein, and I work as a policy analyst at Disability Rights California. I am also a disabled person, and I am deeply concerned about the impacts of HR one on the community that I love. You have already heard how HR one disastrously cuts 1,000,000,000,000 from health care. And now, as we speak, congress is debating cutting even more funding for Medicaid to reappropriate to ICE and other violence towards immigrants.
California has two options, enable this violence or take action to protect our people. I hope you choose the latter, and here are my suggestions for how to do so. First, in line with SB one thirty eight, we need to address generic resources in a way that makes our system more equitable and efficient. Due to HR one, we can no longer assume people will have access to generic resources like CalFresh, Medi Cal, and Covered California. For example, a regional center client may lose their IHSS not because anything changed about their daily needs, but because they are a refugee who no longer no longer qualifies for Medi Cal this October.
The generic resource, IHSS, no longer exists for them. The regional center must be ready to respond to quickly fill the needs for personal care and safety. Second, California can do more to mitigate the harms of HR one on regional center consumers. This can look like better resourcing regional centers to address Medi Cal questions in an increasingly complex system, or it can look like the diligent work already underway to automatically exempt 12,000 regional center consumers from HR one's work requirements. These tools to address navigation and administrative burden can only go so far.
Speaker 8
We urge the state to avoid further cuts to services like IHSS and Medi Cal, each of which only saves the state dollars by withholding needing care and by disenrolling people out of confusion and administrative error. Third, we must address gaps for disabled immigrants, particularly Latina immigrant families who are already experiencing the racial disparities that we have heard about in this committee. As immigrant families lose health insurance due to cuts to Medi Cal, they will increasingly turn to the regional center, and these families need to be met with language access and readily available culturally competent services. We have spent the last several years working to address the racial and ethnic disparities embedded in our system. Now we are at a fork in the road.
Speaker 6
Do we accept the logic of racist, ableist federal leaders who thinks our lives are not worth living, or do we instead tackle these problems head on, embrace the promise of the Lanterman Act, and use public funds for what we all agree they should be used for, to help people live lives of their own design with the supports they need in the community surrounded by loved ones. We have hard policy decisions to make, but these decisions will not be harder than a disabled person deciding between buying insulin or fixing their wheelchair, between paying an attendant to get them out of bed, or addressing a dental emergency. I urge you to find a solution so my friends and I don't have to make that choice. Thank you.
Speaker 7
Good afternoon. Karina Hendren, LAO. As the director already noted, HR one requires that states exempt individuals with intellectual and developmental disabilities who are enrolled in Medi Cal using the income eligibility pathway from the new community engagement requirements. And this affects about fifteen thousand individuals in DDS. We just want to emphasize that these exemptions are key.
And just to reiterate the reasons why, any errors or mistakes that might happen in the exemption process could have broader fiscal implications for the state. One implication is that any loss in Medi Cal eligibility could affect the amount of federal funding that regional centers can claim for the services that they, coordinate. And the other reason, which has already been mentioned, is that loss of medical coverage for health care services could create fiscal pressure for regional centers to pay for some health care services at 100 general fund cost. We do have some questions at the legislature capacity administration about its, exemption processes that it has its planning and that it's putting into place right now. And those questions are included on page nine of today's agenda.
Speaker 1
Two main questions to start off with is, number one, obviously, we wanna make sure that we have a very successful data transfer process to make sure we get as who is eligible for exemptions get get their exemptions. What is the quality control measure to ensure that once we say we have completed the process, we actually do another check just to make sure? Like, what is the can you walk me through the process besides clicking a button and it telling you we did it? You
Speaker 2
Simpler. So I think it's one exercise to identify who's potentially impacted. I think it's another to realize that people's lives are are not static, but rather dynamic, and they come and go from these programs. So increasingly, an approach that I'm leaning toward and would advocate through the department is to actually transfer 100% and just flag people as you are a regional center served individual in the system for the entire half million caseload that we have. Not providing additional lots of additional information.
They have that already. But if we can just flag everybody in in the statewide automated welfare system who's a regional center client, that would go a long way to making sure nobody is left out. So hopefully simpler than than ChatGBT. Having said that, of course, when you do that, you're gonna wanna go back and spot check the results of that. But we also want to build our data capability to do that kind of matching.
And if I can turn to Alexis, she can talk in more detail. Thank you.
Speaker 3
So as the director mentioned, we'll do quite a bit of work between departments to ensure the lists are as complete as possible. Once they get into the eligibility system, we use standard processes which have built into them, sort of backstops, if you will. So normally, when we run eligibility at scale, because we're running a large list of people, we have what is called a a fallout list. So if for any reason a case doesn't run as it was intended, staff can work those cases individually. So that's the first kind of backstop that we have built into how we standardize, these processes.
The second and not the preferred, but another place where there's a backstop is because of the way we've, outlined our guidance to counties, the exemption screening is going to happen at either a recertification or an application when there is a required interview. And so to to the extent that is not showing up in the system, there is still another chance for the worker to engage with that individual and establish that exemption right then and there even if they haven't seen it prior in the system. Of course, the goal is to run all those data matches, do that as automated as possible, but it's a second backstop from a policy perspective to ensure that everyone is captured. When
Speaker 1
is your hope that what's your deadline of completion of this pro the this process?
Speaker 3
So it's a a little early for us to have a hard date for when the data will be in the system, but we are working toward a very, clear goal to have that available before any case may reach the point of a discontinuance, of course. So June 1 is our, implementation date. The first set of cases that, could be subject to an exemption screening will happen in June. And then, three months from then, July, August, September, is the potential for a discontinuance. And our goal is to have this done well before, that discontinuance can happen for this first group of people.
Speaker 1
Obviously, there, this is a unique time that we've never faced before. Is there a way because, you know, as a social worker, we're always taught that everything is connected. And just because the client is okay doesn't mean the household is okay. And in order to make sure the client stays okay, we have to ensure that those homes stay stable. What can we do to utilize our infrastructure, including our regional centers, to ensure that if instability starts to present in a household, we can still utilize that infrastructure to keep the household stable to protect the client.
Speaker 2
Sure. So appreciate the recognition. It's not just about the individual, but their ongoing well-being by based on the family. I I think the answer to most questions like that is education and outreach. This is what people need to know.
This is what they need to know to protect themselves. This is the kind of stuff that they need to present to the county to to document that their exemption, for example. We need to reinforce the importance of making sure as as eligibility, for example, in Medi Cal goes from twelve months redetermination to six, The importance of being timely and prompt with that. We talk less about the fact that people will also have thirty days instead of sixty to cure, any missing documentation. So time is of the essence, and families need to know that, and its importance needs to be stressed to them.
So that that's just one example. And that's that's not just the department. That's not just regional centers. That's not just state government writ large, but that's also our service providers, our regional centers, our advocacy organizations, some of the nonprofits like family resource centers. We all have to have a same similar common message about this available to individuals and families, but also to proactively push it out.
We've already, as a department, for example, run several newsletter articles in our monthly newsletter about this very topic and what families need to know about what's coming, and we have, more on the way in the upcoming April and May additions as well.
Speaker 1
I wanna follow-up on this subject just because I know it's very often that someone a constituent may call my office to complain about that pothole.
Speaker 1
And I'm like, I'm sorry. That's not me. That's that's your city council member or that's your mayor. Right? And if regional centers are doing their jobs well, no matter what the issue is, they might be a trusted organization to go to when they need help of some kind, but they just don't know where.
I'm wondering if it may be worth continuing to look at, at least for the initial year of this HR one implementation, whether we should be resourcing regional centers and others to have their own navigation teams for the household, I believe it's inevitable for them to get some type of things, and I'm sure the caseload is already daunting sometimes, and so they may not be able to have the time to do those things because they're still working with their individual clients. But is there a way to resource these institutions in the regions to be able to handle those type of calls, right, and to be able to give them the type of support they need to maintain support within their family? Mhmm. Because we gotta do everything we can to keep that household stable, and it may have nothing to do. It may not have anything to do with Medi Cal.
Right? It may not have anything to do with some of the things that you you all are responsible for, but there's something that created a ripple that affected that household. You don't have to respond to it. I'm just thinking I I wanna kinda dig a little deeper. Obviously, we'll chat with our regional regional centers as well.
But I I think it may be warranted because we don't know what to expect. So should we be should we expect the unexpected, I guess, you can say? Okay. Any questions for committee members? Elio.
Speaker 7
Thank you. Corina Hendren, Elio. Going back to the question about the household Mhmm. H r one also includes an exemption that caregivers of individuals with disabilities can be exempt from the community engagement requirements. And our understanding is that the department has some information on caregiver relationships Mhmm.
Particularly for individuals who are children. And so that could be another avenue to pursue as well and to better understand how the administration can collect and use that information for exemptions.
Speaker 1
Yeah. Absolutely. I appreciate that. I mean, definitely, we wanna make sure that I think that's part of the education part of it, making sure that they understand everyone in that household who gets that exemption. But we also know that we're starting to have multiple people, multiple generations in a home.
Right? And maybe his cousin's staying in that home, and that cousin now has some needs. But as we know, when one person becomes unstabilized, the whole household becomes unstabilized. And so I just wanna make sure but that information is great to know. But I think also we just need to be prepared that households are more complicated these days.
They're not as they all have all kinds of stuff. Right? And, you know, some people are in the household you may not want either, you know. You just have to deal with it. So at the end of the day, we wanna make sure that we're highlighting that this could be an issue and and worth some further conversations, especially as the May revise comes out.
Okay? Additional questions or comments? Oh, this one here. Just some housekeeping, things. I want to reiterate the request of a comprehensive update on the data matching activities that the administration is engaging in for CalFresh and Medi Cal and the schedule for the implementation of this.
I know you're still working on the dates and all those things, but as soon as you know, if you can let us know, that that will be great. Our our hope is that we know before May 1. Right? Even yeah. If we can know before May 1, that would be great.
If the administration does not expect the data matching to be complete before 06/01/2026, we also want to know what does this mean for CalFresh impacts and the projected estimates on which DSS has been relying on. And we also wanna know, won't more CalFresh participants potentially lose food benefits? I know we have a lot of estimates right now, but as always, our goal is to make sure that we have the most up to date information as possible. So once you know deadlines, please pass that on to us. Once you know you have more refined numbers, please pass that on, to us as well.
Anything I also want to ask the administration for feedback on the blanket exemption concept, which we will seek to codify alongside the state's principles on implementing HR one. Staff will be in contact on this, and we may ask for DDS and DSS to attend our April 29 hearing and provide a response there as well. We are looking to codify as much of this as possible so that we can make sure that not only do we have, now, what is the requirements on the federal level, but we also make sure that we codify these things on the state level as well. And if you have any questions on any additional or any clarification on any of these requests, just please feel free to reach out to us. Oh, doctor Sharp Collins, you have the floor.
Speaker 9
Yeah. It was just another thing just to kind of follow back up on our last CalFresh hearing that we just did. We were discussing the variance as well and just identifying how the rates are, the numbers are actually being calculated and then the then looking at other states, and trying to get our numbers. So that was brought up, and and we did ask if that can be brought back to us in regards to the structure and being able to respond. So I don't have the exact question here with me, but I just want to point out that we did discuss it.
Mhmm. And it adds to this conversation that it would be nice if you can go back, and and look at the question that was, asked and be able to share that at the next hearing.
Speaker 1
Absolutely. Appreciate that, and we'll be in contact with your office to make sure we're I know there's some folks that are still trying to get a lot of those answers for us, but let's just make sure that that is on the list. If you can check-in with my office as well so that we can make sure that we're setting up everyone for success. Okay? Yes, sir.
Speaker 2
If I could, back back to the point you made a minute ago, you've requested we come on April 29 to the hearing to provide feedback on the concept. I just want clarification. Are you asking the administration whether they're okay with the idea, which I said yes to in my opening remark, or should we be expecting draft language from the legislature that you'll want a reaction to? If you could just provide a little bit more on the process exactly what you might be expecting. Thanks.
Speaker 1
We are looking at language so that you'll be able to respond to that. However, as you know, we will reach out for technical assistance. But also, usually, the last meeting of the month is kind of like almost everyone coming back together to making sure that we get the answers that we are. So at the end of the day, if you don't wanna come back, try to get us the answers as quick as possible so that we can make sure that we can. This is really just about making sure that we're cleaning things up and ready for the May revise, everyone has all the information they need to move forward after the May revise.
Speaker 2
Alright. I appreciate that. We'll be on the lookout for language. Thank you.
Speaker 1
Absolutely. Thank you for that question. Anything else? Seeing none, thank you very much to this panel. Thank you, Joe.
Appreciate you.
Speaker 1
Have some kettle corn for me. Issue number two, mister director, you are you may begin when you are ready.
Speaker 2
Thank you, mister chair. So one of the large generic so so called generic services for the regional center system is the in home supportive services system or IHSS program. My colleague, Claire Ramsey, from the department will will describe those proposals in in a moment. If I can, I'll jump to number three as the question, which is what would occur if a person currently served under IHSS loses IHSS or experiences a reduction in hours. I I talked about it very briefly in my opening remark.
It's my understanding there there aren't particular proposals that would reduce somebody's individualized assessment, but may impact their ability to find a provider for those hours. And of course, IHSS being an optional Medi Cal benefit, if somebody were to lose Medi Cal, would go away as well. While both Medi Cal and IHSS offer a variety of services, not all of those are things that are offered by regional centers. Good example of things that are would be personal assistance services. Know, think of assistance bathing with eating, those kinds of things.
And under current law, and it's been this way for years, once the generic service has been exhausted or is not available, regional centers have the obligation to pick that up. So to answer that question, regional centers would would be picking that up and it would be funded out of purchase of service for personal assistance services in that example. The next question asks about the master plan for developmental services. I'll take a minute on the record just to share that the administration recently released the master plan for or the not the master plan, but the the first annual report on implementation of master plan. And so I want to flag that for folks.
It's available on our website and if you're subscribed to our newsletters. It's a brief read. The master plan itself and the implementation update is not, but the report is only about nine pages, give or take a page for formatting. So that's out there. Because we don't see a significant impact, again, you know, not knowing what to expect exactly from in home supportive services on our system.
But again, people already have to be eligible, so there won't be a flood of new eligibility seekers. It's mostly a question about managing hours. But it very much, I think, aligns with one of the themes in the master plan, which was to view people as a whole person and make sure that the way that we're providing services is person centered in nature. So, you know, that that continues to be a theme in the in the master plan and how the regional centers on the receiving end would see that. I think I already touched on the next question in in the first panel on how Medi Cal state changes would impact regional center caseload.
Again, don't, for Medi Cal, expect an influx of people newly seeking eligibility to regional center services. For us, it's mostly an impact of the fund split for the cost of the services. And similarly, I think already answered about the unsatisfactory immigration status. We don't for for members who weren't here at the time, we don't, in the regional center system, track immigration status. We we track whether somebody's a resident of the state or not.
So we're already serving them, but there is a potential fund split impact there as well. And then the next question asks for the relationship of the proposals to our response to the Centers for Medicare and Medicaid Services. I I think on that question, I would simply say this. Department of Health Care Services did a very thorough job. It's a 64 page letter to CMS.
I hope they read each and every page of it. I I read the first half myself and didn't feel that I needed to go further because it was very compelling. There's been long a nationwide push to rebalance health health care spending in favor of community living as opposed to institutional settings. And it was somewhat disturbing to see the federal government question why HCBS spending in states across the country was ballooning through the roof. The answer is obvious.
That's been the policy direction for all The States and nationally pushed by CMS itself. So, you know, yes, we continue to see rising caseloads. We continue to serve more and more people there. I mentioned in the opening, Fairview has now been closed. It was the last regional center.
We've moved people into the community, into community based settings. We're very proud of the progress we've made. Yes. There are cost implications with that, but the cost of serving people in the community is vastly cheaper than serving them in institutions like nursing homes. So I don't know.
I think I've gone as far as I probably should in my remarks about that. But just to say, we think that what we've proposed and what we continue to propose is very consistent. I'll stop there and ask my colleague from Department of Social Services to pick up the first couple questions and correct anything that I screwed up. Thank you.
Speaker 11
Thank you for having me. My name is Claire Ramsey. I just flagged that I am in place of Lior Felicina. I'm one of the chief deputy directors at the Department of Social Services, and we'll speak on a number of your questions related to IHSS, including going over our three proposals in the governor's budget. Just for level setting, the in home supportive services program known as IHSS is a cornerstone of California's long term services and support system.
IHSS supports more than 850,000 people with disabilities, children, adults, and older adults to remain safely in their homes by providing assistance with daily activities of living. These can include, items such as bathing, dressing, meal preparation, mobility, and paramedical services. Counties administer the program. They conduct the assessments and authorize service hours based on each person's individualized needs. As noted in the agenda, about a 150,000 people of our total 850,000 IHSS recipients are also regional center clients and are eligible for those services.
The governor's budget does include three IHSS related proposals. First, there is a proposal related to the assessed hours, which would require the state and counties to jointly establish a baseline for average authorized hours per case by May 2027. After that baseline is set, any nonfederal cost for hours above it would shift to the counties proportionate to each county share of the statewide caseload starting in fiscal year twenty seven twenty eight. Our goal with this proposal is to support accurate and consistent use of the assessment tools and to ensure that increases in hours are tied to verified changes in a person's condition. This proposal is not intended to impact any individual recipient services, including any recipient who's also eligible for regional center services.
And just we'll clarify one point, which it it shouldn't reduce any provider eligibility either or availability. It really is a cost shifting between county a cost proposal between the county and the state. Second, the proposal proposes to align IHSS with Medi Cal eligibility processes. IHSS is a Medi Cal service, and it individuals must remain Medi Cal eligible to be eligible for IHSS. As such, there is a proposal to automate the disenrollment and the reinstatement if a recipient loses Medi because of failure to provide information to the counties to allow for reassessment, but would also automate once they've completed that process to regain Medi Cal.
They would also automatically regain IHSS, which would streamline the county workload and improve consistency statewide. Finally, we do have a proposal in the governor's budget to eliminate the IHSS backup provider system. After reviewing program data, we found that administrative costs exceed the cost of services delivered. And so while the system was intended to meet urgent short term needs, the growth that we felt would materialize has not yet materialized. Just quickly, I'll just to get to one of your other questions, we do wanna highlight that these proposals do not reduce IHSS services or hours to individuals, and hours will continue to be based on individualized assessed need.
Speaker 9
We were asked about protective supervision. Although protective supervision cases do often involve high hours, they represent only 11.5% of the caseload, about 98,000 recipients, and we do not see them as the primary dryer driver of hours growth statewide, more that we have observed overall authorized hours rising even as functional index rankings, which are used to assess need, have remained, essentially unchanged for approximately a decade. Finally, we just wanna reemphasize how important we know IHSS is to individuals with intellectual and developmental disabilities, including those who are eligible for regional center services. As such, we will continue to coordinate and collaborate closely with DDS. And, of course, we defer to them for particular impacts, but I'm happy to answer any questions related to IHSS to be helpful to this panel.
Speaker 12
Good evening. Thank you for having me here. I hope you can see me through my story. My name is Anna Alonso from Breckersville, California. I am a Disability Voices United ambassador.
My family is composed by my mother and my three sons, two of whom I adopt. Every single person in my house has a disability. We rely on medical, income support services, and regional center services to survive. So when you talk about cuts, please understand you're talking about our lives. I live with cardiomyopathy, complex PTSD, and myotonic dystrophy.
My mother has dementia, pulmonary hypertension, and arthritis. My 17 years old has autism, epilepsy, and born with fetal alcohol syndrome. My 17 years old have three genetic conditions, cast multi organ damage, particularly to the brain, muscles, and liver. His heart depends in an ICD to work. He is autistic and use ASL to communicate.
And still, we give back by volunteer at the Ronald McDonald House and through my nonprofit, Padres Unidos de Kern. We help other families with these disabled children navigate the system that are so hard to access. We are doing everything we can, but we cannot do it alone. We rely on medical. My mother and two of my sons depends in income support services.
We have 12 caregivers coming into our home each week providing support twenty four seven. They are the reason we are alive. We depends on them for basic needs and more when emergency hits. That's our reality. In home support services is cuts, We lose our caregivers on our stability.
If medical is cut or or cost more. The cuts is even more direct. We will die. One of my son's medications alone cost $5,300 a month, but the problem is he take 23 medications in total. It is no way I can afford to keep him alive by myself.
Speaker 29
Every day, I see families like mine forced to beg for basic services. We are already we are already exhausted. And for many of us, the fight is even harder because of the systemic racism and anti immigration bias. So I need to ask you if medical and income support services are cut and regional centers don't receive more funding, who is going to support families like mine? Someone has to.
Speaker 12
I want to be very clear. You are making decisions that will determine where people live or die. Please do not treat this like a light topic. These cuts put families like mine in dangers. It means choosing to turn you back on people who cannot survive without support.
Protect our health, care, and services. Don't let these cuts going in effect. Do whatever you can to protect disabled people, and do the right thing for 15 millions of Californians. Thank you.
Speaker 7
Karina Hendren, LAO. We have two sets of comments. The first is on IHSS and the second on Medi Cal. So first for IHSS, as the administration stated, its proposal to shift the cost of increased hours to counties is not intended to reduce hours of service. That being said, the way that the governor's IHSS proposals will work in practice remains unclear at this time.
To the extent that the proposals could impact access to IHSS services, regional centers, might be able to fill in any lost hours of services as the payer of last resort, but potentially at a higher per hour cost. The degree to which regional centers might provide personal assistance services as a substitute for IHSS could vary across regional centers. Second, the agenda asks how the proposed and enacted state budget solutions in Medi Cal could affect people served by regional centers. So separate from HR one, these are just the state budget solutions. Many of the enacted and proposed state budget solutions in Medi Cal focus on enrollees with unsatisfactory immigration status.
Speaker 44
As the director noted, regional centers have never considered immigration status as part of eligibility for services, And this means that state budget solutions affecting Medi Cal eligibility generally should not affect directly eligibility for regional center services. That being said, the state budget solutions in Medi Cal could affect individuals' access to health care services. For example, an individual with unsatisfactory immigration status who is served by a regional center could lose comprehensive health care coverage under Medi Cal due to state budget solutions enacted in 2025. And as we noted previously, loss of Medi Cal coverage could create fiscal pressures for regional centers to pay for certain health care services for consumers at full cost to the state if no other source of health care is available. We also wanted to note that our office has heard some concerns about individuals' experiences requesting that their regional center act as pair of last resort to provide a service not available through any other sources.
Speaker 7
So similar to what we noted for IHSS, the degree to which regional centers, might be able to fund health care services as a substitute for Medi Cal could vary across regional centers in practice.
Speaker 1
I'll start off by just stating an obvious red flag to me, and that is almost in every hearing, no matter what the subject is, it seems as though the cost savings are coming from is coming from a shift of fiscal responsibility to the counties. And when you add all of that up, it makes me wonder what makes you all think that the counties can withstand a shift whether they be CalFresh, whether they be in home supportive services, whether they be on IDD work and other things. It seems to me that there's an assumption, but maybe it's not an assumption. So can you share with me, and this can be for the administration or Department of Finance, what gives you the confidence that they can be able to withstand that cost shift but still maintain hours, still maintain services at the same time?
Speaker 11
Sure. Chair Jackson, I'll start. Claire Ramsey from CDSS with respect to IHSS. We do have one proposal that would increase cost to the county based on them going above a baseline that is jointly set. So there is a lot of discussion to the ILAO's point about working out what the practice would look like, what the baseline would be set.
We do know that a lot of conversations would be happening. Counties are fully in control of hours assessments, and that's why we are putting forth this proposal and think it is a proposal that is workable because the counties will have control of the assessments. But, you know, we are sensitive to the fact that this has been a extraordinarily hard year on the counties in terms of, particularly h r one proposals that do involve, increased costs. I'll defer to my colleague at Department of Finance for the broader question you've asked.
Speaker 30
Good afternoon. Lourdes Morales with the Department of Finance. The comment I'll add to my colleague's comment related to the proposal for assessed hours is that our proposal also includes a resetting of baseline on an annual basis. And so there is an acknowledgment from the administration that there may be sort of natural growth. And so as long as there is this this baseline that sort of allows for that, counties would only incur cost to the extent
Speaker 13
over that changing baseline. So just wanted to make that point that it's not inherent that counties would absorb additional cost as a result of this. It just really reflects on where they are relative to the baseline that we'll work with counties to establish. I'll also highlight for this proposal in particular, we're proposing a budget year plus one, so a 2728 implementation so we can continue to discuss the the particulars of these of the implementation as we realize that those are critical.
Speaker 1
I I seldom see the administration and counties agreeing on a number. And as a matter of fact, I think next week, we're gonna have another meeting about a disagreement on numbers. So I'm wondering, you know, I'm just worried about whenever you do a cost shift to counties and even if you are increasing the baseline funding to counties to be able to try to mitigate that. There is a a natural assumption to me that a way for them to stay within their funding levels is going to be a natural cutting of hours or something that's gonna end up hurting the client as opposed to ensuring that the client has everything that they need to be on a pathway to thrive. And so which is why in many cases, this committee prefers that the state holds on to it so that we ensure that the county that the client is getting what they need.
So if, so we're reluctant to support such a shift, because this is not the only shift happening. And so if you can share with us what that baseline intends to be, or if you haven't because you're might be still talking with counties, which is still understandable, just know this is that whenever we see that number, we are gonna be going to counties. I'm gonna be going to my county, or I won't be going home, in order to, ensure that they have what they need. The realignment screwed over counties, and many counties and many programs are on life support because of it. And I don't want to do another, another decision like that until we are confident that at the end of the day, it won't end up hurting the client.
Right? So I I appreciate that, but I'm I'm a bit skeptical at this point. Questions, comments, committee members? Anyone? Okay.
Assembly member?
Speaker 15
Thank you. I just wanna echo the sentiments of the chair. You know, I I think it's more than concerning or it's more than concerning the the cuts and the and the cough shifts down to the county. Our county is experiencing monumental shifts right now due to the the structural deficit that the state has, the federal cuts and due to h r one. Just in my county and Santa Clara County, we're the first to enact a sales tax increase of over $300,000,000 to save our local county hospital system.
Many counties are now attempting to
Speaker 15
same, but it doesn't backfill the over $1,000,000,000 in cuts that Santa Clara County alone is facing. And, and we are in a world of hurt in the county that has one of the largest concentration of millionaires and billionaires that also has some of the most extreme income inequality, which is often not talked about and is burden on our county where we have had to to take over and buy several hospitals in the last few years where we are heavily reliant on a federated system to support our health care. It's the second largest health care system in California in Santa Clara County. And so to now see the state proposal, which is sympathetic in trying to make impossible choices due to the situation that that we're in. But as the chair has commented, won't be receiving a lot of sympathy from the state legislature on trying to balance our budget on the backs of people who are already pushed on the brink and and our push our persistent exclusion of revenue options to alleviate state and county concerns is also deeply troubling.
Speaker 45
And so I I I recognize the the difficult position that the administration is in and and our capable Department of Finance. But I I would I would presume that this committee and several members of the legislature will be pushing back very forcefully in ways that that we haven't perhaps in the past and do more than just register our displeasure because decisions that this committee makes based on the recommendations of the department will have very consequential effects that will impact these communities for decades to come, and I think there's a better way of doing it. And I would I would charge us to try and look at those solutions, including revenue that needs to be on the table because we can't cut our way out of this budget without irreparable harm in in and to communities that are already pushed to the brink. And as the chair has mentioned very publicly that in the past, things happen when people are pushed to desperate levels of basic human decency, and it is our charge to take care of the least among us. And I take that responsibility very seriously as as to my colleagues.
Speaker 15
And so I merely suggest that we're going to be we're going to mean what we say when we say we need to go back and look at other solutions because this truly needs to be compromised and leaving no stone unturned. But the the suggestions that I'm hearing about, as the chair mentioned, I have to go back to my county too and and effectively advocate in their best interest. And I can, in good conscious, support or not speak up of of the cost shifting it to the county. I I they're just going through too many devastating fronts that they they don't need ones created by us. And I know that many of you and all of you know that, but I do think that we need to be more loud about finding other solutions.
Thank you, mister chair.
Speaker 9
I wanted to say to Anna, thank you. You being here, I know that it it took a lot. It took a lot. And I'm watching you, not only through your testimony, but even as my colleagues speak. You're tapping your leg now.
The funding for this means the world to you and everybody else here in this room. And you being here, as I always talk about humanizing a situation, putting a face to the name, reminding us that this is the reason why we're here. You're right. Well, I can't go back to my district without having an answer, without having a fix. But I just wanted to acknowledge you so you'll know that you are seen and you have been heard here today.
It's on and and it's on record that you are here advocating not only for yourself and for your family, but your providers. You said you have 12 that come into your home?
Speaker 12
Yes, ma'am. We are. I have the lucky to say they are my family. I immigrated this country, and I don't have nobody except my caretakers Mhmm. To count on it.
And for me, they are my family. And all the families that I serve in my nonprofit, they are the people. They are my family. And these these subjects, regional centers, medical, in home support service, touch touch home, and for me, is the world.
Speaker 9
Mhmm. And that's what I want to highlight in this conversation, that it's not just about there being your your providers, your caretakers.
Speaker 9
this is your family. This is what what happens when you have services such as IHSS. You know, when you do have the original sinners centers and everything else, it's not just about the services, but this is your livelihood. This is their livelihood, and this is what you need to be able to, you know, to do what you do. I did put forth a three part budget as one, of course, still rejecting the proposal to shift the state's share of IHSS per hours per case growth to counties.
Speaker 16
I also that that letter talks about the rejecting the proposal for the alignment. It also talks about, basically, all all three points that were made in the last panel. We did we did we did submit that budget letter, the budget ask. And so not only as myself and colleagues who've all signed on to that letter, we were gonna continue to advocate, to ensure that we do what we know is right and not cause more hurt and pain, put more burden on you guys, adding more walls, more barriers, putting more barriers in place. So, just seeing you and others in this room,
Speaker 9
I really am heavy. It's not that often I get this humble, doctor Jackson. I'm like, this is this is this is very heavy, and this is why I'm here. So I I thank you for allowing me to be here and to hear your story. My county is struggling as well.
They've been here. We've had our conversations. I've spoken with UDW and others. The the county the county can't handle it. They're trying to shift funds from reserves and all these things to try to be able to move forward.
But it's hard when they're in a budget crisis too. So, doctor Jackson, thank you for leading this work. As I said to one of my colleagues yesterday about them being a moral compass of a certain field, you are also a more a moral compass when it comes to advocating for social services.
Speaker 1
Obviously, there is nothing more there's no community more unifying that brings Democrats and Republicans together than our IDD brothers and sisters.
Speaker 1
there's not gonna be as much and I we promised from the very beginning. I promised three years ago. This community is not at the back of the line. They are now at the front of the line, and we're gonna keep that commitment. And so we're gonna do whatever we can to make sure that at the end of the day, what goes on between state and the county, that that's for us to worry about.
What you need to worry about is do you get the services that you need to making sure that you stay stable and that you can have a high quality of life and be on your pathway to thrive. We'll figure out the rest of it, but at the end of the day, that remains our priority. Director, I'm gonna ask, you to provide us, with some sort of harm mitigation strategy. What are we gonna do to make sure? Like, what are you all planning for to make sure that the services that are that clients are being provided with are gonna be able to stay stable?
Right? And, what can be some alternatives to just a cost shift, that can help to ensure, that we are keeping clients stable, and we are preventing any threat of a possible lowering of ours, and those type of things. We've we've gotta figure this this baby out. And so we're gonna ask, if you can provide us with some harm mitigate a harm mitigation strategy before the May revise, and all the different things we can do, whether it's through from Ike, that will, again, keep these families stable. Trying to figure out what are some other options as well.
CDSS, if you can help us out, especially in terms of the in home supportive services part of it, it's gonna be important. And then we're also going to ask for the same type of help from Department of Health Care Services if they need to be a part of any type of harm mitigation. We just need to know what our options are. One of the greatest mistakes we made during the great recession, and the reason why we're asking all these questions, is that we did a lot of across the board type cuts that we are now just recovering from decade later or more than a decade later. How old am I?
Oh, lord. Sorry. I just had some trauma there. I had to Oh, Lord. How old am I?
Dang it. What happened? What happened to me?
Speaker 1
You almost made me cuss. But a part of that is is because so we wanna make sure that we take a surgical approach here. There's no doubt we have to live within our means. But to me, that means it's just a priority issue, and it's us making sure that we're being as innovative as possible and that even if the way to do this becomes more complicated, the complication is worth it to us. But it takes us having these conversations now instead of the very rushed and chaotic process that happens a week after the May revise where we don't get any sleep, where we are forgetting what our priorities can be.
We're missing details, and we don't wanna do that. We don't wanna harm anyone that does not need to be harmed, if humanly possible. And so we're gonna ask for this harm mitigation strategy, whatever your strategy is to prevent harm and to prevent any instability. And if there are alternative ways we can accomplish this because I understand there's a structural deficit that the governor wants to solve for. We understand that much of the increases or a significant portion of the structural deficit is in the medical space.
Totally understand that. But we also wanna make sure that we are looking at all of our options as possible as well. So if you can provide that to us before the May revise, hopefully, by Friday, May 1, that'll be great. Happy to please, if there's follow-up questions, fire away through our staffs as much as we can. Whatever we need to do, let's think about this.
But I wanna make sure our goal is to prevent harm.
Speaker 1
Any other questions or comments? LAO, do you have anything? Any other questions or comments from panelists? Everyone good? Okay.
Thank you very much to this panel.
Speaker 1
Okay. Now we're gonna start going through a series of trailer bills proposed by the administration. We'll start off with issue number three. And DDS, you may begin when you are ready.
Speaker 21
Good afternoon, doctor Jackson and members of the committee. My name is Dana Simon, and I am a deputy director with the Department of Developmental Services. Thank you for the opportunity to be here today. The proposal I'm speaking on this afternoon is the trailer bill for rate reform quality incentive program contract exemption. The proposal seeks to extend the contract exemption previously authorized in the annual budget act through 12/31/2030.
This department also proposes extending the timeline to finalize rate reform regulations from 06/30/2028 to 12/31/2030. These extensions will provide the department additional time and flexibility to procure services and issue operational guidance necessary for the continuation of the full implementation of person centered outcomes based rate models and the associated quality measures as introduced as part of rate reform. Existing law also requires the department to review and update current rate models every two years. The department posted the first of these updates just this past January. Although we do have percentage increases for each of the rate models due to the changes in service codes through rate reform, along with the lag in current utilization data, it is difficult to develop an accurate cost projection at this time.
The update process itself requires a detailed cost analysis of each service code's rate model using the available information at the time. This has been supported by the expertise and technical guidance of our current contractor. Changing this now would cause delays and inefficiencies before the knowledge transfer is complete to our department. Additionally, current law requires the department to complete rate reform regulations by 06/30/2028. However, substantial technical revisions to title 17 regulations, the complexity of the rate models across hundreds of service codes, and the need for stakeholder engagement require more time for the regulatory process to be completed.
Speaker 23
These extensions are budget neutral and no additional funding is required. This proposal is generally supported by our community partners, although we are aware of concerns including the new provider requirements that have been put in place as well as addressing the individuals with the most intensive support needs. Through current directive authority, we are able to address issues as they arise rather than waiting for public comment period within the regulatory process. A recent example of this was the behavior analyst positions within the behavioral day programs. Through provider engagement, we were made aware of the hiring difficulties of this position and were able to extend the original twelve month compliance period to add an additional fifteen months before auditing in this area would go into effect.
Speaker 21
Although one of the goals of rate reform was to standardize the vendorization process through rate models, we do acknowledge that we are serving individuals with very specialized needs, and not every service rate not every service is going to fit into a standard rate. We continue to explore explore options with our current contractor to look at
Speaker 21
areas, current examples being specialized residential homes and respite. The department remains committed to collaboration with our community partners as we continue the rate reform process. Thank you again for this opportunity to share. Turn it over to Aaron.
Speaker 22
Good afternoon. My name is Aaron Christian. I'm a chief with the Department of Developmental Services. Appreciate the opportunity to talk about the quality incentive program and respond to some of the questions that were included in today's agenda. Do wanna call out and express gratitude for the write up that was included in the agenda.
I felt it provided a really good overview of the quality incentive program, the status of the administration of the program, as well as the complexities associated with administering the quality incentive program. Most importantly noted, the shift from a reimbursement based service to one that incentivizes the achievement of individual outcome. So I think that's gonna be really important for the individuals that we support in
Speaker 22
community. As noted in the summary, there are those complexities that are associated with the rollout of the quality incentive program. This year's measures went live in November, and the the window for reporting closed at the February. As noted, there there was a a series of directives that were released in advance of the measures going live that helped outline what the criteria was to achieve those individual or those measures by service category. We followed that up with a series of virtual town halls that had open ended question and answer to support providers in how to complete those surveys and achieve their their quality incentive program rate, and then recorded those and posted them online so that service providers could access those at any time.
Speaker 4
We also then worked with our, our our providers to put together a, guide guide for a step by step guideline for our service providers to access and understand how to meet those those quality incentive measures and provided updated information on the newly newly implemented prerequisite requirements that included the need to register for the electronic visit verification, be compliant with the home and community based final rule, as well as be compliant for those that met the financial threshold for the independent audit and reviews. In in doing so, we were able to support our providers to achieve those. As it stands today, we are currently sitting at a completion rate of about 81% of those providers that completed the quality incentive measures and met the prerequisites that were set forth in the trailer bill last year that that added those prerequisites. We are currently working with service providers to work through any technical difficulties that they experienced in the administration of those surveys and are committed to working those through and will honor the efforts made by the service providers to meet those goals. With that being said, administering a program and making a shift of this magnitude is not without the hiccups.
Speaker 22
Providers did experience some difficulties in completing their surveys to no fault of their own. As as such, we're working with our community and our service providers and provider organizations to do a look back and look at what worked well and what did not work well and look at making those improvements for the next round of the quality incentive program, hopefully, to achieve those, improvements and make and remove any administrative barriers that people experienced, in accessing the program. In in the agenda, there are were a series of questions, that related to how our our budget will be updated from the proposal that was included in the governor's January budget. At this time, we are still working on getting final numbers on those that achieved the quality incentive measure and met those, and we'll update accordingly for the May revise. With that being said, administering a program of this measure, this magnitude is complicated.
It is complex. It would not be possible without the support and being informed by the quality incentive work group, the subsequent focus groups that are associated to the quality incentive program, and really is a a partnership that we have with our community to roll out this program and make it a reality. We are committed to continuing the improvement, removing any administrative barriers to accessing the the program, and trying to promote the opportunity for all of our service providers to achieve the the quality incentive rate for their their services. Thank you.
Speaker 23
Good afternoon, mister chair, members of the subcommittee or doctor chair. Sorry. My name is Barry Giardini, California Disability Services Association. We represent nearly a 130 service providers throughout the state of California. It's my honor and privilege to be here with you all today, and I thank miss Simon and mister Christian for their comments.
I'm gonna be focusing mostly on rate reform implementation and the quality incentive program, but I do hope to have a little bit of time to to weigh in on the trailer bill proposal as well. And I I really wanna focus on rate reform generally. It has been a massive undertaking. A lot of work has been undertaken by the department, regional centers, service providers, individuals themselves in our system, and reflect a lot of gratitude for the department, for their partnership and coordination with stakeholders throughout this process. A lot of that rate reform has been on rate changes, service code realignment, and ultimately QIP qualification or the quality improvement program.
And that's where I'm gonna focus most of it today. I think the agenda sets out a really nice background on the establishment of the QIP measures as being 10% of the overall rate. At a baseline, I just wanna set you know, make sure we're all operating from the same place that when rates were developed in the rate models, the hun 100% of the rate was meant to cover the cost of delivering services. The ninety ten structure was meant to incentivize and make sure we were prioritizing and working towards quality. I think everyone is on board with that.
Speaker 5
But the way the current system is set up with a ninety ten, it's really more of a penalty structure for providers who do not comply with the measures that are set forth and therefore risks further destabilization of services if they are unable to achieve their 10% and they are then have fewer resources to pay their workforce, to take more clients on board, and other things that would actually evince quality in the long run. So I think it's important to establish that baseline. And as a result of this ninety ten structure kind of being more of a penalty structure, it makes qualification and meeting those QIP criteria even more important. Mister Christian, I referenced the fact that about 81% of providers have met the QIP criteria for the next fiscal year. That means nearly one in five providers are looking down are looking down potentially receiving 10% less than has already been established to be required to deliver services for the rest of the, next fiscal year.
Speaker 23
Now there's some caveats to that because the department has been flexible in some ways, and that number may move a little bit, Particularly with the, audit and fiscal review requirements, the department has provided an opportunity for later, compliance to achieve that 10% for the next fiscal year. But we are looking at potentially a lot of providers and a lot of services operating with 10% of their funds taken away in the next fiscal year. When that happens, the the agenda speaks to what are the adverse consequences. Well, you have wage structures that are set based on anticipated rates. Service providers operate exclusively state funded.
There aren't additional sources. And so while we're all proud of the achievement of rate reform, it's been a a great collaborative effort from the administration to the legislature to everyone in the system. You know, we are risking undermining a lot of that progress in the course of the next, coming year. Qualification for those QIP measures, mister Christian also referenced that there were some technical challenges. Providers did face a lot of difficulty in in completing their providers' surveys.
Through no fault of their own, I know the department is going to recognize and acknowledge folks who made a good faith effort, but there's a lot of anxiety in in terms of trying to complete those. Because of the substantial nature of the 9010 structure and the risk to funding, it created a lot of concern. And as we go forward, I know that we're gonna implement lessons learned and try to make sure that providers can ultimately achieve this. I also mentioned that 9010 is really kind of out of line with other systems in California for incentive structures and also with other best practices for value based payments. So I hope that that 9010 structure is something we can keep in mind in the long run, maybe not this year given the budget constraints, but something that I hope we can look at going forward.
Finally, I just wanna mention, this is all against the backdrop of a b 2423, which miss Simon referenced. On January 1, we published new rates that show an average of 12% underfunding across all services. For some, it's as high as 23%. As of January, that's what providers should be getting to operate fully funded in our system. We are not in a fiscal condition where we're going to be able to come up with the one point five to two billion dollars.
I know we don't have a distinct number from the department, but our back of the napkin kind of analysis shows that that's the kind of amount we're talking about. That's an amount that individuals with disabilities and our system is is subsidizing the state budget deficit by not by not receiving those increases going forward. Again, maybe not the year for us to look for those increases, but maybe a defense against any cuts coming here. And certainly appreciate your comments, doctor Jackson, about saying we're no longer at the back of the line. We're gonna be at the front of the line.
We're gonna try to protect progress. Hopefully, that is in consideration of you and your, fellow assembly members as we go through the budget process this year. Very finally, on the TBL proposal should I stop? Sorry. Sorry, assembly member.
Just on the TBL, no concerns around extending the, contract extension for health management associates. Make sure, think that makes sense. We do have concerns extending the regulatory timeline just because some of those new service requirements that were implemented via directive do create challenges and new obligations on service providers that we think would better be established through a comprehensive policy making process of of regulation. So thank you for that. Apologize for our going over, and thank you for your time.
Speaker 7
Karina Hendren, LEO. We do not have comments on this trailer bill proposal, but we have some comments on rate reform implementation more generally. First, as the department noted, in 2025, the state enacted a budget solution that requires providers to meet three prerequisites in order to be eligible to earn the quality incentive payments going forward. The actual savings that will be achieved in the current year depend on compliance with those new requirements. And as the department noted, they will be able to provide a revised savings estimate for that budget solution.
So just flagging that the legislature should expect to see a revised estimate that may revise for that, savings amount. Secondly, we wanted to note that, providers have expressed some concerns about whether the department or regional centers would be able to provide any technical assistance to providers who might fail to meet future quality measures. The tar department stated that its intent is to maximize the number of providers that can earn the quality payments, but it has not yet discussed in detail how it might approach circumstances in which providers might fail to meet the quality measures across multiple years. And so the legislature could ask the department to share its current thinking on how, either the department or regional centers might be able to provide this type of technical assistance to providers going forward as future quality measures are developed and put in place.
Speaker 1
Questions, comments from members at this time? I think my first question is what what does assistance look like to providers to help them get to a 100%?
Speaker 22
Yeah. I think that is is is the question at hand. I think going into this first round or this this round of qual the quality incentive program, doing a series of virtual town halls, having open ended questions, the the the guides and all of the things that we went over that were was pretty comprehensive. However, we still struggle to reach all of the providers and provide the level of assistance, sometimes, quite frankly, hand over hand to the service providers. For this next round, we are pulling together a group of regional center staff, some providers to really talk about what was the experience, what could we do better, what would be more effective to reach some of those those service providers.
In past years, we rolled out a provider directory, which was aimed at including up to date contact information from leadership at each of the service provider levels. We leveraged that this time, used those, contacts to push out, regular updates, reminders, put, information on the billing screens. Hey. Remember to do your your quality incentive surveys and data collection. One of the ideas that we are looking at doing is is maybe going out and doing in person town halls and supports to groups of providers, looking at leveraging the resources at the regional center level to help reach some of the providers that they are familiar with and their their respective communities to try to get to some of those those providers.
Speaker 1
What resources are in the budget to ensure that I mean, sometimes when I had a real job, I I looked at, assemblyman, this is not a real job. I hate to tell you. This is not a real job. Hate to tell you that. I was in the nonprofit sector.
It took me from the time I started the nonprofit, it took me six, seven, eight years to be in a position to do a full audit. Like, it's not an easy thing to be able to, number one, find someone who who specializes in nonprofit audits to ensure that I have the fiscal systems necessary to ensure that it'll capture all the information and be able to produce the type of reports necessary to make sure that someone can, when you have the thousand questions from the auditor. So it's not an easy thing. And especially if someone has never done an audit before and by the way, they might be providing fantastic programs. They may be doing it based upon the latest research and best practices, but the back end might need a little help.
Right? What so what this committee is gonna be looking for is if we're gonna hold them to because I don't think we also can afford a weakening a weakening within our provider system either. And so we need them to be able to recoup a 100% of their rate as soon as possible so that we maintain everybody unless a provider is just saying, you know what? Y'all asking too much. I'm done.
That's different. But if they're willing to do it, I think it's also our responsibility to strengthen our system, and we should be utilizing this opportunity to help strengthen them and get them to realize how they can continue to not just maintain programs, but maintain an institution that provides those programs to their community. Right? So I'm wondering if there's number one, we would love to begin to get to the point where you're gonna be providing this committee with actual assistance. What does assistance look like?
Because if we don't know what assistance look like, I'm not sure we can hold them to to that just 90% of funding because we're not doing our part either. Mhmm. Right? So be ready for that. I'm not sure if we're there yet unless someone tells me different.
So I would like for you to, number number one, make sure that you are looking at the provider feedback. And I'm asking for you to provide this committee with a revised version of the administration's language both in a new RN form format and a red line format that shows shows the changes to present provide to the committee. Also, and if you can provide this within the next week or two, that would be that would be great. Would that be possible?
Speaker 8
Chair, I'd like to and so just as part of the the the process here, I think this is part of the ongoing conversations for the the May revision process. So as as far as working through the language and feedback, we can take back feedback and request information, but I would like to just Or, yeah, on timing that we do have the mayor revision process to continue dialogue.
Speaker 1
Well, we would love to have this before the May revise. And after we don't get the feedback, we'll be rejecting the bill the bill language. I just wanna make that clear. We wanna make sure that providers, their input is being considered. It looks like there were not too far off.
It's not it doesn't look like there's a lot complications here. So I I wanna make sure that we understand that too. We just wanna make sure and is there a process to where if they're gonna be asking for assistance, is there a way that maybe they don't get the full 10%, but maybe they get 5%? Right, because they're making a good faith effort. Right?
But without assistance from the department, they can't get to that full 100%. Right? Let's I want I want us to make sure, like, let's let's help each other out here and making sure everyone understands we're all on the same team. Right? But we do wanna make sure that our clients are receiving quality services too.
Right? Because at the end of the day, we're all in the service of the client. And so if providers are not willing to provide the best service because now, guess what, providers? You're part of the system too. You're one of us.
And which means that the system should always be doing what's in the best interest of the client, not forcing clients to do what's in the best interest of the system. Right? And so let's make this happen together. But we also know that people might providers do need help. We wanna provide them with that help, and we wanna continue to make sure that they are being reimbursed to the full extent of what it costs to provide the service as well.
I also would like to receive as much information as possible about the potential loss of the 10% for providers, and what can be done to reduce that. That's my whole point about, you know, if they're making a good faith f, faith effort, maybe we can give them a part of the 10% while they are providing technical assistance. In my in my estimation, as long as they're willing to receive the help, and once receiving the help, they're responding to the help, right, then I think we're improving in the right direction. Questions or comments, committee members? No?
And as always, committee staff is always available to be able to work out any iteration of the trailer bill language as well. But great start. Let's get it to the finish line. Okay? Right.
And again, please please please continue to work with this. I think we're almost there already, and so I would hate for us to reject this bill proposal just because we're not having a communication and a good process. Thank you very much.
Speaker 1
Thank you. And Barry, I think this is the first time I've seen you this year. Have I seen you?
Speaker 1
Well, come on. Get it together. That's that's on me. Yeah. I you.
Let's do this.
Speaker 1
I'm gonna take that. Issue number four. DDS DDS, you may begin when you're ready.
Speaker 2
Thank you, doctor Jackson. Pete Chervinka, again, director of the Department of Developmental Services. Happy to do this. As for a description of the proposed trailer bill language on this this topic, Let me first say that this falls in the category both of complex but also surgical. The intent of this language is very simply to make sure that the boards of regional centers, most of whom at this point now operate or responsible for budgets over a half $1,000,000,000 each, have the skills necessary to to appropriately run a regional center, which is their task.
And as you pointed out, the purpose of running a regional center is to serve individuals and families. But the regional center itself is the responsibility of the board. They have a fiduciary obligation to make sure that the institution is operating correctly, and our language is intended to address that. The main points of the language are covered on page 22 of the agenda. There are six topics there.
Enforcement for the department when regional center performance is not where it should be. We also are proposing an administrative simplification, but I think also an important emphasis on the purpose of regional centers. The purpose of regional centers is not to do things. The purpose of a regional center is to do things well and try to do them better over time. And so what we are looking for here, we have a core contract between the department and regional centers.
We also have a what we call a performance contract between the department and regional centers. And in the last several years, we've seen an investment in regional center performance measures. And what we are proposing to do is collapse all of those three things into a single contract to deduplicate and make sure that it's very clear for regional centers for the public and the department to be very clear about what we expect in terms of performance from regional centers. The third item, although it sounds mundane, is fiscal allocation authority, we have seen various gyrations at the federal level with our ability to access federal funding. And we need to be incredibly nimble in response to the things that can happen on that front.
We have three primary sources, as I mentioned earlier. Medicaid funding is our primary, but we also get $58,000,000 in federal early start funding, and it seems to be moving around within the federal administration. And at one point, wasn't clear whether we'd be getting it at all. And we have a very small federal grant for the foster grandparent senior companionship program. It's only a million and a quarter, but we actually had to sue to get that released to us.
So what we're seeking is authority not to have to execute formal contract amendments through the state's contracting process, but so long as the funding is maintained within the budget allocations to be able to write fiscal letters to regional centers to allocate that money. It would still be pursuant to the contract terms, but it would be essentially an exhibit at the end of the contract that could be swapped out as long as it stays within the budget. It's a much faster mechanism than requiring everybody to execute agreements. Number four, I think I already stated the intent of the language. We really wanna professionalize and improve the support available to regional center boards, and I'll talk about that perhaps in another minute.
And there are a couple, and then the last two are what we perceive to be barriers to provider capacity. Simply put, one, there's what we consider to be an outdated requirement that if you are going to provide services within a regional center's geographic catchment area, you have to have a physical office location there. Of course, that makes sense if you're providing residential services or a day program, you need a location. But if you're offering speech therapy, it doesn't make sense that you would need an office location for that. In large part, your business is traveling to people's homes to provide that service.
And the last one is what's referred to as courtesy vendorization. This is essentially that when Judy approves somebody to do business and then I want her to do business at my regional center that person to do business at my regional center too. I shouldn't have to put that person through another vendorization process or wait for paperwork to be transferred. If you're approved to do business, you should be able to do business. So those are the the basic outlines of the actual language.
Of course, I said and and the agenda notes as its first question, there's a volume of stakeholder input on this proposal. It covers several pages, which I've flipped out of order. But there there's a fair amount there. What I would also say is that it's un it's it's not insurmountable, meaning these problems that people are raising, by and large, can be resolved. Whether everybody, including the administration, would be thoroughly happy with the outcome, that's not the nature of the negotiation, but I think everybody shares the purpose.
We all want regional centers that function better and have more oversight and accountability with clear performance expectations along with the provider benefits that I talked about. So if I can tick through really quickly just in reaction in response to the first question, appreciate state council's, support. One of the things that we're proposing to do, not all regional centers actually have, what's called a consumer advisory committee. So we're proposing that instead of that being permissive, that become mandated. In addition, the language would mandate that that consumer advisory committee could on its own appoint two members to the the governing board of the regional center.
So right away, I'll cut to comments here, but we're proposing that boards be 10 to 15 members large. So right off the bat, we're proposing that 20% of the board be people with disability themselves. A number of stakeholders raised concerns in statute. There there's a current requirement that half of the board be reflective of people with disabilities or their family members, including a quarter of them being individuals receiving themselves services. Our intent in that was not necessarily to dilute the voice of individuals and families in the governing board.
I think primary focus for the administration and primary importance is that members of the governing board complete the initial training across a number of competencies that we've suggested be covered and also have annual refresher training on those. The problems that we see with boards involve their operation of meetings under parliamentary process. We've had some problems with open meeting notices. It not being correct, the operation of boards themselves have not always been efficient because people don't understand the rules and the vote taking. There's a distinction between what must be covered in open session versus closed session.
And so these are a smattering of the things that we think it's important that that boards be aware of in addition to the demographics of the catchment area and things like that. So more important for us than the composition requirement is that the composition of the board reflect the competencies necessary to properly operate a board. There are some revisions as well. Boards, as I said a minute ago, the vast majority of them now have half billion dollar budgets. For many years, contracts under 250,000 have been exempt from approval of the board itself.
And that in part allows the small business to to proceed without the board needing to to take a vote on that. Not not all boards meet twelve months a year, for example, so that can cause some delays. We think it's time to both update that threshold to 350,000 and also index it every five years by another $50,000 in recognition that that's not a lot of money. And there are some contracts, for example, vendor authorizations for services that are also exempt. But we think that this is a reasonable thing, recognizing the history, but also allowing the board the time not to have to get involved in every little detail, but still maintain their oversight.
Speaker 40
We're also recommending that the boards all have access to independent legal services, both for board operations, like appropriate meeting notices, board member conflict of interest in the voting on different issues before the board, and how to deal with closed session versus open session, and how to what what level of minutes need to be taken. It's a little bit weird for some regional centers today to rely on legal counsel employed by the executive director, and that legal counsel is then, for example, writing the contract for that executive director even while they work for them. We think the board is best served by independent counsel that's not employed by the regional center board. We put in language and we understand and accept that others may want it to be more meaningful about the support available to people with intellectual and developmental disabilities and their family members so that they can meaningfully participate in the boards. We have language there that I think was a start at that, but it's been indicated that can be approved and we're amenable to that.
Speaker 2
And we're also adding including language that requires more specificity around the topics that a regional center executive director should be annually evaluated on by the board. We've seen some examples where board members have provided evaluations to an ED that aren't particularly tied necessarily to the performance of the executive director in some cases, but also in some cases have been more inspecific so as to be unhelpful. For example, saying things like you need more leadership training, but not explaining what that is or what the training would be, what specific topics the board would be prepared to support the ED with. So we have some language around that as well. And also requiring the regional center board every year to evaluate the performance of regional center itself and make some recommendations based on community input to the executive director for changes that could be made.
Appreciate, I'm at the bottom of page 24 and onto the top of 25. I appreciate support from the Disability Services Association for some of the eliminations of barriers to providers. And continuing on page 25, you know, some question has been raised as to the appropriate number of board members. Our proposal was 10 to 15. We found that larger boards tend not to operate as efficiently as they can, But we also know that TENS sometimes can raise a question about the viability of achieving a quorum at any particular meeting.
Disability Voices United has suggested 15 to 18. The difference between our 15 top and their 18 top is not a surmountable obstacle. There is some drafting language that we could clean up as well to to the Disability Voices United's third bullet around whether people have lived experience or not. As I've said, board composition to the administration is less important than the competencies possessed by the board. Open to additional language either about topics or the format or content of training provided to board meetings as well.
I think you get the point. I worry that I'm joining on here. But these are really examples where I'm trying to say consensus is entirely possible and we appreciate the input that so many folks have provided here. This particular piece of language has generated more comment than most, but I think it's a recognition of its significance and importance
Speaker 2
Particularly in a time where we've seen budgets exploding, caseloads exploding, provider capacity needing to grow, federal questions about program integrity, and so forth. So we we feel pretty strongly this should be in the budget process for the reasons I've articulated and those as well. And again, as I said in my opening remark, I mean, if there's some direction that the legislature wants to provide about how to achieve that consensus, Mhmm. We're happy to either come back with a cleaner set of language or work with ledge staff to accomplish that. So
Speaker 10
Thank you for the opportunity to speak today. My name is Vivian Han. And in addition to my role at DRC, I have a brother who's a regional center client. Given the ever increasing complexity of these times, we have to level up our system. No question.
We'll need more and stronger professional expertise at regional centers to make that happen, and we appreciate the department for emphasizing that in this proposal. But what regional center boards are best positioned to do goes back to their founding principles, that no one with a disability should be left out or left unseen in their community, and that the more we listen to disabled people, the more we'll know how to truly make California a place where everyone belongs. Ensuring that boards reflect and are responsive to the communities they serve means so much more than complying with a rigid mathematical target for the racial or ethnic composition of the board. It means making sure that professional expertise doesn't crowd out the wisdom and expertise of lived experience. It means not just including but centering the voices of those served by regional centers.
You can't do that without a critical mass of self advocates on your board. But frankly, it's not that hard to meet a certain percentage or quota. What's harder is ensuring that board members with IDD have the support they need to meaningfully understand all the materials and issues before them so that they can be full participants, not feel good tokens. That's the real work. It takes dedicated intention, time, and resources, and we need to make it a standard board practice.
As my colleague, miss Epstein, stated earlier, as more public benefits are pared back based on things like assets and immigration status, few priorities are more urgent than equity. If our system is a safety net, then we need to tighten its weave. What regional centers are doing now around language access, translating IPPs, cultural competency, and especially generic services is more critical than ever. Boards must be dialed into and regional centers must be held accountable for this vital harm reducing work. Finally, regional center performance measures.
We support the department's proposal to consolidate what are now various scattered measures into one place so that expectations can be focused and clear. However, our system has had performance measures for regional centers for years. How will this version be any different? To achieve the kind of progress that director Chervanka mentioned, to achieve outcomes for people, regional center performance measures have to be more than aspirations written on paper. The sticks and the carrots that come along with them have to be real.
It will also take hands on direction, capacity building, and support to regional centers, all of which has been lacking for years. We would urge the department to provide much more specificity and detail about the process it will take for this to happen. Thank you.
Speaker 24
Thank you. I'm Judy Mark. I'm the president of Disability Voices United, an organization led by and for people with disabilities and their families. And I'm also the proud mother of a 29 year old autistic son named Josh who relies on the regional center system. So before you is an enormous amount of trailer bill language, moving through a much less transparent budget process with many provisions not directly related to the budget.
So that alone should give this subcommittee pause. But I wanna focus on the most concerning parts for our organization. So the proposal removes the long standing requirement that regional center boards include at least 50% of people served and their family members. That is not a technical change. It is a fundamental shift away from ensuring that the most affected by the system have a strong voice in how it is governed.
We appreciate the requirement that two members of the Consumer Advisory Committee sit on the board, but that is not enough representation. 20% is not enough. And there is no requirement that a board member be a parent or family member. That is a profound departure from the vision of the Lanterman Act, which was created by parents who fought to ensure that families would always have a strong voice in the system. We are also concerned, as you heard director Trevinka say, that 10 members are just too few.
We are lowering the number of board members while increasing our expectations of them. And I have a little show and tell for you to show you all the boxes that need to be checked by a regional center board. You have to have diversity by race and ethnicity, diversity by geography, diversity by disability, to somebody with two years of legal experience, somebody with two years of management experience including managing subordinate supervisors. You need to have somebody with one year of governing governance experience, not at a regional center. You need to have somebody with two years of professional financial experience.
You need to have somebody with one year of policy advocacy or three years of IDD program administration noting aside from lived experience, which our organization found to be problematic. And then, obviously, you have two members of the consumer advisory committee. If you have a board of 10 people, even if you have a board of 15 people, it is going to be impossible for regional centers to meet these goals. We are not questioning whether this diversity is valid or beneficial, but you're gonna have to have a larger board to meet those requirements. Regional centers oversee budgets that can reach up to a billion dollars.
A 10 member board is simply too small to provide meaningful governance at that scale. Board members, let's not forget, are volunteers. They have professional and personal responsibilities. A small board will struggle to meet quorum and fulfill its duties. So boards, first of all, should have the flexibility to determine the size that they that is needed to govern effectively.
More importantly, we need boards that are deeply connected to the IDD community, grounded in equity, inclusion, and transparency. Boards that are accountable to the community they serve and that ask thoughtful questions and provide real oversight, not simply boards that rubber stamp decisions. And to do that, board members must feel safe. No one should fear losing services for themselves or their family members because they speak up as a board member. We recommend adding strong grievance procedures and anti retaliation protections, including oversight of any service reductions affecting board members or their families.
At its heart, the system exists for people with disabilities and our families. Professionals play a critical role and we are grateful to them, but they cannot be the voices heard louder than ours. So preserving meaningful community representation and oversight is essential to ensuring an equitable and accountable system. Thank you.
Speaker 25
Good afternoon. My name is Amy Wesseling. I'm the executive director of the Association of Regional Center Agencies. As you can imagine, we have a lot to say about this one, but trying to be respectful of everyone's time. Much appreciation to the sergeant for handing out our complete letter on this to members who are present today.
Much appreciation for the opportunity to speak to the chair and members for engaging in this important dialogue. The system, as director Trevenka highlighted, is at an inflection point where regional centers have become major corporations, but they are still rooted in the principles of community driven organizations. And they must be informed and led by the perspectives of the people we support and their families. The system is rapidly growing and the capacity of providers must grow to support it too. But the regional centers play a major role in quality assurance activities, so the two need to be balanced.
We recommend rather than advancing the proposed language related to the elimination of requirements related to physical sites and courtesy vendorization that we take a step back and that by 2028 instead, we provide the administration with the marching orders to streamline the vendorization process to address some of these issues, but to do so in a thoughtful way that also considers who's responsible for quality. If you have regional center service providers being vendorized in areas out outside of where they are physically located, where their offices are physically located, quality assurance becomes much more difficult to measure and to retain. Second, we support the fiscal allocation letter authority. And as director Trevenka noted, it allows for more day and real time allocations to meet community needs. Today, we see sometimes regional centers bumping up against their contract authority and running into a situation where they may not be able to cut checks until they get that next contract allocation, which is a lengthy process.
So we believe this will address that. Next, we support the inflationary adjustment and clarifications to the board contract review. The level was set at $250,000 back in 2011. Inflation would have taken it to $363,000 by now. So we view this as just keeping up with the times.
And then most importantly, we view the boards of directors regional centers as carrying out a really critical role or perhaps it should be stated really critical roles. They are the bridge between the state who holds the contract with them and their community, which is why they were established, to provide a place outside of Sacramento where people could come and help shape their own services and their own policies. They also provide oversight of very large organizations as my fellow panelists have noted. We believe that the it is essential that we don't leave lose the lived experience of individuals served and their families on the boards. We believe that all of that should be retained at current levels, but we must support them to carry out their prescribed functions with adequate training, support, and increasingly, as director Trevanka noted, legal consultation.
But the legal consultation needs to be a funded mandate for regional centers. Similar to the way mister Giardini described some of the shortfalls in funding for service providers, regional centers are operating at historic deficits for what it would take to carry out all of their functions already. That being said, in terms of all of the support that regional center boards need, one thing that we've learned in doing extensive training with regional center boards and with regional center staff is that training interspersed with real world application of information over time is far more effective than a large amount of upfront training. So the because that model allows for synthesizing and applying information, which in turn results in greater retention. And so our proposal would be for board members to complete the training within the first year of their service.
As miss Mark demonstrated, and I appreciate the graphic.
Speaker 25
I don't need it. I have it memorized. It's I may have a tattoo of it. And but it is exceptionally difficult for regional centers to manage to all of these expectations and requirements. And one way that they do that is through their is through their board development or board nominating committees.
We believe that regional center board members should go through these board development or board nominating committees because it helps with compliance and ensuring that you have a well balanced board. And we view the role of the provider advisory member on the board differently given the statutory limitations on their participation. Specifically, they can't act as officers and they, of course, can't vote on certain things. And then in conclusion, the ultimate question to be asked is how we best set up regional centers to have the tools at their disposal to meet the needs of them of modern large organizations. And we greatly appreciate that the administration is taking a fresh look at that issue and started an important conversation with the introduction of its proposed language.
Thank you.
Speaker 7
Carina Hendren, Elio. We have no concerns about the fiscal allocation letter component of the proposed TBL. And then for the components on the regional center oversight and the board composition, we do not have any comments at this time.
Speaker 1
Questions or comments from committee members? Okay. You will once I'm done. So number one, this is a good problem to have. The difference between a good institution in the community can make a world of a difference based upon the quality of your board.
And so we have to take this seriously. And the more various experiences that a board has, the better the quality because you never know what an organization's gonna face. And you want someone to at least know where to look, whether there are legal issues, fiscal issues, governing issues, it's horrible to have a board that doesn't know how to run a meeting. It is a a waste of everybody's time. That doesn't mean it can't be learned either.
And representation does matter. And I am more concerned about the quality of the board than I am the number that's on the board. I don't I don't care whether it's 10. I don't care if it's 15. 20 starts to get a little shaky.
Right? Because quorum is quorum. Whether you have 20 people, that means you need more people to show up. Right? And so quorums are kinda funny too, which means you wanna make sure you have the right people who are going to I mean, my HOA rarely has quorum.
Speaker 1
Even though it probably will save rates from going up. Anyway, that's my own trauma. Okay. So so a few things is, number one, we gotta get somewhere. I'm not in a rush.
So I just wanna make that clear. Whether we get this done this year or next year, it all depends on the good faith effort. I'm always gonna land on the side of making sure that we have a good governance structure than I am about making everyone feel good. We're talking about public dollars that continues to be allocated, and we have to make sure that we are doing our fiduciary responsibility, which means we have to have the right people on the board in order to safeguard public dollars. Okay?
There's a couple of things I want to point out that I would love. Number one, you already know. We're gonna ask you all to sit down together and try to work some things out, provide provide us with a working draft on along with the changes that are lined out and all that good stuff as we're going through the process. But there's things that I know that I have concerns about already. The first thing is there's nothing wrong with the level of expertise you want on the board.
I think it's good that you're asking for that kind of expertise. Is it hard to get into on a volunteer basis? Yes. But that doesn't mean it's not necessary either. And there may be a way to say, hey, if you've made a good faith effort, maybe you can be exempt for this position if you can't find that many people who can who's willing to do it on a volunteer basis.
But that doesn't mean that it's not important to have. Okay? I am not willing to budge from a 50% threshold. Now, I think the 50% from people with can be coupled with 50% made up of those with lived experience and parents and guardians of those that have lived experience. I think the two can work together.
And you might be able to find some of those that actually help also to fit some of the expertise that you have. Right? That's pretty great. So there so I'm saying there might be a way to mix that in so that we make sure that we're not missing out on parents and guardians that might actually have some other professional expertise that might be valuable to the board, but then also making sure that we are not dilute but we're also making sure that clients are at the table as well. Right?
So I think 50% should be in those two categories. You can work out the nuances amongst yourselves on that, but I still think it's important. You never wanna lose the voice because then there are some people who forget what they're there for and they're more in favor of being in the position than serving the clients. So we don't wanna I do not wanna have calls about that. I mean, I know Judy's gonna try to call me if there is this after that.
Yeah. Right?
Speaker 1
let's have better rationale in terms of the cost of con contract threshold. I wanna think a little bit I need to understand your rationale a little bit in terms of the 250,000 to 350,000 kinda what, what, can you provide me some feedback in terms of what you were thinking or whoever thought of this was thinking, about changing the threshold?
Speaker 2
I was writing them down. I'm happy to respond to all of those points if you'd like. I I didn't mention in my overview, while we've proposed this as trailer bill, we've actually asked that the board composition and competency requirements we have we've offered one year until 07/01/2027 for boards to come into compliance. So we know as of July 1, right after this budget is enacted, that's not realistic. We've get the language already allows a year for boards to come into compliance, meaning they have a year to find people and and get them through the training.
Speaker 2
So I think we're like minded on better do it right than better than fast. You heard me say earlier those competencies and I am gonna take your
Speaker 2
is that nobody has suggested something be crossed off this list. Right? This is the right thing to do. It's a good thing to do, and it's an important proposal. And having these things is more important to the administration than a 50%.
We're happy to retain the language that's in current law around that, making sure that it's not just family members, but legal guardians and others. And in terms of the contract exemption threshold from board review, again, there are lots of contracts that regional centers do. They do hundreds of them every single year. We want the board focused on the things that are material. The $250,000 threshold in current law has not been adjusted in, like, thirty years, I think.
Speaker 2
My colleague Amy Wesseling from Arca said, if we applied an inflation factor, we'd be at 363,000. We've proposed three fifty. So it's like an inflation catch up adjustment. That's the rationale I would offer to you. But please yeah.
Speaker 1
So all that to say is is that we wanna just make sure that we're gonna ask administration and and stakeholders to, see if we can, come to in a reasonable agreement. Right? I've kinda told you kinda what my thinking is. There's no way this is gonna be perfect. I mean, in a way, we might have to revisit it again at some point, hopefully, not every year or something, you know, but I mean, what we're doing is we're trying to make the best assumptions as possible, and we have to be okay with that.
Right? But if we start to see some red flags, right, if we start to see things like, the board is so stacked that even in the midst of family concerns and client concerns, they're still doing something that is actually harming clients, you better believe we're gonna pay attention to that.
Speaker 1
Right? And I know that's not the intention, but the intention is is we have to raise the level of quality on our boards to ensure that we safeguard public dollars. Right? That's really what it's all about. And we don't wanna waste public dollars on lawsuits and all those kind of things too because then that's our additional dollars that are not going to the clients.
Right? So please take that into consideration. Department of Finance, have?
Speaker 26
Can you hear me? Okay. Doctor Jackson, Chris O'Neill with the Department of Finance, and we really appreciate the conversation that's happening today, and there seems to be consensus on the way things are moving. Just to clarify on expectations of process of where where we're at. So we obviously the administration put forward its proposal at governor's budget.
It's been out there for review. We have received all the same stakeholder feedback and are going through those changes as well. What we're prepared for at this point is to react to maybe those changes that are prioritized by the legislature and provide feedback in TA on that type of on on and have that kind of iterative process, but we're not in a position to produce another draft in as as to the way that you're that you're requesting at the moment. So I just wanted to clarify the
Speaker 1
process. I I I respect that, but I need to clarify that if there isn't additional feedback from the clients and with the revision that reflects some things, some common ground, there won't be a trailer bill approved. So I also wanna make that clear. Right? And so I would suggest that this is important enough that we are not comfortable moving forward without the stakeholders being a part of the process because we don't wanna make a decision.
In other words, nothing nothing nothing for us without us. Nothing about us without us. And so I would say that I don't think it's appropriate for the legislature just to make that decision. I think it's appropriate for those who have the real experience to figure it out as much as possible. And then if there are a few technical things, then we'll make some hard decisions.
And I think everyone in the room knows that I'm not afraid to do so. But so I would caution the administration of of taking that stance. We can have additional conversations, but just know we are in no hurry to approve this.
Speaker 26
Understood, doctor Jackson. We were we weren't intending to suggest that we were putting this on the legislature and that stakeholders wouldn't be involved. But I think, as you've noted in some of your comments today, you've you pointed out areas of interest like the the dollar threshold and board composition where we can take a look at and have those continued conversations with stakeholders. But what may be helpful for the administration and having those conversations with stakeholders is maybe having just clear clear expectations of, like, where interest is with the legislature in making those changes. So if we could request, like, information like that, but stakeholders would be involved in the conversations as well as, obviously, the legislature.
But we we do want this to be a collaborative process. But Mhmm. And we just we just wanted to make sure we were clear on what expectations are for the for the process.
Speaker 1
And I I would just say that when you look on let me see here. When you look on starting on page 23, when you see all the concern the different feedback, I would pay particular attention to those items where organizations that are labeled in the agenda, where they're opposing some things, that we have a conversation with those organizations to ensure that those are whether those are hard oppose. And if they are hard oppose, how can we come to some conclusion? If we can't come to a conclusion, we're more than happy to do our part to say whether it should be something warranting a halt of the trailer bill or not. Right?
And this might be something where we're gonna we're gonna build this as we go. Right? But all I'm saying is is that we we wanna make sure that if this is the administration's proposal, that the administration needs to do the work. If the administration is not willing to do the work, then we are in no hurry to approve this.
Speaker 1
I appreciate it. Thank you. Additional questions or comments? Any questions or comments from
Speaker 24
I just wanna add, Judy Mark, Disability Voices United, that director Trevinc and I have had conversations about this trailer billing, which and I I actually don't think we're that far apart.
Speaker 24
We both have the same interest in making these boards be accountable to the communities that they serve as well as provide effective oversight of the regional centers. I don't believe in the current form with the 50% and everything that we're doing now. I don't think this is working today, and we agree on that. We we believe that there needs to be reformed boards. I don't know that we should rush it is is is the issue.
I mean, I think this is a very large topic, and it's gonna require a lot of conversation and ensure that we have all the right stakeholders in the room to have the discussion. But I do believe that we are coming to it from the same place. I do believe the director and I are coming to it from the same place.
Speaker 1
Absolutely. My my request is to do what you can. At some point, we will check-in
Speaker 1
And then see where we're at. And if we think we have we need more time, we'll take more time. But if we think that we can get somewhere and what we're not agreeing on is doesn't warrant enough to just say no, don't do anything, we're not looking for a 100%. Right? Because I've never seen that that exist.
Right? And nor should we really. We we we need to make sure that as many thoughts and viewpoints are are there as possible. And so I think we're headed in the right direction here. I think we have some common principles that should guide our discussion.
And I think with that, we'll we'll see where we go from there. Okay? Thank you very much to this panel.
Speaker 27
Good afternoon, doctor Jackson, doctor, Shapiro Collins. I'm Mary Cruseikon, deputy director for early childhood and youth services division at the Department of Developmental Services. Thank you for the opportunity to speak with you today, and I'd like to, acknowledge the committee staff's very helpful summary of our proposal. As noted in the agenda, the department is seeking three year time limited authority to issue written directives to local educational agencies and regional centers operating early intervention programs. Our proposed legislation includes changes in law reflecting the end of our department's interagency agreement with the California Department of Education to oversee and monitor early intervention programs funded with federal grants and operated by local educational agencies.
It is a mutual decision by both departments to end the agreement. The proposal also consolidates transition related provisions for toddlers exiting early intervention programs in the current law into a new government code chapter. Proposal transfers the Department of Education's oversight responsibilities of LEA programs serving infants and toddlers with vision, hearing, and orthopedic disabilities to the department, thereby creating a unified statewide oversight structure that strengthens fiscal and programmatic compliance and streamlines monitoring of part c programs. On quest with regard to vetting with partners, we are engaged in discussions with the CDE, and our department would like to acknowledge our colleagues at the California Department of Education for their partnership on this transfer of state duties. The department is also engaged in discussions with state special education local planning areas and the fiscal subcommittee of the special education administrators of county offices.
We have provided a presentation among other things at their membership meetings. Thus far, the discussions with state SELPA and the fiscal subcommittee of the special education administrators of county offices have yielded clarity on what is changing. Most significantly, it is clarified that the changes in state level duties will not in any way disrupt provision of services to children and families in the program. Both partners had the opportunity to understand the department's record review process as a process for reviewing program compliance of local early intervention programs. In addition, it yielded understanding and clarity on first, how federal part c grant funds will be allocated to LEAs going forward, and secondly, the federal grant requirements the state and the local programs must comply with.
On question four, the administration has presented our proposal, and we assume that the legislature will have a reaction at an appropriate time. And then lastly, this is the administration's proposal at this time, but we're continuing to engage in discussions with California Department of Education. With that, I'm happy to answer any questions.
Speaker 7
Karina Hendren, LEO. The proposed trailer bill language aligns with a recommendation from a 2018 LEO report that evaluated the state system for serving infants and toddlers with special needs. In our 2018 report, we recommended that the state unify the early intervention system under regional centers as a single lead agency towards the goal of providing more timely services and providing more equal funding for each child served. In the report, we found that regional centers already serve the majority of infants and toddlers with special needs. They provide more parental choice, and they are better equipped to access public and private insurance billing.
So given this, we do not have concerns to raise with the proposed trailer bill language at this time.
Speaker 1
My question, to DDS is what is our how has the conversations between your colleagues in education, special education, What conversations have happened? Is everyone on the same page? What does that look like?
Speaker 27
Thanks. Thank thank you for that question, doctor Jackson. It has been a productive conversation, series of conversations really with the Department of Education. We actually spent more than three months to ensure that there's smooth transfer of duties. They have provided us us with provided us with forms that they've been using to track.
They have connected connected us with the leadership at the local level through, you know, the state SELPA and also the subcommittees so that everyone is understanding what exactly is changing. And on so on that note, it has been very helpful.
Speaker 1
Can you give us a description of that process that'll be helpful to the committee to make sure that all the stakeholders, everyone involved in this subject area has been, you know, that conversation. The the one you've just outlined it, but if you can just provide that process in writing, that'd be great.
Speaker 37
The inter the interagency agreement between both departments is is focused on the process to flow the federal Part c grant funds from, the US Department of Education's Office of Special Education Program to the departments of as lead agency into CDE into LEAs. So when when that ended, at the end of fiscal year 2425, so June 2025, we proactively had a series of, meetings with the Department of Education to make sure that they can transfer to our department all the forms and paperwork related to how they allocate the grant funding to the local educational, agencies that do serve those, specified pop the specified population. They also work with them in continuing some of the monitoring work for local programs operated by LEAs. So it it's been hand to glove. I mean, we could not be more proud of the partnership, during that transition process.
Speaker 27
I mean, we've had, meetings to go over what forms, what processes, they they do currently in flowing those funds, in doing the data collection, in doing the the monitoring of, those programs. And as I've mentioned, they connected us with pertinent, parties, at the state SELPA the state SELPA and also the the special education administrators of county offices. And through those, presentations with their membership, we were able to engage in q and a so that we can clarify what exactly is changing, how it will affect or not affect the the current processes that they used to. And with that, that that that's that explains how I describe it as productive.
Speaker 1
No. I appreciate that. If you can get that to us in writing, that'll be great. Because this is generally something that would go through a policy process, have you have you checked has this have you gotten this language to our education committee counterparts?
Speaker 34
On on the on this on this issue, so as was mentioned was that this proposal is the governor's budget proposal on this issue. So the intention is that the legislature will review as part of the governor's budget process. And also noting that the the rationale behind this going through the trail of a process is given the the nexus to the budget with the resources and the resources moving back to the Department of Developmental Services through the termination of the IA. That that is the nexus to to the budget and for this process.
Speaker 1
I think the the issue is we just wanna make sure that although the administration we don't have we're not in generally in opposition to the process in which we're going through now. We just wanna make sure that the appropriate people who generally has jurisdiction over the education portions of this, that they are have an opportunity to give feedback as well. And one thing you don't want to happen, and this will actually save all of us some headache because you don't want someone calling me, some chair of some other committee saying, what's going on? And why y'all doing this? Right?
So I think it'll be to all of our benefit for you to ensure that this is reviewed or at least given to our policy counterpart in terms of on the education. And I'm not saying there probably would be any issue, but we just wanna make sure we're covering our dots because if I if we get any pushback somewhere else, it could actually derail everything, and we don't and we don't want that to happen. Alright? Is there any other people or organizations or or stakeholders who have had concerns about this?
Speaker 1
Okay. Okay. Well, appreciate it. Please, please, please, we will be checking back on whether you have been able to get this, to our education committee staff. That's gonna be a big deal for us.
So please don't take that lightly. Any questions, comments on this? Oh, okay. Only
Speaker 9
The only comment I would do is echo what what our chair is saying, because of the proposed new structure for CDE as well. So it would it would be, be nice for you to be sure to talk to our education counterparts just to kinda see where we are, in regards to that aspect to ensure that what this proposal is doing tends to carry over if that new structure actually come in comes in into play. So but yeah. Because there there could be pushback in that area. So just wanted to make sure.
Mhmm. But thank you. Thank you, chair.
Speaker 1
I just know my people, and we are a bunch of cats around here. Okay? That's all I have. Thank you so much for you. Thank you.
Thank you so much.
Speaker 1
Issue number six, we're almost there. Yeah. Is the sun is the sun still out? Oh, okay. Oh, no.
Okay. Whatever. Who's who's for issue six? Is Aaron here?
Speaker 22
Well, good afternoon again. Aaron Christian with the Department of Developmental Services here to talk about the Life Outcome Improvement System, proposal. As outlined in the summary in the agenda, the Life Outcome Improvement system is an effort that we are underway to replace and modernize our existing legacy systems. The current systems that are used in our in in the IDD service area are really outdated. They're 40 plus years old and are really only internally facing to the regional centers at this point.
The Loa system is aiming to change that and create a more user centric approach that has end to end user capabilities that is inclusive of individuals that are receiving services, having access to information about them, creating a a more informed user experience where they can see in real time services that are authorized, the amount of services authorized, and amount of services that are utilized. We're also aiming to enhance communication between individuals and families and service coordination staff to improve and facilitate service delivery. We also want to look at creating more fiscal transparency for users so they can see what is being utilized, how much is being spent on them, what is in process of the approval, and really have real time information about them that's contained in this system. As outlined in the agenda, we embarked on a a series of town halls throughout the state that were held in person that began in the 2025 and continued all the way through the 2025. I say town halls, they're really more facilitated listening sessions where we invited individuals and families to attend those and tell us about what they would like to see out of this type of system.
A lot of what the outcome of those those town halls are what you see included in the legislative intent in the bill in itself. And it it is all of those core components that I just listed off, so having that transparency and access to information. It was really informative and empowering. Also included in the legislation is really centered around creating a more formal governance structure around the existing legacy systems. And what we're seeking to do is have the regional center seek approval from the department before making any updates or changes to the the different, you know, fragmented systems they're using today.
And the intent behind that is to make sure that we are, one, protecting the lowest project so we define the business rules from end to end as they they are today and make sure that when we go out to procure those, that they're reflective of the current processes. And if we have different regional centers doing different things, we then lose control over that that kind of end to end flow. So in the proposal, that is what we are aiming to do. Included in the governor's budget was funding for the project team and to continue efforts on data cleanup. One of the things that we wanna do is make sure that we create a solid foundation of information about our service providers, about our individuals and families and what they're receiving, the types of services, the financial aspects of that.
What the efforts have yielded thus far is is quite substantial in terms of our ability to submit federal reimbursement, upwards of a $100,000,000 thus far. So it is really an effort that's been funding itself, so to speak, but we, are looking to really make sure that we enhance that governance structure and, and controls about the, upgrades to the existing system. So that's really what the the bill before you, aims to do.
Speaker 7
Karina Hendren, LEO. As the agenda notes, we find it reasonable for DDS to continue the planning process for the lowest project, particularly given that the department was able to secure enhanced federal funding for planning. The planning process that the department is undertaking will eventually result in a cost estimate as well as a timeline for the finalized project. And once the legislature receives this information in the future, it will be able to evaluate the merits of the proposed project. We do wanna note, though, that given the fiscal constraints facing the state legislative oversight of this IT project, Its costs and its progress will be particularly important over the coming years.
And to this end, the legislature could ask the department if the project would be eligible for enhanced federal funding for project maintenance and operations after the planning stage is complete.
Speaker 1
Mister Christian, another technology project. There's one thing that scares me to death, and that is a technology project created by the state of California. How do we ensure that it will not exceed projected costs? And how in the world do we ensure that the project will be done before I retire? That's a real question.
Speaker 22
Yeah. No. No. Okay. I think that really emphasizes the the planning stages that we're currently in today.
We've done an ex this this project has gone through extensive planning and preparation and different iterations where we lumped in multiple projects into one, wanted to make sure that we are moving at the same pace. We we've just wrapped up some market research looking at what existing platforms are out there. We are consulting with other states to look at what they've implemented, try to learn the pitfalls from even some of our sister departments in implementation. I'm I'm know that I'm stating the obvious, but these are all things that we take into consideration. I think the planning is is really the key piece of this and making sure that we understand what we are asking and what we are we are gonna be buying and working with the the the vendor that gets selected once we go to procurement on a realistic timeline and and fixed costs for each one of the stays the stages of the the implementation.
Speaker 1
LAO, this might be one of the things that we need your help on in terms of accountability measures, in terms of finding ways that the legislature can continue to get updates and have some some better or increased participation in the process so that we can make sure that, especially as we're going through a transition to another administration, priorities might change, things like that. There's no doubt this what we're hearing is this is something important that we need to do. I think how how old is the current infrastructure?
Speaker 1
Have mercy. Yeah. So, I mean, there's no doubt we gotta get into the twenty first century. Right? Absolutely.
But we wanna make sure that, you know, what process has started now continues on in a efficient way, a productive way, and making sure that we're all informed along the process. So if there's recommendations on additional language we need to do to codify, for the legislature to help with that consistency, we want to make sure that we do that. Again, the more money we spend on delays and things like that or less money we can do to provide to get to the clients as well. Right? So we wanna make sure we're good stewards of our dollars.
Any questions or comments on this item? Doctor Sharp Collins.
Speaker 9
I think it was answered. This is going back to LAO of your about being able to provide an overall, project timeline and expected cost broken down by physical years by by by the actual years, would that only happen after the planning process is complete? Or I I just want a point of clarification.
Speaker 7
Yes. That's correct. So the legislature has not received that information yet,
Speaker 9
but it will. Okay. I just wanna make sure I had that right. Okay. Thank you.
Speaker 1
Absolutely. Especially the in terms of the reasonableness of the time in which timelines can be provided, I think, could be something that we we we start to to work on. And then also, just some check-in points, think, is gonna be, important as well. Okay? As you know, again, Lord, please please let this be done before I leave the legislature.
That will be that will be great. I know. I can't retire because I don't have a real job. Alright. Thank you very much to this panel.
Speaker 29
Hello, doctor Jackson. Good afternoon. My name is Ernie Cruz. I'm deputy director in the community services division at DDS. I'm here to speak on the trailer bill language on remote services.
The department is seeking to establish permanent authority for the continued option of remote service delivery within the regional center system. The services where remote the remote option would apply include day programs, look alike day programs, independent living, behavior therapy services, and clinical assessment activities. This proposal would codify the ability of individuals and families to select remote services when appropriate while maintaining standards of quality, accountability, and compliance with applicable statutes and regulations. The remote delivery service option was made available through directive authority initially in November 2022 and subsequently extended. The last directive was in March 2025 and extended remote services through December 2026.
This action, provides continuity when the current directive expires at the 2026 and maintains our commitment to choice and flexible services that meet the needs of individuals and comply with federal and state stand requirements. While broad support is anticipated, we recognize potential questions regarding provider participation and quality safeguards. This proposal provides individuals and families the choice to select remote services when appropriate to meet their needs. With regards to some of the questions that have been posed, one of them being the concern about the proposal widely opening the possibility to utilize remote services for services that are better delivered in person. The current proposed tail trailer bill maintains the same services that have been approved to be provided remotely through a directive.
Speaker 11
Also, it should be noted that early start services and tailored day services, can already be provided remotely through existing statute. Remote services is voluntary. Individuals and families choose whether remote services work for them and whether they wanna receive remote services. There was a question about concerns with some individuals and their families having expressed a preference for more in person options instead. For that, the planning team, through the person centered individual program plan, decides the way that they would like services delivered.
Speaker 29
Remote services are another option on how an individual receives services and is not a requirement. There's also a question about, how the department will ensure that remote services are provided, with full choice provided to the individual, for either in person or remote. And the primary way, to capture that services are provided with full choice given to the individual is through discussing at and documenting in the individual program plan. Thank you.
Speaker 4
Thank you, mister chair. Aaron Caruthers, executive director of the state council on developmental disabilities. As you know, the state council is an independent state department, and part of our job is to find barriers that keep people with developmental disabilities from living full integrated lives in the communities and codifying flexibilities to allow for remote services. It removes barriers. People experience barriers with limited transportation, for living in rural geography, scheduling challenges.
So we appreciate the administration advancing this flexibility. However, the conditions that made remote services necessary during the pandemic public health emergency should not become the ongoing standard of care. We're concerned that the current language opens the door a little bit too widely, for remote services, especially in cases where in person supports are essential to achieving the goals within the IPP. So, for example, day programs, they build social skills, communication, self advocacy, and community integration through interaction, with each other. Independent living builds real world skills like managing money, navigating transportation, maintaining a home, and making decisions in everyday environments.
Speaker 15
And these skills will they're learned through practice in a setting where people actually live their lives. Behavior analysis depends heavily on direct observation and real time interaction. Clinical assessment diagnostic tools for eligibility, like cognitive, developmental, adaptive behavioral assessments, those have really been designed and normed for in person administration. So the American Psychology Association Psychological Association, their position is that while telehealth assessments can be used in limited circumstances, it may affect the validity of the results by being telehealth. And similarly, the American Academy of Pediatric emphasizes that direct observation of behavior, interaction, and communications in real time, especially for autism and intellectual and developmental disabilities.
Speaker 4
HCBS rules are that services must be delivered in our natural settings that support full access to the community and opportunities for independence. And while this lays out a pretty heavy case against it, the state council does support the flexibilities. What we'd like to see is that we'd like to see some guardrails and some language put in that creates guardrails. The language we recommend specifically is that these remote services are delivered consistent with professional standards. And this small change, we think, would reinforce that the mode of service, delivery should never compromise quality or purpose of service.
Also, while we appreciate including reporting requirements, just tracking the number of remote services delivered alone isn't sufficient. We must ensure the outcomes, are measured, and those outcomes of success, including independence, inclusion, and quality of life. So in closing, our position is we support flexibility, but flexibility must be balanced with accountability, quality, and true choice. Thank you.
Speaker 30
I think I can officially say good evening, chair and members. I know we've crossed the threshold. Emeline Chabard with California Disability Services Association. CDSA represents nearly a 130 community based organizations across the state that work to support nearly 200,000 individuals with IDD. I'm grateful for the opportunity to provide comment in support of the TBL today and to share our involvement in implementing remote services over the past few years.
I'll also highlight some of our ongoing work to ensure that this permanent option is offered in alignment with HCBS requirements as mentioned in the agenda and the person centered promise of the Landerman Act. CDSA's advocacy around remote service flexibility began with our involvement in the Disability Thrive Initiative in 2020. Through the statewide initiative, CDSA worked closely with DDS to identify and elevate best practices for safe alternative service delivery. Organizations use these practices to develop innovative remote programs that encouraged engagement during lockdown and throughout the pandemic. What began as an emergency response to protect the health and safety of individuals has since evolved into a meaningful option for Californians with IDD.
To better understand how this service option is being used across the state, we've shared member data with the department and are providing feedback to help establish processes to track future utilization. CDSA fully supports the TBL language granting permanent authority for remote services. However, we also recognize that implementation must include thoughtful guardrails and appreciate the comments from previous camp panelists. CDSA shares a commitment to ensuring that remote services are delivered in a person centered manner that prioritizes the goals of an individual. To support this work, we're sponsoring complimentary legislation, s b nine six nine, authored by senator Reyes, to establish a clear process for informing individuals, families, and service providers about the use of remote services.
Speaker 39
This effort is intended to reinforce transparency, strengthen informed choice, and ensure consistency across the state. We applaud the department for its recognition of the value of remote services and dedication to ensuring the system continues to evolve to meet the changing needs of Californians with IDD. We look forward to continued collaboration to develop the necessary policy guidance for this permanent option. In mainstream education, employment, and health care systems, remote delivery has become a standard option. Individuals receiving regional center services deliver that that same choice and flexibility the hour is getting to me.
Speaker 30
Ultimately, building a system where individuals can truly thrive requires that we listen to how people want to be supported, not how we think they should be. We urge your support for this TBL and appreciate the opportunity to provide comments this
Speaker 8
Department of Finance? Omar Sanchez, Department of Finance. Nothing further to add.
Speaker 1
Let me just start off by saying that, obviously, we we recognize the the usefulness of remote. However, fidelity is important. And just because you provide a service, if it's not done in the correct way, you can't get the outcomes that you need. And so I do believe that we should be each service, not just say a service, but each service has this level of fidelity that if you don't do it in a certain way, you cannot expect outcomes. And so if we are not going to pay attention to the fidelity, I am now wonder I will then wonder, are we just throwing away money?
Right? It's not enough to just do it. It's how we do it and the outcomes we need to have to do so. So I do believe there needs to be a balance. And I can't say particularly what that balance is.
I'm not gonna just say every service should be available remotely, but I am gonna say that some probably could be if the fidelity and the data and the research shows that it can be done that way. So I would be more interested in seeing some language in the trailer bill that really says an assessment will be done based upon of the particular service, that's gonna be based upon the fidelity of what the best practice is. And then, I mean, there's a lot of nuances here. Part of the nuance also is, in some cases, remote service may may result in no effective outcomes being achieved, but there may be some effective outcomes being achieved, but not to its optimal level based upon the fidelity. What part of percentage of outcome is gonna be acceptable.
Right? For instance, every year I try to do a physical. I'd be getting out of bed and things just start hurting for some reason. Don't know why I didn't do anything, but why this hurt. Alright?
Yeah. Right? You don't know nothing about that.
Speaker 1
You don't know nothing about that. You little whippersnapper. But I know I'll have a better outcome if I go in to see the doctor as opposed to just doing a virtual physical. Right? And I think it's the same thing.
Sometimes we do things based upon convenience, not based upon what was the best outcome. And so I am not willing to just do a service without understanding if we should be expecting outcomes or not. So if we can figure out what that language could be, that will really make sure that we are honoring the fidelity of a particular practice or a particular intervention, I'll be more comfortable with that. But as the language stands right now, I am not comfortable with that. And that's just the social worker that says to me, there's a little bit of red flag.
Department of Finance?
Speaker 8
I I just like to flag one thing for you, Jared. Just the the language is it's for an individual. It's notes that it's if deemed appropriate in the individual's in individual program plan. So there's that level of oversight when, like, who who's receiving the opportunity to receive the remote services so there would be that layer of review.
Speaker 1
I think the question is who is it that's deeming it reasonable? That's a question.
Speaker 29
Yeah. Who's deeming it reasonable? And to that to what Omar indicated, the individual program plan, the individual, the family, they guide that discussion. They do it in a person centered plan. And as mentioned before, it's not a requirement.
It's a choice. Mhmm. So, you know, if that's a discussion that that planning team has and has determined that, yes, remote services in this instance for this individual makes the most sense, that's that layer of oversight
Speaker 1
But whose sense is making that decision? All I'm saying is this. There are some interventions that if you don't know exactly how that intervention is supposed to work and someone with that knowledge is not in the room when the plan is being done and that decision is being made, then that is not a professional assessment. So that's why I ask whose reasonableness is making that because outcomes is what we're trying to achieve, not just providing a service. And if we need to have some more off the off the record conversations, I'm more than happy to do that.
All I'm saying is is that I'm tired of just doing stuff. I wanna do it right. And when I have decisions that have to be made on what's being cut and all and what's being saved, I wanna make sure if we're gonna pay for it, that it's gonna do what it's supposed to do. Right? And in some cases, hate to say it, but in some cases, the clients might want it to do it a certain way, but the outcomes may not be there.
Right? And so sometimes you gotta take your medicine too. And so if we can find a way to get to a point that we're comfortable with, I would appreciate it. Questions, comments?
Speaker 30
Yeah. Professionalization, and the department can speak to this as well. But just a little bit more context around that individual planning team. While it does include family members, the individual, and other support members who might be a part of that person's life, it also does include a service coordinator and an individual from a regional center who is determined to, be able to make that appropriate decision. So, I understand the level of, hesitancy, but there is a process that is identified in statute.
And I wanted to add the additional layer of the requirement that exists in statute for those to be at least in person once a year.
Speaker 4
Aaron from the state council. I'll state what was just articulated, and all due respect is not enough. And then to the core of your question, what are the quality of the services, and are we getting the outcomes we need and the legislature's investing in? And I just want to point to some of the initiatives that are underway within the department, specifically the PAVE project, which really does take a unique approach to measuring. How do you measure individual outcome on an aggregate basis about quality of life?
That's a challenging question, and the legislature has invested in that. And I think maybe the solution is just linking what's happening there with with the services here. The state council's concern is actually more fundamental. Our our concern is will there be a choice? Will there be a true choice?
Because we all we want flex, we want remote services an option. We don't want it to become the only option, and we can very easily foresee a situation that because of budget constraints, things get shrunk, the pressures are on, and suddenly those those in person services don't exist anymore. Remote is the only option. And in that case, there is no true choice, and that's our core concern.
Speaker 1
That is a very valid concern. Let's I'm gonna ask that department continue to meet with stakeholders, ensure that many of these issues are being resolved. It doesn't seem like we're too far away, but we just wanna make sure we do it right. Mhmm. Right?
I mean, this is I think this is a critical time where we we just have to double check with ourselves and just to make sure that we're doing things based upon what's in the best interest of the outcomes that need we are expecting to have with these services. Okay? So let's see here. Can we possibly by May 1, I'm gonna ask the department to kinda give us an update where we are on on this language and to see if we've made any progress, and then we'll make a decision from there. Department of Finance.
We can can take
Speaker 8
that back as far as timing and just wanna reiterate the points that were made previously on the other issues around the the process Mhmm. As we continue dialogue, but we can take take that point back. Absolutely. Appreciate it. Thank you very much.
Speaker 31
Good afternoon, doctor Jackson and members. Michael McNulty, chief of the community appeals and resolutions branch of the department, and I'm joined today by deputy director Hornberger behind me. We appreciate the opportunity to be here. To comply with with the federal access rule requirements, the department has proposed trailer bill language that creates a single statewide grievance process that expands access, strengthens oversight, and increases transparency. We've also submitted a budget change proposal to make permanent the resources granted in the prior budget year.
These were resources, which include positions and funds to build an online grievance portal, will soon be needed to shift from development and implementation work to ongoing operational and oversight activities. After reviewing the feedback from the agenda alongside what we have gathered from meeting with the community, there are two dominant themes that have emerged, a request for greater process details and timelines. The department's proposal establishes a statutory framework for the policy, and the department intends to issue additional process details through directives to regional centers prior to the implementation date. We also plan to finalize this policy through state regulatory process, which will include opportunity for community partners and advocates to comment and participate. On process timelines, all actions must occur within the ninety days required by the federal regulation, and timelines in our proposal represent maximums.
We do not anticipate the department or regional centers using the full allotment of days in most cases. While we understand advocate concerns about the seven day period for individuals to request a state level review, The department does not believe individuals will need a consultation to determine whether or not they are satisfied with the resolution put forward by the regional center. If a griever is unhappy, they can simply ask for a state level review. The current complaint system focuses on identifying and documenting violations. The access rule allows us to shift to a more person centered outcome driven model.
Speaker 12
Regional centers will be directed to focus on resolving issues with individuals rather than producing lengthy administrative letters. The online portal will give the department real time oversight of timelines and resolutions as well as help us identify systemic areas where technical assistance is needed. We would note that our proposal aligns with the work group four's recommendation on improving access and support. However, the proposal does not include compensatory services as the governor's budget does not contemplate their inclusion in this policy. Finally, although the federal enforcement has been delayed until December 2027, the law will still take effect this summer.
Speaker 31
The department is moving forward toward the July implementation date and views this new process as as an important tool to hear directly from the community on key issues they are facing in real time. The department believes this policy change is the right thing to do for individuals served in our system. This proposal will allow the state to shift to a person centered model with improved access and oversight. We acknowledge that change can be difficult and increased uncertainty, but we ultimately believe there would be immediate benefits to the community from this policy. We've engaged extensively through public and individual meetings with community partners and advocates.
We're committed to continued engagement and believe we can reach a consensus ready proposal for adoption in this budget. Thank you again for the opportunity to be here, and I'm happy to answer any questions.
Speaker 17
Thank you for the invitation to be here today. My name is Will Miner. I'm here on behalf of DRC. I also come to this work with a personal connection. I have a brother who's served by the DDS system.
DDS has described a goal that I think we all share, a grievance process that leads to meaningful individual outcomes for people while at the same time giving DDS the tools to better monitor and oversee patterns and trends and intervene when they need to. And I I trust DDS's intent with this goal, but our concern is that the proposal as it's drafted today doesn't quite meet that intent. So we have we had a number of we had a lot of feedback within our budget letter, but I wanna focus on two primary things I think can bridge that gap. The first is about grievance responses. So we think that grievance responses need to be timely, and they need to address harm in a meaningful way.
Speaker 18
So under the proposal, the resolution plan, which is the written outcome of a grievance investigation, it can just be a summary, a brief summary of the grievance along with a resolution which the statute, the proposal can define as more meetings or more communication. And regional centers have up to sixty days to issue a resolution plan that looks like that. That's too long for too little of a resolution, especially when somebody has lost something tangible. Right? Something real, like an authorized service because a regional center blew a legal timeline or maybe a family had to pay out of pocket for an authorized service because someone dropped the ball and it wasn't their fault.
Speaker 17
So for the grievance system to be meaningful, we think that resolution plans need to consider how you make it up to somebody when they're harmed through no fault of their own, when they lose a service, when they have to pay out of pocket for an expense. And this isn't just my opinion. This is part of the master plan's recommendation as a critical way for how you can restore trust in the system. People don't trust the system anymore. And a way that you can restore trust is by asking, how can I make it up to you, and how can we make sure it doesn't happen again?
Second, we also think that TDS oversight needs to be stronger both for individual cases and at the systemic level. For individual cases under the current proposal, DDS review would only consist of checking the resolution plan for appropriateness relative to the grievance. What's that mean? That's that's vague. People don't know what that means.
And that standard appropriate to the grievance needs to be spelled out somewhere, preferably in statute, so that people know what to expect to the grievance process, and the legislature can determine whether DDS is exercising its oversight in a meaningful way. And at the systems level, we support DDS's use of aggregate data to provide technical assistance to regional centers when they identify repeat patterns or trends of things going wrong. But DDS also needs clearer authority to escalate when sometimes just technical assistance isn't enough. Maybe there's an egregious situation that arises through a grievance or maybe there's a repeated pattern that happens over and over and over again with a failure to cure. I might suggest that more than technical assistance needs to be done at that point.
And finally, before I close, I wanna address one point that I saw on the agenda about the implementation date. Now that the feds have given us some breathing room about when this new process needs to be effective, and I think DRC, we're open to talking about a kind of new implementation date, right, to maybe push things out, an effective date. And director Trevenka often says sometimes doing it well is more important than doing it fast. But we wouldn't wanna defer this TBL until next year. Right?
Not at least until everybody has a chance to get together and work through everything and and on a solution, and I'm I'm optimistic that we can get there. Thank you.
Speaker 16
Yes. Good afternoon, doctor Jackson and committee members. It's a pleasure to be here and sharing today. But before I start the testimony, I wanted to acknowledge the many families and self advocates who are here today. Many drove from Los Angeles early this morning, some from Stockton, others from Redwood Coast.
And it's because of what you said, nothing about us without us. And in addition to this room, there's an overflow room with many other families. And I'm not sure if you know this, but we also have been monitoring the the video feed and translating it for hundreds of other families via a digital platform. So thank you for this opportunity to share from the community. So what I'm saying is not only as a dad of two young men served by the regional center system, but also as the founder of the inter created community collaborative.
Speaker 10
We are composed of parents and self advocates, and we support families across California's developmental service systems. And we have walked with families in thousands of IPP meetings across all 21 regional centers, including through the complaints, through the appeals, the ombudsperson's engagements, and the forty seven thirty one process. I do wanna acknowledge the Department of Developmental Services for taking the steps to revamp and to remodel the grievance process. And this is an important opportunity. However, based on our lived experience, we're concerned that the proposal as it is today is structured to meet possibly repeat many of the challenges that our families are facing today.
Speaker 16
The first, the shift of the direct submission to DDS. While this creates the appearance of independence, complaints are ultimately routed back to the regional centers for investigation. From a family perspective, this raises a critical question. Is the system truly independent, or is it still reviewing itself? Without clear DDS authority, oversight, and accountability throughout the process, not just at the submission aspect, the trust issues will remain.
Second, the sixty day investigation timeline. Now while structure is important, many grievances are urgent and cannot wait. The proposal lacks a clearly defined expedited pathway for immediate risks such as loss or of services or unsafe conditions. In our community, delay is not neutral. Delay causes harm.
So we strongly commend recommend looking at options like a maybe a dual track system for standard and urgent cases. Third, the lack of defined outcomes and enforcement. The proposal outlines how complaints are received and reviewed, but it's not clear on how in what happens when a regional center is found out of compliance. Who enforces the corrective action? What are the consequence cleanses for failures to act?
Without clear enforcement, the process risks acknowledging concerns without resolving them, and we're back to square one. Fourth, continued concentration of control at the regional center level. Even when DDS intake or submission, regional centers maintain significant influence over the investigation process. A grievance system must not only be fair, it must be perceived as fair, and the perception is currently at risk. Fifth, accessibility.
Many families, especially those from culturally and linguistically diverse communities, already struggle to navigate the system. So without plain language guidance, language access, and community based support, this process will continue to exclude most of those who are at highest need. So finally, the fear of retaliation remains unaddressed. Families depend on the system, but they often fear that speaking up will impact future services. So without those safeguards, utilization of the of the process will still remain low even though the need is there.
So in closing, this proposal is a step, but not yet a solution. A meaningful grievance system must be independent. It must be timely. It must be enforceable and accessible and safe to use. So this is an opportunity to restore trust, not just redesign process because at the end of the day, this is about the dignity, about the equity, and where their families can count on the systems what matters most.
Thank you for your time, and most especially, thank you as you started to say that you see us, and that does not go unnoticed.
Speaker 25
Good evening, I think, at this point. Amy Wesseling, Association of Regional Center Agencies. Just wanna note that AARCA appreciates that the department in response to a new federal requirement is taking the opportunity to look at what's not working. What's not working is our long held forty seven thirty one system, which has been in place for decades. It's cumbersome, formal, and requires the determination of whether a right granted to someone was violated and then a proposal really focused on how do we avoid this in the future rather than how do we make things right.
And having worked on both sides of forty seven thirty one proposals, all I can say is thank you for taking the opportunity to think differently about this. That process is too formal and rarely gives people a satisfactory response and opportunity to move forward. The proposed framework promises to be more flexible, less formal, and to bring the process of resolving issues that arise closer to the work, and more importantly, closer to the relationship between the person and their regional center. It provides the opportunity for those difficult conversations and for people who are closest to the issue to try to resolve the issues that have been that have arisen. When people express dissatisfaction with the process, they generally aren't looking for a big bureaucratic response.
Usually, they are seeking for someone to address the issue at hand. It could be anything ranging from a procedural error to a belief that services aren't being provided in alignment with federal expectations for integration. Some issues will be resolved quickly, as my colleague from the department noted, and, there is no expectation that sixty days will be the default timeline to resolve simple simple issues such as ensuring someone, for instance, receives the accommodations they need to participate in a planning team meeting. But the sixty days is important for other more complex issues, such as if someone raises the issue about wanting or believing they need additional level of choice and control in a residential setting. That requires a lot of work between the people who are providing services, the regional center service coordinator, the regional center community services specialist, and that takes time to get it right.
Some of the proposed changes may highlight bigger systemic issues that need addressing, such as the inclusion of people in the intake process might highlight that part of our issue as a state is we don't have enough clinicians in California, whether within our system or outside of it. But knowing those things are important too. Knowing the systemic issues help us with long term planning. We support the changes, but note that this is an increased workload on regional center staff. And while less formal, we expect to see more grievances than we do forty seven thirty one complaints today, in part because we expect it to be more accessible and more widely used with a higher level of satisfaction with the process.
Additionally, we need to do it right. Doing this July 1 is not reasonable. When we modified the regional center appeals process a number of years ago. The implementation date that was arrived at through the budget process was March 1. And doing something similar here would provide us with the opportunity to create the plain language documentation that mister Gomez spoke of to provide comprehensive training to regional center staff to roll the process out correctly.
So again, we agree that this shouldn't be pushed out to another year, but we need to slow down and do it right and appreciate that, we've been given the opportunity with an enhanced timeline to do that. Thank you.
Speaker 7
Karina Hendren, Elio. For the BCP in this item, we have no concerns. And then for the proposed trailer bill language, we don't have any comments at this time.
Speaker 1
It feels good. Okay. Good to know. We're lovey dovey around here. You know?
That's really good. Obviously, there's some work to be done continuing to work with stakeholders. We wanna make sure our grievance process is one that takes care of everyone's needs. Obviously, the most important need is the client. And we also wanna process that it's not so difficult that it's more likely that the client will lose services or not get the services that they need.
Speaker 2
I believe that, number one, it is a good point that depending on the service that is needed, sixty days may be a lot to wait because there are some services that are more important than others, and we don't want harm to be done while a process is going. So what could a dual process look like where depending on the need of the service that they are able to receive some type of service while the grievance process is being done. I think depending on the service that is being asked for or being considered, that that would not be a stretch to do. But, certainly, we we with so many trailer budget trailer bills that are being presented by the administration, This is something administration's gonna have to bridge right now. Seems a a gap that I'm not sure we can meet in a timely way.
Speaker 1
And so I would encourage the administration to engage thoughtfully and thoroughly, if this bill, if this is gonna move forward, because it is it is that important, but it's also pretty difficult as well. So I just wanna leave you with those thoughts. Questions or comments from committee, members at this time? Let me see here. So I do want to make sure that you're taking stakeholder comments seriously on this.
Again, thinking about sometimes depending on what the service is, some type of dual track I think is reasonable given the possible level of importance a service can provide and the level of harm that can be can happen if that service is not provided. Want to think about those kind of contexts. Those are gonna be very important. And so, please, the more you're able and the quicker you're able to provide us a renewed draft, the better it will be for us to be able to make sure that we're making a reasonable decision or not. To be honest, this is we're gonna rely on you to give it to us as soon as you think is reasonable, but understand that we have many other bill trailer bills that we're gonna have to consider.
And given the fact that the federal government has extended the deadline, doesn't make us feel very rushed. I'll just say that. Okay. Any additional questions or comments? Anything else from the panel at this time?
Speaker 16
and I think that you pretty much captured the spirit, but I just wanted to put emphasis in taking the example of miss Westlink that she used. And we understand and respect when it comes to complex issues that it takes time to get it right, and and and we need to get it right. But if you're on this side of the ledger and you're that person with a complex issue, you don't have that time. It is it that sense of urgency is so real that however which way we can bridge this and to find it so that these individuals don't have to suffer or go through a sacrifice in their lives, I think we'll all have that outcome that we expect. Thank you.
Speaker 1
Absolutely. And I would just say say this as well that we how do you find that balance between the time of the process is important because in order for the system to get it right, they also need reasonable amount of time to make sure that they've considered all the evidence, they've done all the homework that is necessary to ensure that the client does get the right result as well. What that balance is, good luck. Okay? But I think we let's try to work this baby out.
I think that's all I have on this issue. So let's let's double back on this. And whenever you have another draft, please send it as soon as you can to us. Okay?
Speaker 1
Thank you very much. Thank you. Number 9. Number 9. Come on up.
No. I need to take a break. That's alright. I need
Speaker 32
I'm not saying anything. Hopefully. Oh, I love And I was climbing to So much I left my talking points. I'm sure you knew them. I think I I know what to say if we need to.
Speaker 15
don't chair a committee, so this is a little new process. Alright. So we're gonna bring up the department. Sonya Fox,
Speaker 15
are very important topics. So, but I know that we have very capable communicators, and you will be sure to communicate effectively and with brevity. Thank you.
Speaker 20
Oh, yes. Thank you. So my name is Sonia Fox, and I'm with the Department of Developmental Services. Thank you for the opportunity to present on the proposal related to employment access alignment. The committee consultant has done a great job of explaining the proposal and the agenda to ensure I can address all the questions within the time slot.
If the members, have no concerns, I will focus my presentation on responding to the questions. First, regarding the proposed trailer bill language and stakeholder concerns, the proposal authorizes DDS and the Department of Rehabilitation to enter into an interagency agreement that aligns responsibility and allows funding to be coordinated at the department level. Its purpose is to reduce barriers and improve access to employment services for individuals with intellectual and developmental disabilities by creating an integrated employment services system and a dual provider process. The proposal also makes Commission on Accreditation of Rehabilitation Facilities or CARF accreditation optional. We recognize the concerns raised by the state council, and DDS will replace CARF with service standards developed collaboratively with regional centers, providers, self advocates, and the state council.
As to AARCUS concerns, we we aim to create standards that will not result in new or additional workload for both departments and the regional centers. We appreciate their partnership and look forward to continued collaboration. Second, regarding the timing and content of the interagency agreement and integrated system and how DDS will work with stakeholders. The interagency agreement will be completed by 08/01/2027 and will outline responsibilities for DDS and DOR, the sequencing of services, and how funding will be managed between the departments. Implementation of the integrated employment services system is targeted for 03/01/2029.
Speaker 3
DDS will engage stakeholders through the existing employment work group and welcomes additional ideas to strengthen collaboration. Progress will be reported semiannually on our website, including documentation of who was consulted and the status of planning efforts, providing a clear written record of engagement. Third, regarding the Employment First Office. The Employment First Office was intended to coordinate collaboration, guide strategic planning, and make policy recommendations at the Health and Human Services Agency. While this office itself was never established, the collaborative work envisioned continues through this proposal as DBS and DOR work together to support individuals with IDD in accessing employment services.
Speaker 20
Fourth, regarding funding for DBS and DOR. Existing funding for employment services within each department will be used. The governor's budget includes $3,300,000 in reimbursements for DOR to streamline employment services. DDS anticipates having sufficient reimbursement authority to cover any increased reimbursements needed to support this partnership. Fifth, regarding measurement, reporting, and evaluation of outcomes.
DDS and DOR will use an existing data exchange agreement to track caseloads, employment placement rates, and long term outcomes such as retention and fading of support. DDS will publish these outcomes in an employment report on our website. Sixth, regarding the administration's measurable goals. Goals include reducing the time for individuals to move between regional center funded and DOR funded services, improving DOR placement outcomes, and strengthening long term employment outcomes. These measures will help evaluate the effectiveness of the integrated system.
Finally, regarding the coordinated career pathways service, this proposal does not directly impact coordinated career pathways. The 2022 budget provided a three year one time funding for the pilot. As of November 2025, more than 7,000,000 has been expended. The program is no longer accepting new enrollees, and current participants have been in have been allocated a maximum number of hours to complete the program and report outcomes. Thank you for the opportunity to present.
We value our community partners, regional centers, local DOR offices, providers, and advocates.
Speaker 32
Thank you. Jessica Grove, Department of Rehabilitation. We just wanna express our appreciation for partnership with our colleagues at DDS and look forward to the opportunity this
Speaker 10
Thank you for having me back. I'm Vivian Hahn. My brother, who has autism, previously held a job in the community with support from the Department of Rehabilitation. And prior to joining Disability Rights California, I worked for several years representing a local education agencies and supporting schools with post secondary transition for students with disabilities. We strongly support the proposed elimination of CARF accreditation.
However, when it comes to a replacement, we don't necessarily need to reinvent the wheel. We would encourage DDS and DOR as they go through their stakeholder process to consider existing best practices and other, accreditation standards so that, the process can be as smooth and streamlined
Speaker 10
possible. Employment provides more than just income. It provides a sense of purpose and accomplishment, structure, a valued role in the community, dignity, so many of the things we say we want for people in this system. Employment can provide all these things, but the deeply entrenched funding and service silos between DDS and DOR have been a major barrier for years. So when we saw this proposal, we were thrilled, and we commend the new leadership of both departments for finally stepping up and saying this messy, inefficient, ping ponging back and forth across two systems that we've been making disabled people go through just to find a job, we own this.
That's not inevitable. That's a choice. Government can choose to take the burden of navigating off the shoulders of disabled people and onto themselves and work much of it out at the state level so people and frontline service staff don't have to. That's what this this proposed interagency agreement could potentially do for Californians with IDD who want to work. We support its vision wholeheartedly.
Our one concern, however, is will this agreement hit all the notes it needs to? Will the two departments lay out clear mandates for what regional centers and local DOR field offices must do differently to align with the department's vision and achieve the overarching policy goal. Will they make clear that these new expectations
Speaker 10
A requirement and not a suggestion. And lastly, will they listen to the right people as they develop the agreement?
Speaker 7
Carina Hendren, LEO. We have no concerns with the proposed trailer bill language, but just one thing we wanted to flag is that the administration is still developing its plan to monitor the quality of employment services going forward under this new approach. And given that the quality of services is an area of legislative interest, the legislature could consider asking the administration to report back once it has that, rather quality monitoring plan, flushed out.
Speaker 15
We encourage the plan to be completed as soon as possible. Thank you. Department of Finance.
Speaker 1
Thank you very much. A couple of things. Obviously, you're still going through the process of getting feedback from stakeholders. Is there a, how far do you think you are from kind of getting some good landing this language?
Speaker 1
Mhmm. And from our stakeholders, how do you oh, do you have anything specific that you believe you would like to see in the process that would strengthen, the trailer bill?
Speaker 17
Thank you for your question. Again, overall, we very much support the, the intent and purpose of the trailer bill language. In light of recent developments with coordinated career pathways, we would like to make sure that the expertise and experiences of the providers and the individuals who have used this really promising new service be looked to and incorporated into the process of developing the interagency agreement. If we are planning to build a road through a very complicated jungle of services, then I think it makes a lot of sense to listen to the people on the ground who've been trying to find those paths through on an individual level. We want to retain and learn from where all all the stopping points are.
Speaker 1
Thank you very much. I'm gonna ask LAO. You have some great suggestions in terms of some language that could be inserted into the trailer bill. And so we're gonna ask you to help us draft that so that we can present it to the administration for final approval. Okay?
Speaker 15
Thank you, doctor Jackson. The committee is interested in edits to this language, just reiterating doctor Jackson's point, particularly around the data collection and reporting of outcomes. Can the administration take a look at adding this? And is the administration expecting to release a new version of this language?
Speaker 15
Thank you. And with that, we're gonna hold this issue open and move on to the next issue. Thank you all so much.
Speaker 34
Good good evening, doctor Jackson and members of the committee. My name is Marlene Morales, and I am from the Department of Developmental Services. It's a pleasure to be here today. The agenda today already clearly outlined the factual information regarding the proposal to clarify the intent of the current law to first use any savings from federal funding for prior self determination program pilot participants to cover the administrative cost of administering the Self Determination Program. Local volunteer advisory committees will continue to have an integral an important advisory role in supporting the program.
They will continue hold their responsibilities including ongoing recommendations to the regional centers and the department for improvement in the self determination program. I'm gonna go ahead and move on to answering the questions. In regards to the first question, page fifty and fifty one of the agenda have this information. I'll highlight the information regarding fiscal year twenty five-twenty six. The average monthly caseload is 8,826 with cost estimates at 736,700,000 with an average cost of 83,000 per participant.
And then for fiscal year twenty six-twenty seven, the average monthly caseload is 11,526 with cost estimated to be at $970,000,000 and an average cost of 84,000 per participant. And moving on to the next question in regards to characteristics for participants in the program. As of February 2026, the diagnosis after participants are represented by multiple disabilities, so the total will add up to more than one hundred percent. Thirty eight percent of individuals identified with intellectual disability, sixty six of them with a diagnosis of autism, ten with a diagnosis of cerebral palsy, and nine percent with a diagnosis of epilepsy, and nine percent with an other category. Broken down by age, participants in the Self Determination Program as of February 2026, forty three percent of them are in the category of ages three through 17, eighteen percent of them are from ages 18 to 22, and thirty eight percent of them are from ages 23 to 54 with two percent in the 55 and older category.
In regards to the next question about have there been impacts for participants in the self determination program, The anecdotal information that the department has received is that participants in the self determination program have experienced several meaningful positive impacts including increase of choice and control over services, more individualized and creative services, as well as improved quality of life and stronger community inclusion. There are individuals on this panel such as miss Mark that may be able to speak a little bit more to this. Moving to the next question, the governor's budget continues to assume savings of 22,500,000 for the current year and 45,000,000 in the budget year. And on to the next regarding the 45,000,000 in general fund savings for the self determination program, regional centers now have the responsibility to certify spending plans. And so the certified spending plan regional centers are expected to review and verify that services and supports being purchased by participants address the participants' IPP goals as well as that they're not available through a generic service and that they're eligible for federal financial participation.
In addition, any movements of funds for, in spending plans must be reviewed by the regional center or the IPP team. And the program, the self determination program, the individual budgets are not expected to be reduced for participants at a participant level. Individual budgets are based on needs and therefore are based on the IPP goals developed and what the regional center would fund to support those. There also is in regards to the question about racial and ethnic breakdown of the program participants as of February 2026, 17% identify as Asian, 6% as black or African American, 20% as Hispanic, 42% as white, and 15% as other. These percentages have stayed consistent, very similar over the past three years with very small changes.
And to support the equity of the program, we have provided information at every annual IPP meeting for participants as well as the SDP orientation is available in multiple languages. And lastly, this proposal is consistent with the current law which prioritizes the funding for administration of the program. The funds will help support the department to meet the growing administration needs of the self determination program. The program has expanded from a thousand participants in 2021 to more than 9,000 participants as of February 2026. This growth increased the number of criminal background checks from about 117 per month in July 2021 to five twenty three as of February 2026, requiring additional staff to support participants having access to their preferred providers in a timely manner.
The the department self determination program team team has grown from about four staff in 2021 to 12 staff. Today, these staff support community engagement, training, development of standardized development of standardized process to support consistent statewide implementation of the program. Some of the services and supports that the local volunteer advisory committees have funded in the past are now available by the department. Examples of this include pre transition supports, which support participants in their transition into the program, as well as additional services for participants to learn more about being an employer at an individual level. The department does, remain committed to the self determination program and its long term sustainability.
In closing, I do wanna note that this proposal doesn't limit local volunteer advisory committee roles and responsibilities. They will continue to have a vital role in supporting participants and families in this program. Thank you so much for the time.
Speaker 24
Hi, Judy. Mark again, president of Disability Voices United. I do not have any visual aids with me unless you wanna see pictures of my adorable son. But I I am part of the group of family members who got the self determination law passed back in 2013, and I'm also the mother of a an amazing young man who's 29 years old named Joshua, who's in his sixth year in the self determination program. I cannot overstate how life changing the program has been for him.
He has been able to move out. It's it'll be two years on May 7 that he lives in his home home with round the clock support. He has six staff who come in and out. His roommate is his sister who does not have caregiving responsibilities for him. She's just his awesome roommate.
And it has been amazing for him and super amazing for my husband and me. So it is really a life changing experience. But what is equally powerful is that the what the STP shows us about the systems, the system that is supposed to be supporting us. For decades we have had to adapt to a rigid system often struggling to fit into services that weren't designed with individuals in mind. The SDP is changing that and shows that when disabled people are trusted with choice and control, better outcomes are not only possible, they are happening right now.
Put simply, the SDP is working, especially for communities too often left behind. Each participant receives services tailored to their unique needs, ensuring no one goes without support. And that is something the traditional system has too often failed to do, particularly for people of color. And yet, at this early stage, the program faces real uncertainty. Today, about 9,000 Californians, less than 2% of people served by regional centers, are enrolled.
It has barely begun to reach the people it was designed to serve. And I'm just gonna put a little off comment here that you just heard from Marlene that people are learning about the STP at their IEPPs, their annual IPPs. It is not happening. I every single week, I encounter parents and individuals who've never heard of the self determination program and don't understand the opportunities it provides them. So this proposed $45,000,000 reduction raises serious concerns for us.
We are told that the savings will come from lower than expected enrollment. But that raises a question for me. Are fewer people choosing to participate or is it becoming harder to access or they don't even know about it? We hear that barriers are increasing with enrollment timelines tripling. And that is why community based support is so essential.
The local advisory committees at each regional center have used modest funds to support outreach and training. And these efforts have helped families understand the program, connect with one another, and take part in something that once felt out of reach. They have also begun to address these long standing disparities that you all have heard about. Many people of color tell us that they are receiving services for the very first time because they're in the self determination program. And if these community based programs cease to exist, we will lose all of that progress.
So at its heart, I'll I'll close, the self determination program is about something very simple but powerful. We that we trust people with developmental disabilities to make decisions about their own lives and that they know more about themselves than professionals do. And the final comment I'll make is that we know that this is working and we are about to face some massive cuts from Medicaid. And we might as well build on what's working right now because the most cost effective way to provide services is to get it right the first time. And we know that the STP does that.
Thank you.
Speaker 25
Amy Wesseling, Association of Regional Center Agencies. First and foremost, I wanna note that ARCA does not have a position on the DDS proposed trailer bill language but supports the self determination program as a model that, as my colleagues have said, provides those served by regional centers greater control over the funding used to meet their needs and the people who support them. I was asked to discuss today fiscal accountability for the program as well as funding levels for people in self determination compared to the general population supported by regional centers. Self determination allows people to think creatively and to seek services that feel like the best fit for them and where appropriate their families. For some, this has been life changing, particularly for those who could not secure the needed vendored services in the traditional system, sometimes due to a lack of significant demand in geographically isolated areas.
Service providers just didn't exist. All purchase services must be compliant with federal funding requirements. This includes HCBS. In fact, self determination program services were required to comply with HCBS before every other service and be paid through a financial management service that validates staff qualifications and their eligibility to work. The historic question asked in establishing individual budgets has been what the regional center would have spent in supporting the individual, including previously unmet needs through the traditional system.
Changes in the individual bread budget process as a result of last year's trailer bill language instead looks at the cost of services that were authorized before the individual entered the self determination program, which is an easier question to answer and should ensure greater consistency across the state as well as streamline the process for entering the program. It is true that average per capita expenditures for those in the self determination program are higher than for the overall population served by regional centers, but this expenditure data must be sliced and analyzed carefully in order to be meaningful. We know from overall purchase of service data that top line numbers about spending on one population compared to another aren't as helpful as nuanced explorations of cost drivers. For example, in the overall system, the age of those served and whether they live in or out of the family home are significant drivers of cost. For instance, we know that former residents of developmental centers have much higher than average purchase of service costs, but that's because of their high support needs and their living situation.
It's important to note that in the context of SDP, those exclusively in the in early start are not eligible, and they are the cheapest population to serve in the traditional system. It is also possible those with high support needs are more likely to seek out SDP than other populations, thus pushing up the overall per capita cost. Examining whether we are equitably supporting various populations is critical, but we owe it to the people we serve and their families to approach this work carefully due to the individualized nature of their services and supports. Equity does not mean we need to spend equally on everyone, but rather that we need to strive to meet their unique needs. Thank you.
Speaker 1
My question first is for administration. I mean, obviously, to redirect funds from LVAX to the administration, I mean, what what do you anticipate would be the consequences of that? Meaning, what do you because, obviously, you're deciding to make a trade off between what LVAX are using the funds for and what the administration needs funds for. Tell me about that trade off and tell me why you thought it was more important for the administration to have those funds.
Speaker 34
I appreciate the question. One of the things that we've been able to see is that the program has grown over the last five years. And, working with the community last year, there were areas that were targeted for the self determination program that are key factors to standardize. So there's five major areas in the self determination program, which is the individual budget, the spending plan, the pre transition supports that help an individual get into the program, learn more about the program, have the tools to hopefully be successful in the program as well as enrollment, and also the financial management service vendor, which is one of the required services in the self determination program. So with that, we have heard from the community over the years of the need to streamline the information that is being provided to participants.
Speaker 47
That way, no matter where they live in the state, they can have a similar experience in the self determination program where there is consistency across how it is being provided to them. So in efforts, the department is looking to standardize these processes and we have started to engage with the community through community engagement efforts regularly as the department has worked on proposals to receive support from the community and see that we are addressing some the concerns that they have brought forward to us in regards to items that the local volunteer advisory committees have attempted to address over the last five years, two of the very major, services that the department has put in place over the last couple years that weren't available before are pre transition supports. That is a one to one service where individuals have access to a trained provider that is able to help them transition into the program. There's also financial management service transition supports, and that is where that financial management service helps that individual learn what does it mean to be an employer, what does it mean to take on this additional responsibility along with the freedoms and authority that they have over their services.
Speaker 1
So are you saying that you believe that you the administration can do that better than LVAX? I will say
Speaker 33
this to is the Yang department, it's development services. To run any effective program, you have to have the staff support of the department to do that. This program is growing as as Marlon LeMerno has noted. And without the sufficient staff, the department won't be able to take care of lot of the issues that we're seeing at the moment. Like any other office, if you have the sufficient amount of people to do the work, you could take on those responsibilities, take on the challenges, develop solutions to address those issues that are coming.
So that's one of the key thing. Like I said, we are making sure that we have the support necessary support at the state level to do this work.
Speaker 1
Yeah. I'm not arguing about what you wanna what you need the the resources for. I think the question is, why did you choose to take it from
Speaker 33
LVAX? Oh, I could I'm sorry. Sorry. Button to you on that part. Well, this we're just compliant with current law for the most part.
Speaker 19
The current law says the priority of that resources goes to the state administrative costs. And this is and so we're complying with that. We're conforming with that with this proposal. Okay. Judy, tell me
Speaker 7
Well, one of the biggest concerns I have is in the trailer bill language where the administration wants to strike all of the things that the funding for of the LVACs are going to with the primary thing being creating equity in this program and reducing disparities. Right now, we know that Latinos and African Americans are horribly underrepresented the STP or not not being given this life changing opportunity. And the fact that that language is getting struck from the underlying legislation that I helped to write back in 2013 is is kind of like breaking my heart because the what the administration is saying is that we're not gonna do that. Like, we're gonna use it to do the bureaucratic things we need to get done to run this program, but equity is not a priority for us. And I can tell you that that the way that the LVACs have been funding projects, equity was first and foremost in their mind.
Speaker 24
Most of their projects were about providing supports in Spanish or or in Korean or in other languages, reaching out to African American communities to make sure they're aware of this opportunity. And so all of that's gonna go away, and all the progress that we're making is gonna disappear. And I I fear that it's gonna be this program for white educated people and leave behind people of color who actually need this program more.
Speaker 1
Great argument, but it doesn't seem like LVAX have been successful in achieving equity.
Speaker 24
So there's a lot that goes into equity. Let me tell you, it's it's not just about they they don't have a lot of money to spend. They it's a very limited amount which is why I really don't understand why it's being taken away. For me, equity has there has to be a partnership between the LVAC and the regional center to make sure that everybody hears about it and everybody has this opportunity. In many regional centers, that has worked beautifully.
I can tell you that it hasn't worked well in many regional centers as well. And so I think that the LVAX can do their part by giving contracts to small little community based organizations that have the trust of their community, but then the regional center has to join with them to make sure that everyone they serve knows about this in an unbiased way. I'll tell you one other thing. I every week hear stories of self advocate adults who maybe don't have family in their lives or people of color and immigrants who tell me that they asked their service coordinator about the the self determination program and are discouraged from entering it. So, obviously, that's gonna add to a lot of the disparities that exist.
So, you know, I think there has to be a true partnership. I don't think we're even close to that happening, but I think we're getting there. I I absolutely loved Amy's testimony, and I'm going to get a copy and share it with everyone I know because it shows that ARCA has a deep commitment to this program. It I don't think it's playing out that way on the ground.
Speaker 25
Oh, gosh. That's a challenging question. I think that one of the things that we know and, you know, this is one of the questions that was asked, oh, I think at the beginning of the pandemic, if I recall correctly, of self determination participants who opted or people who were selected for the self determination rollout who opted not to continue. And one of the issues that was raised was the difficult administration of the program, the sense that it requires a pretty high investment of time and energy on the part of families and individuals served. And for many people, that is that's more bandwidth than they have.
Speaker 21
I think the interest in in trying to streamline the program, trying to make things more standardized across the state is to hopefully chip away at that administrative burden and give people who don't have a ton of bandwidth in their lives a greater opportunity to participate. One thing I would also note is that while not a replacement for the self determination program, we see much more equitable participation in what's known as participant directed services, which which don't give people that same budget authority to move dollars around within their program, but it allows them to still choose who's going to be providing critical care to themselves or their family members. And so what we see is that once you remove some of the kind of bureaucratic barriers because that program is easier to participate in while you're still in the traditional service model, that we get more equitable participation.
Speaker 1
And I I I appreciate your being a disruptor. I am opposed to getting rid of language, dealing with equity goals, dealing with training, dealing with facilitation. That is a no go for me. So I wanna make that clear. Number two though, is the current model to achieve equity is not working.
So let's just be honest. Right? And we gotta figure out a better way to do it. And I think so I'm hoping that some of those discussions can happen because the current model is just not working. We tried one.
I believe in the scientific method. Try something, test if it's working, and if it ain't working, try something else. But I'm not but giving up on it is also not an option. So I need another option if this trailer bill is going to be successful to get through the process. Number two is I mean, obviously, the program is growing, which is a good thing, but it also presents a problem because now we're having some growing pains.
And a part of that is how do you continue to make sure you have all of the administration necessary and the infrastructure necessary to ensure that the program is being maintained properly and all of those things too. So with increased clients comes increased infrastructure that needs to be had. Right? So we have to recognize that too. And so my hope is that we can continue to be at the table, kind of figure figure it out, and find a way how we can still achieve equity goals that will actually produce good outcomes over time, but at the same time making sure that we're still addressing the administrative issues which is reasonable because at some point, we don't wanna get to the point where we're saying, well, where's the money?
Where's the data? Where's this? Because we did not have the infrastructure to maintain that or be able to do it. So those are just my feedback right now. I'm gonna leave it up to you all to kind of continue some discussions and get back to it.
But I'm just saying right now as the language is currently right now, I am not comfortable with. Okay? And my hope is that we can bridge the gap, achieving equity, but still ensuring that the resources are there to support the infrastructure that's needed for a growing program. Right? Once we it took a lot to even talk about equity.
We are not. We're gonna hold the line, baby. I'm just letting you know right now, we're gonna hold the line because that is equally as important because right now, the well resourced and well connected are the ones that are benefiting from this program. God bless them for it, but there's a lot of people who are not equally resourced, not connected, don't know the right people. They may have additional challenges in their lives that don't give them the time necessary to be able to understand and navigate these things.
We gotta figure it out. And so, regional centers, I need y'all at the table. I I need us to step it up so that we can make sure that we get this right. Okay? Additional questions or comments?
Assembly member.
Speaker 15
Thank you, mister chair. I will just say that, you know, I wanna align my comments with with chair Jackson. It's not just comments and an opinion. He he feels it is shared by me and and and the committee, and I feel very strongly that I think we all want the same thing. I think what we agree on far outweighs what we disagree on.
And as has been said in a very lengthy way by this hearing, that doesn't always need to be just
Speaker 15
You'll tend to repeat yourself a little too much. And I know how smart you are, and I know how capable advocates you are, and how much you care about the issues. But being brief and being effective can also help us stay focused. And that is my concern is we need to stay focused. And how we solve these issues that are raised is we stay focused so we don't need open monologues and reiterating how we support all of these issues.
We're we're here. We support them. But we let's get to what we agree on and figure out a way to solve the problems because that is what my constituents want. That's what San Andreas Regional Center wants in my district. But, you know, these committees are only held for so long.
And people, as I've noted, have come very far to be heard by us. And I think it's very important that we we need to to to cut and focus on aligning what we actually need to do instead of talking about everything else, with all due respect. Thank you.
Speaker 1
These chairs. Number 11. Are we at the last one? Yes. It feels like we need more time with each other.
I don't know.
Speaker 38
is Christine Bagley from the Department of Developmental Services. The proposal is reflected in the materials before you, and I appreciate the opportunity to give you a brief overview of the department's proposal to codify a forty hour work week for supported living services hourly employees. So just quickly, the proposal codifies state law overtime protections for supported living services hourly workers after a forty hour workweek. These protections are already the federal law and are applied and used by supported living services agencies currently. Second, this proposal aligns SLS with IHSS state overtime protections, clarifies vendors responsibilities around that, and defines a standard work week.
Speaker 32
This proposal specifically is in response to the 2025 US Department of Labor who initiated federal regulatory rollbacks that would impact the federal rules that provide overtime protections for in home support workers. In response, in 2025, the state codified through SB one five six, a forty hour work week for IHSS. So this proposal is set to create parity across both SLS and IHSS, which really helps to, create consistent overtime calculations because oftentimes both of those programs are taking place by the same employee in the same residence. So this proposal really addresses consistent labor standards, reduces administrative confusion, and most importantly, protects the overtime rights of supported living services employees. In response to some of the concerns that were raised by stakeholders, this proposal does not prescribe, interfere with, or make any reference to employee classifications or specific wage orders.
Speaker 38
Therefore, the personal attendant exemption structure is not being altered in any way, and the applicability of a specific wage order, specifically wage order 15, is also not interfered with. So again, this proposal is in response to the concerns that were raised by our supported living service community, and I'll leave it with that.
Speaker 37
Brought my glasses this time, so I'm not addressing this committee in sunglasses like I did last year. I you said everything that I was gonna say.
Speaker 37
I know you're gonna love that. I know you're gonna love that. You know, I would just say, you know, we have proposed an amendment, a slight amendment. This certainly did address the overtime issue, and we we've submitted that amendment to the committee. This did address the overtime issue.
It's it's, you know, we're in a situation where there's a proposed rule change to the FLSA right now and a non enforcement letter for investigators to cease all enforcement at the federal level. So we needed to act to ensure basic worker rights, folks get overtime in SLS, and this continuity of care. Right? You mentioned the parity between SLS and IHSS. So, you know, we're we're looking to continue that.
Speaker 49
I think that, you know, to be brief, I think the amendment that we've offered really I think that there's lots of individual and class action lawsuits, and PAGA claims, which, have plagued state funded providers, services, programs, and supports. This proposed language along with the amendment for SLS is a start. I think there's still work to be done. We don't know what's gonna happen at the federal level. A companionship exemption could come back into play.
Speaker 37
But we stand ready to work with our partners to ensure all people receiving services living in the community thrive with the supports they need. And thanks for the opportunity to provide testimony and not have to read, Christine, on this important proposal and happy to answer any questions.
Speaker 8
Department of Finance. Omar Sanchez, Department of Finance. Nothing further to add.
Speaker 1
Looks like y'all are very, very, very, very, very close. So let's just keep on talking, but there's no significant concerns that we have. And so I I think it'll be easy to get there.
Speaker 1
Public comment. One minute each. I hope you all have been utilizing these four or five hours to practice your one minute.
Speaker 4
He is young. Keep your voices down. Thank you. Still in committee. Thank you.
Speaker 35
First of all, thank you, doctor Jackson and committee. My name is Luis Saldana. I'm a mother of three, regional center clients and ICC manager and cofounder. We are grateful. You have captured the words nothing about us without us.
I'm concerned that the the department new plans will take us back to the past. Self determination is the hope for many families in the present and in the future. The way it's being implemented is taking away the hair of the person centered approach. We are worried about all the changes being proposed are in the ground speedy. DDS prefers to halt and slow the program rather to allow allow clients to live self determine self determinant life.
Speaker 13
In community, the word is SDP is changing our clients' lives are the best served in SDP, yet every certification of the constant spending plans provision, including the minor things like name change, providers changes, and is or a small adjustment has slowed down the process. All paperwork related is instead of investing in the quality of life, the department wants to use more money to add workers who increase control over every part of the process. Latino families want to be part of self determination program, but the department has no intention of allowing the long waiting list to move at a reasonable rate. Instead, it has been slowed down to stop interest most mostly affecting minorities. So I ask the committee do thank you.
Speaker 13
Hello. Good afternoon. I wanted to say thank you so much for having us here today. As an sibling of a 40 year old served by the regional center, The system has been broken. So I love to hear everything that you guys had to say that the families come first.
Self determination is a program that saves lives. My sister's in a wheel wheelchair. However, she is included in the community, and that's what self determination is all about. Thank you.
Speaker 24
Good evening. My name is Rafael Garcia, and I am with AFSCME Local twenty six twenty. And I'm here speaking on the budget change proposal for Department of Rehabilitation to increase 54 permanent positions. We're concerned that well, one, I support the budget change proposal because we're concerned that counselors there, which we represent, have, unsustainable caseloads, so we would appreciate if you do move forward with that. Thank you.
Speaker 28
Hello. My name is Michelle Lam. I'm part of the ASME Local twenty six twenty. I work at the Department of Rehabilitation as a counselor in the Golden Gate Silicon Valley District San Jose office. Many counselors carry unsustainable caseloads, so I support the proposed budget to better serve our communities with disabilities.
Speaker 20
Hello, mister chair and members. Jordan Lindsey with the exec the executive director of The Arc of California, only speaking on issue number four in regards to regional center oversight. And while we appreciate the efforts and do not disagree with the efforts to improve oversight, only that one issue of retaining families and parent voices on the boards, and so we very much appreciate your comments earlier in the committee hearing. Thank you
Speaker 25
My name is Jake Holberg. I'm the CEO for Schrader Deeds to Empower People. And so I wanted to drop off some letters in support of the forty hour week so most of our direct support professionals don't make very much money. And when you talk about the 10% cuts that they talked about already, they're making sub they would be making sub minimum wage. So just hoping that everybody will that everybody will support that.
Speaker 14
Good evening. My name is Yasmin Herrera Viches. I am here with the Disability Voices United. And I wanted to make a comment to the committee. First of all, thank you very much for for for your tremendous work for our community.
Speaker 42
I wanted to mention that my family moved to California about nine years ago. I am the mother of a 27 year old adult with high needs, significant disability. We moved from a state, from Virginia, that has participant directed supports and we had that program there. When we moved to California, we were without services because the only option for my son was to go into a behavioral residential place. It wasn't until the self determination program, years after we moved here, that my son started receiving regional center services.
It has been life altering for him and our family, the level of dignity and choice that we have, to say where with who and how he's supported in a way that supports his individual needs, his preference, and his cultural values is a game changer. So I just wanted to tell you that self determination is really true to California, and I wanna thank you for supporting my family, my son, my community, and for your time.
Speaker 19
Hi. My name is Maria Hernandez, and this is Marie Hernandez. Since she started the self determination, she has made a tremendous change, and it's unbelievable how much it helps our kids. So I just wanna thank you guys, and I hope that you guys could help to maintain this program because, honestly, she's not what I had before. So please help us.
Speaker 31
And don't let Harbor Regional be so strict with the parents because, you know, we need somebody. We don't have lawyers. We don't have anybody to advocate for our kids. So please help us maintain these programs. Thank you.
Speaker 23
Hi. My name is Peter Hahn. I'm a proud member of AFSCME Local twenty six twenty. I work for Department of Rehabilitation as a voc rehab counselor for Northern d r s Northern Sierra District at Capital Mall Branch in the Sacramento area. I strongly support the this budget, which will provide more support towards our high caseloads.
Speaker 11
Hi. My name is Lynn Broyles, a proud member of AFSCME twenty six twenty, and a proud vocational rehabilitation counselor for the Department of Rehabilitation Capital Mall office. I'm here to support the additional positions for the Department of Rehabilitation, not just to manage our high caseloads, but also to provide the quality of care, dedication, and service that the individuals in our community deserve. Thank you.
Speaker 11
Yes. Hi. My name is Pauline Cherrill Frederick. I'm account I'm with ASME Local twenty six sorry. Twenty twenty twenty six member.
I work for Department of Rehabilitation, the the Greater Los Angeles District, the Westchester office. I'm a vocational counselor. I have a caseload of 200 to six, and I serve people living with disabilities in my community. And we are asking that you guys please support the budget, and we are in dire need for it to pass.
Speaker 22
Good afternoon. My name is Maria Rodriguez. I am a proud member of AFSCME Local twenty six twenty. I work for Department of Rehabilitation as a vocational counselor in the Orange San Gabriel District in the City Of El Monte office in the city Of El Monte with the office of that services, El Monte, Whittier, and all of the San Gabriel Valley District. I'm also the occupational chair, and I represent the 550 counselors that we have across the state of California.
Speaker 43
And I'm aware of the highs high casel sizes that we are having to manage. We're having to manage dual casel where we also provide student services. And I'm here to strongly support the bill as I the budget as I believe that it is crucial for us to be able to serve all Californians with disabilities and that it's a right for them to for us to maintain ADA, that they, have the protections and access to obtain competitive integrative employment. I thank you for making time to listen to this bill. And on behalf of all of the vocational counselors with Department of Rehabilitation, I'm speaking for them to let you know that we all are in dire need of additional positions.
Thank you.
Speaker 38
Good evening, chair members. My name is George Cruz. I'm with California Behavioral Health Association. Sorry. The combined impacts of federal HR one changes and proposed Medi Cal and HHS reductions, strengthens the stability of of community based system when coverage becomes harder to maintain.
Speaker 44
Providers are left to manage the disruption in care, increase administrative workloads, and patients falling out of a treatment. At the same time, reductions to HHS and broader Medi Cal pressures do not reduce demands. They shift them. Providers will see higher acuity needs, more crisis driven care, long term a longer wait times, all while the workforce that's already strained on rate reform and quality incentive, provider support accountability and outcomes. But when requirements are layered without adequate funding or technical support, providers face financial risk, losing portion of funding due to administrative barriers undermines the capacity the state relies on to deliver services.
We urge the legislature to prioritize, provider stability, maintain coverage, and align funding with the true cost of care. Thank you so much.
Speaker 26
Good evening, chair Jackson and committee staff. I'm Julie Sherman. I'm director of public policy for the ARC and United Cerebral Palsy California collaboration. I'm just here to make one point, is about the elimination of CARF. We're very glad to see that because it is a costly and onerous barrier to a lot of employment vendors of the regional center.
Speaker 45
We just hope that it isn't replaced with something even more onerous. Thank you.
Speaker 1
Thank you. Name and affiliation, please. Gracias. Name and affiliation, please.
Speaker 14
Good evening, every everyone. My name is Maria Lopez. I am a cofounder and manager of ICC. And, also, I am a mother of HIO connect with a special need, who is client from Regional Center from SCLAR, South Central Los Angeles Regional Center. I am here because I oppose I am oppose to the the the forty seven thirty one complaints.
Oh, and, also, I oppose to the changes to the board directors. For a lot of years, a lot of professionals was involving in this force and never changed something. No words will. At this time, we also need a lot of support in, cell determination issues. We have also, for Elva, we hear about it.
Speaker 48
We have also a lot of barriers barriers, when navigate navigating the systems. Also, I would like to say the the no more retaliation for the families who are advocating for the system. It's very crucial to helping everybody to to be better at the systems Mhmm. For all all our clients. And also a lot of a lot of those changes are affecting several to our clients, not especially to you or us.
Speaker 18
I'm grandmother to a 33 year old man who came home high Of course he hugged you. Where was he? That's why I didn't bring him because he'd be all over.
Speaker 18
Well, he sure loved you because he keeps talking about you. Anyway, I'm his grandmother and I'm also part of the ICC organization that's why I have my shirt on. I'm very proud to be part of this organization who has taught me how to navigate the whole system of the regional center. Now it's my turn to help others, and that's what I do now. I do that in my I have been now retired nineteen years, and I found this organization six years ago, and it really gives me a lot of intrinsic satisfaction to know that I'm helping others.
Speaker 35
When I didn't have the help raising this little guy, now the 33, as a per a one person family and him, And his parents couldn't handle him, so I took him in. So I didn't know anything about services. I worked as a teacher and then as a school principal, so I was many, many years working, and I couldn't find no one to care for him. I didn't have I didn't have the knowledge that I have now, so now I have to give back to these people that helped me. Today, I'm here to support my friend Fernando Gomez, who's director of the ICT organization.
Speaker 18
Elizabeth couldn't come. She did wanna come, but she's ill right now. So, anyway, I wanna thank the organization as well as mister Gomez and everything for for what they have done for me and my family and my boy. Our families don't know about and I'd like to support what he said today. Our families did not know about the forty seven thirty one grieving process.
Do you know why? Our culture is always grateful. We're always grateful. If I got if I had twenty hours of respite, I was grateful. Somebody gave me something.
And so we had to teach a lot of about the procedures of the forty seven thirty one, and I wanna talk about a word that was used today, timely. I know I worked for a large system. And when you go up in a in a system as high as it goes, there's a lot of bureaucracy. It's lost in translation. It's on somebody's desk.
So I think that what was said today by mister Wheeler and mister Gomez is that how long is it gonna be up there in DDS before it comes down to the regional center who is then again going to be looking at it for sixty days? How long do we wait? By then, I've forgotten what my grievance was. I'm just I mean, my age. Right?
Speaker 18
Anyway, so thank you for listening. I'm I'm very grateful to be here, and I'm grateful for everything that this little guy has been able
Speaker 6
My name is Carolina Sate. I am mother of two clients of the, Valley Mountain Regional Center. I'm oppose, in opposition to propose change, on 4731. Board of directors have probably included professionals, and that approach has not produced the expected results. Repeating the same strategy, does does does not guarantee real improvements on the community.
Speaker 46
Within the framework of self determination, there is a concerning reception of retaliation against to the Latino community by regional centers and DDS. This create these tools and limited access to services. As previously stated, nothing about us without us. The community must be meaningfully include in every decision that affect them. DBAs is attempting to silence the voice of the Latino community, and we will not allow it.
Speaker 28
Oscar Mercado. I'm a self advocate with the ICC, and I'm also somebody served by the regional center system. A lot of things were talked about. Forty seven thirty one complaints and the grievance processes. I think the simplification of it might make situations worse in the sense that they're trying to add an Orwellian language to it by trying to say, well, we're simplifying it, but we're taking away the various forms in which families and self advocates, people served by the system, are able to give complaints.
Speaker 47
Board of directors, a lot of people are saying that they're trying to add more professionalism to it, but at the same time, they're taking away the voices of self advocates, people being served, and the people who have the lived experience on the ground. And I think that those voices shouldn't be taken away, but there should be trainings in place to capacitate those individuals to better perform the functions and hold regional centers accountable. And finally, self determination. The same system is discouraging families from joining, and a lot of people don't know what the self determination program is, and I think it's very beneficial. I am a beneficiary of the self determination program, and I think a lot of people can benefit from it too.
Thank you.
Speaker 36
Thank you for the, to the committee. Mister Jackson, at the beginning of the meeting, you said that, we don't want to lose ground. With these changes to 4731 complaints and the, changes to the board of directive directives, we are taking some steps back. We don't need that. At 02:30, mister Sherbinka mentioned education and outreach.
The education must not be provided yet because we've seen a lot of fail failure. And the outreach is not working because I know for a fact that some of previous clients, now they lost their services through the regional center just because the coordinator, figured that they don't need them anymore. That is not fair. At 03:15, you mentioned that we have your promise that this committee is gonna is gonna work to do the right thing to support the IDD community. We're gonna hold you account we're gonna hold you to that promise.
Speaker 48
My name is Pam. I work for Progressive Employment Concepts. We are a local employment service provider here in the Sacramento area, vendored with Alta California Regional Center. We also provide self determination services. I'm also a social security benefits counselor.
I know lots about a lot of things. I was inspired to make public comment by a comment you made early today about perhaps we need to give regional centers resources to have some sort of navigator to help people navigate these issues with HR one cuts. And it got me thinking and seeing a theme throughout today that I see frequently in the services that I provide in my encounters with the regional center, and that is that, people primarily trust their regional center funded service provider or their independent facilitator in self determination to help them navigate the world. Increasingly, I see the burden of that navigation being diverted away from service coordinators and to providers like myself or independent facilitators in self determination. This, of course, is a service that's not funded.
Right? The regional center doesn't pay me to go to people's IPP meetings and explain to service coordinators what services are available or help people figure out where they should go to access the generic resources that the regional center says they have to access or to figure out how to get a medical denial for a service that health insurance doesn't pay for. Like, why would you go ask your health insurance to give you a denial for a coloring book? You know what I mean? Like, they just don't pay for that.
Speaker 1
So that is a theme that I sort of keep seeing. So as we think about how to be fiscally responsible, it it I I would like to invite the committee and anyone who has anything to say about it to think about the process that we take and the administrative hurdles there are to to look at services. Right? Like in self determination, we see very frequently a a six plus month process for 17 people at the regional center to look at something that an independent facilitator said, this is what the regs say. This is allowable.
Speaker 48
This is what you should do. And we have back and forth, and we spent a million dollars to look at that and say no in a bazillion different ways before eventually an attorney looks at it and says, would you know it? The independent facilitator was right, and we could have saved a million dollars if we maybe have a line in the budget funding an independent facilitator at a similar rate to a service coordinator. Right? So foods for thoughts for you.
Speaker 1
Thank you. Name and affiliation, please. My name is Juan Francisco Perez, and I rely on IHSP,
Speaker 1
My name is Juan Francis show Resident Ion HHS. Don't cut resource to IH s s b. Please.
Speaker 39
Self determination continues to be blocked by the regional center. Now that I serve as the chair of the self determination committee, I have realized that the program director has become a bottleneck. As she is the one who decides who is approved to transition, a process that entails an excessively long waiting period, sometimes lasting up to a year. Regarding Medi Cal, when our children turn 18, their coverage is being revoked. Consequently, Juan Perez currently has no access to speech and occupational therapies.
Regarding IHSS, please do not implement cuts. The individuals who receive IHSS services truly do so because they genuinely need them. Obtaining even a few hours of assistance is an absolute odyssey. The social workers are meticulous and possess an in-depth understanding of each consumer's specific needs as they conduct their evaluations directly within the home. Complaint 4731 requires improvement, not further deterioration.
Speaker 27
There must be no retaliation against families who act as advocates. At the regional center where I volunteer, we face retaliation that manifests even in the form of delayed reimbursements. I personally have yet to be reimbursed for thousands of dollars owed since 2023. Finally, please do not cut funding for the local self determination committees. These resources are essential for continuing to educate the community, provide information, and report on the barriers faced by consumers undergoing the transition process.
Speaker 33
Hi. Carol Wotillo with Progressive Employment. I'm gonna start with issue nine. Just fully support the elimination of CARF. It did not increase quality in any way in our agency.
Speaker 49
It's costly. It takes time from our staffing away from vital services that we don't have time to do. And I know in having worked with the Department of Rehab and the Department of Developmental Services that they have standards in place currently and with the stakeholder process will increase those to take the place of that and provide much needed relief for providers. Support the proposal for employment services alignment and look forward to working with both departments because the devil is in the details. And to undertake such a massive undertaking will require all of the stakeholders involved to to come together and really look at those services.
If we can pull it off, the experience from the end user's perspective will be much improved and outcomes in employment will be greatly improved. However, I'd like to note that if we continue to spend 1% on employment services and the DDS budget, we're gonna continue to get abysmal outcomes. We have to invest in what our values are.
Speaker 4
Hello, I want to make sure that as someone who's paid to be here, I speak after anybody else who volunteers to be here. Oh, I found out how work the microphone.
Speaker 4
Aaron Kurose for the State Council on Developmental Disabilities. I want to speak on the proposal regarding regional center oversight. The State Council is a multi member board of 31 people, third with developmental disabilities, third family members, third professionals. So we have some pretty good experience and skills in how to balance out board representation, and make it effective. The one recommendation is to keep the at least the 50% threshold that's in current statute along with the 25% minimum for adults with developmental disabilities.
Specify and name family members are part of that 50%. In addition to that, make clear that those self advocates, those family advocates are served by that regional center. That's not clear in statute now, but is important. Specify that the consumer advisory committee designates both the self advocate and the family advocate board members, and we think these will improve, the governance structure that is trying to be created under this. Additionally, under the self thank you.
Speaker 1
Looks like that concludes our public comment. I want to thank everyone's participation. I wanna thank the stakeholders. I wanna thank the parents. I wanna thank the clients for being here.
Wanna thank committee staff for their thoroughness and preparation for the materials. I thank the administration for their continued engagement. At the end of the day, we're all on the same we're all on the same team here. And so as we continue to deal with some hurdles and obstacles that are coming our way, I know that we can get through this together. So thank you all very much.
Thank you for LAO and my constant constant request. And thank you for the sergeants for making sure that I don't get too crazy. Alright? Thank you very much. We are adjourned.
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