Assembly Budget Subcommittee No. 1 on Health and Human Services

Good afternoon and welcome. This is the Assembly budget Subcommitee Number One on Health and human services. Today we will circle back to several issues that we have heard previously on or for which we were anticipating a report by this hearing date. We will also hear from all of the human Services April 1 adjustments as proposed by the Administration.

We will not be acting on these proposals today, but we are discussing them in a public hearing to facilitate any feedback, issues or concerns from the stakeholder community and any Member of the public, Members of the Assembly and the Legislative Analyst Office before we undertake votes in the May revision hearings that we have next month. We are accepting public comment at the end of the hearing, both in the hearing room, room 444 of the state capitol, as well as on the phone.

The phone number to connect is on the committee website and should be on the screen. If you are watching over the internet, the number is 1877-692-8957 and the public access code is 131-5444 if you encounter any problems, please contact the Assembly Budget Committee at 916-319-2099 and a staff member will assist you. Those wishing to testify in person may do so when we start public comment. Before we invite our first panel to begin, I will make a few introductory comments.

I appreciate the diverse group of distinguished panelists who are with us today to discuss the number of important subjects before this Subcommitee. Among other issues, we will hear from the State Council on Developmental Disabilities and the Department of Developmental Services on the plan to phase out sub minimum wages. We'll listen to presentations from the Little Hoover Commission on their recent report on Developmental Services regarding the Developmental Services system, and then from Georgetown University on the interim evaluation regarding the disparity grants.

We'll hear an update from the California Department of Social Services on an important pending report on the CalWORKS program and on recently received information on the implementation of the federal Family First Prevention Services act. After these reports and questions, we will then hear the April 1 adjustments from the administration. With that, we will begin.

Let's begin with issue one, where we will hear a report back from the Legislative Analyst Office on stakeholder issues raised regarding the California statewide automated welfare system, the single system realization, and consumer issues. I will remind the panelists who are presenters to please present in the order that your name appears in the agenda, and I'll remind all of the panelists to try to limit your remarks to five minutes maximum.

Given the density of our agenda of speakers today and our desire to turn to public comment before too late this afternoon or evening. With it, let's begin with Mr. Metzker.

Good afternoon, chair and Members Brian Metzker with the Legislative Analyst Office. At this Subcommittee's March 22 hearing, our office was asked by the subcommitee to meet with advocate stakeholders and both Administration and project staff to compile stakeholder concerns raised about the California statewide automated welfare system, or CalSAWS, project. Today, we will provide our report using the two questions asked of our office in the agenda. The first question is, what are the priority issues and concerns regarding CalSAWS development and stakeholder engagement?

First, on the priority issues and concerns regarding CalSAWS development, the immediate priority issue is the migration of the remaining CalWIN counties to CalSAWS before the federal deadline of December 31. Delays in the migration of these remaining counties into CalSAWS could affect federal funding for the development, implementation, maintenance, and operation of the system. Based on our conversations with the project and our review of current project documentation, we do not have concerns to raise at this time about the state's ability to meet the federal deadline.

Other priority issues that we are tracking include the implementation of legislative mandates that are already in queue for automation once CalSAWS migration and stabilization is completed, the unwinding of certain public health emergency related policies such as MediCal continuous coverage and associated support for counties, and the potential transition to a new vendor or vendors for both CalSAWS infrastructure contract and maintenance and enhancements contract.

We do not have concerns to raise at this time about these other issues, but will continue to monitor them and raise concerns as warranted. Second, on priority issues and concerns regarding CalSAWS stakeholder engagement, the agenda includes our response to the subcommitee after our meetings with the Administration, the Advocate stakeholders, the County Welfare Directors Association, and the project. We provide three main categories of stakeholder concerns.

One, a perceived lack of substantive engagement with advocate stakeholders two, uncertainty about the prioritization and use of the project's quote backlog and three, an unresolved tension between customer access and data security. First, the advocate stakeholders questioned the efficacy of existing forums for stakeholder engagement. For example, advocate stakeholders cited their lack of consistent involvement in the conceptual design sessions of the project and felt their proposed changes to public facing elements were not included and or prioritized.

The Administration in the project felt they had included advocate stakeholders during the design of the project and captured their proposed changes, but also felt the stakeholder engagement process in this project was unique and did evolve in ways that could benefit from additional maturation and structure. Second, advocate stakeholders cited the project backlog as a potential source of changes and enhancements that could benefit customers but raised concerns about the lack of prioritization and scheduling of those enhancements.

The Administration and project said the project backlog contains changes and enhancements that have not been thoroughly reviewed or vetted to avoid, for example, conflicts with current state policy. While some processes have been introduced to review and vet the backlog, the Administration and project said they were preliminary and new draft documentation will be reviewed by stakeholders in the near future. Third, advocate stakeholders raised the issue of improved customer access to, as an example, Benefits Cal as a key concern.

One particular point of contention was the email address requirement for Benefits Cal accounts, something stakeholders say is unnecessary as accounts for other health and human services. It systems such as CalHEERs do not require an email address.

The Administration and project did acknowledge the need for improved customer access but also cited concerns about data security using the email address requirement for Benefits Cal as an example, the Administration and project said the requirement allowed customers to maintain control over their accounts and perform routine tasks such as password resets. They also said that CalHEERS's current login options, such as a phone number, have led to issues such as duplicate accounts that they would like to avoid with CalSAWS.

The second question is what are the goals over the next 12 months and can progress be monitored, measured, and conveyed back to the Legislature over the course of the next year? To inform our response to this question, we requested that the Administration and project provide a list of the stakeholder engagement goals over the next year and that's included in the written response.

This list is provided in the agenda and in sum, the Administration and project expects to one, on a quarterly basis, prioritize CalSAWS enhancements using CBO and customer feedback that is shared with advocate stakeholders. Two, formalize and improve the project's collaboration model to gather proposed changes and build out an annual roadmap. Three, share the current status of implementation of enhancements that have been prioritized by stakeholders and four, use a stakeholder input document for better aggregation and use of that feedback that is provided.

The staff recommendation to request periodic updates from the Administration and project staff on the progress towards meeting these goals, along with stakeholder review and possible other goals that they may have for stakeholder engagement, could help the Legislature monitor this issue going forward. One possible start date for these updates could be October 1, after the September quarterly stakeholder meeting for CalSAWS. This timing would allow the project to start their stakeholder engagement efforts in 2023-24 and report back on their progress on a quarterly basis.

We have discussed with subcommitee staff the potential adoption of supplemental report language that requires the Administration to, one, provide those quarterly updates two, define the final goals for stakeholder engagement after engagement with the stakeholders themselves, and three to provide certain information to the Legislature, such as the current number of system changes and enhancements in the project backlog, as well as the number of advocate stakeholder requests that are currently scheduled for future system releases in the project.

And our office would be happy to assist the subcommitee and staff with drafting that language. And thank you. Happy to answer any questions.

Thank you, Mr. Hansard.

Yeah, thank you. Brandon Hansard, Office of Systems Integration Cal HHS and wanted to again thank the LAO for this expedited engagement in which we are able to share the goals that are on the table. And I want to make sure that when we look at things that we are looking at what we have done to date and the success this project has been able to provide.

Five years ago, when this was just a thought about a single SAW system, we heard the stakeholder concerns about past migration efforts and all the issues about ensuring that the systems did not go down during migration and that there was success at the county levels from an operational piece. And that has been taken to heart and really driven a lot of the decisions to date. And I don't want to lose sight of all that success.

And we are still, we're at 48 counties and had a great wave three cow wind migration this weekend, and so there's still 10 more counties to go and a lot to do this calendar year when it comes to the goals that are in the agenda. We agree with these goals and feel that they can leverage the collaboration model that is maturing at this time. I want to hand it over to Ryan Gillette at Social Services.

Thank you, Brandon. Thank you, Chair Arambula and committee members. My name is Ryan Gillette. I'm the chief data officer and deputy director with Department of Social Services to build a little bit on, Brandon was saying. Over the past weekend, three new counties completed the migration to CalSAWS, bringing the total number of counties operating under the single system to 48. Thus far, each migration has, by and large, been completed smoothly and on schedule.

Clients have continued to apply for and receive benefits seamlessly, county workers have been able to support and manage their cases, and the state has received information needed to oversee major safety net programs. I want to open with this context because it's important to remember where we are and the amazing progress that we have made.

By the end of the year, we will have completed this five plus year journey, having finally arrived at a single system that, while it certainly has had its share bumps along the way, has many successes to celebrate and has delivered on its promises. Now, this is not to say that everything has been perfect. Where we have encountered system conversion issues, we've applied troubleshooting to avoid similar issues arriving in the next wave of migration.

We've also identified more opportunities to increase stakeholder engagement and collaboration and are actively working on refining our engagement processes.

And we acknowledge that even once we get the 58th county migrated over, there will continue to be improvements and enhancements to both the CalSAW system and Benefits Cal user portal necessary to deliver the best client experience possible we also recognize that to provide the best client experience possible, we need to ensure that we are hearing from the wide array of stakeholders who interact with CalSAWS and Benefits Cal.

This includes counties that rely on their individual business processes as operators of the system, state staff who depend on CalSAW's data for oversight, Administration of safety net programs, and of course, our clients and the community of advocates, CBOs and other stakeholders who support them. This advocate and community and stakeholder community is a key part of this ecosystem as they lift up client voices, perspectives and challenges that we may not otherwise hear and help us to troubleshoot how to resolve them.

Throughout this journey, these diverse perspectives have made this project better, and for that we are immensely thankful. In response to your specific questions about how the Administration can improve relationships with stakeholders and increase responsiveness to the concerns, the Administration spoke with both the CalSAWS consortium and stakeholders and received the same response.

Mutual desire to fully implement and properly utilize the collaboration model the collaboration model, for some context, is a quarterly meeting that includes representatives from the following groups, advocates, clients, community based organizations, counties, CWDA and the union and state and policy teams, in particular from CDSs and Department of Healthcare Services. The collaboration model group objective is to prioritize enhancements to customer facing technology. This includes Benefits Cal, which is the front end user portal by which clients apply for and manage their benefits.

We anticipate the model will expand to other customer facing technology in the future. Collaboration model members recommend enhancements to improve system access, usability, client experience, and other factors which are prioritized for the CalSAWS project to work through the standard software cycle. This input is used to develop a shared enhancements list and collaboration model members then vote on how to prioritize items on that list. These items are then placed into the development queue.

We have collectively learned a lot in the three plus years of stakeholder engagement and know that it's time to formalize our processes into a structure that allows for more efficient decision making. The framework of the collaboration model is already in place. What remains to be done now is to mature and formalize our processes into a structure that we can all follow and agree on how feedback will be gathered, processed and incorporated. This will also require a mutual understanding that not all recommendations will be prioritized.

Sometimes an issue may be more complicated to implement than it might appear on its face, and tough decisions will have to be made about the time, cost and impact tradeoffs relative to other proposals, especially in the midst of migration and ongoing continuity of operations. When that happens, we can commit to explaining why and any alternatives that we may pursue. Instead, in addition to formalizing the collaboration model, we plan to re examine the opportunities for stakeholder engagement throughout the development cycle.

Some of the tensions identified in the LAO report stem from feedback on an item being provided out of sequence, for example, raising a policy question in an automation forum. After policy guidance may already have been finalized, we will plan to analyze all of the opportunities that exist for stakeholders to provide feedback and give more clarity as to what should be discussed, when and in what forums. This should help stakeholders have a better understanding of where to raise different items in terms of tangible goals.

We would refer back to the list that was provided in the briefing ahead of time that includes sharing customer feedback and how it was used, maturing the collaboration model as events by a jointly developed charter and roadmap, increasing transparency by sharing the current status of enhancements prioritized by collaboration model Members along with high priority policy changes, and jointly developing a stakeholder input document to inform and assist stakeholders of opportunities to provide feedback. A draft version of this document is currently out for stakeholders for review.

With that, happy to take any questions.

Department of Finance Department of Finance, Nina Hoang, nothing further to add.

I'm going to invite Jen Tracy from the California Association of Food Banks to come forward and provide some testimony as well. Stakeholder input.

Thank you Jennifer Tracy, and thank you for the opportunity to speak. And thank you for exploring these recommendations and taking the time at LAO to do the report. And I appreciate the comments from CDSs and OSI. We are grateful for the goals that were laid out and we agree with the comments that were shared today. And we would like to add that the collaboration model we would like to see more of an industry standard approach for managing a backlog list and collaborating on a process.

At this time. We think there is opportunity for the collaboration model to be more collaborative, if we're going to call it that, and to have meaningful inclusion of advocates in the processes. What we've experienced is like, yes, we've had a lot of meetings. We've had a lot of forums, but we find that when we show up to those forums, fundamental decisions have already been made without our input. And that ends up affecting the experience of consumers.

If a design is created that requires them to input their information in English and they don't write in English, then they don't have access to things like CalWORK support requests. And those are the experiences that we've had where we've been asking to be included in a meaningful way, in a timely way, so that our feedback can actually matter in the process. And we recognize that the Legislature does a lot of work to pass bills and make budget investments for improvements to public benefits.

And what we want to see is a nimble and responsive automation process. And if we experience that our expertise results in items being moved to the backlog list, then those things have to be addressed later. And that further creates a backlog that will then put future policies in competition with other changes that need to be made. And we don't want to see that happen. We want to see a nimble process that includes our feedback in a timely way.

Thank you. I'll bring it now up to the dais for any members questions. I'll keep it here at the chair. I wanted to give both OSI and DSS a chance to respond to what we heard from Ms. Tracy there. How do we make this a more nimble and responsive system? How do we make sure that the backlog is reflective of the prioritization that you're hearing from the stakeholders?

I'm happy to start on. You know, again, I really appreciate the comments from Ms. Tracy, and I think we would agree with a lot of that. Again, I think what we have in place now with the collaboration model is the bones of how we need this to work. Right. So what I think our next steps are going to be is really making sure that we have actually implemented it in the spirit of how it was originally designed.

And I think we all agree there's room for improvement there. So as we laid out in these goals, we really want to make sure that we are developing a charter that is jointly developed with all the members that are participants in the collaboration model. We want to make sure that we have an enhancements list that we can all agree with. And part of that may mean taking a step back and looking at that old list and deciding if that really is still serving us.

As you may have heard in the report from the LAO, that list was created a long time ago. There's a lot of items on it, and a lot of them are either no longer relevant or they're a little bit hard to interpret because, again, it was early in the process, we hadn't formalized how some of these systems should work yet and we could do better.

So I think that one of the first things that we would want to do with this model, with this fully implemented and properly delivered model, would be to create that new roadmap, leveraging what we already had put together in the enhancements list, but maybe not relying on that original list as being the source of truth, but having a comprehensive discussion to figure out what the actual pain points are, what we want to prioritize and going forward with a new process that we can start with a clean slate on.

Can you comment on the LAO's recommendation regarding a fall meeting? Is that something that's doable and what would be a timeline that the Administration could be amenable to?

Yeah, I mean, I'd say we'd want to talk to the CalSAWS consortium as well and other stakeholders before we commit to anything on that, but we've heard that we can definitely discuss that.

I think you mentioned there was a September stakeholder meeting. Would October 1 be a good start date for us to begin negotiations? And happy to see if there's anything that you return back with that would change it. But as of now, I'll work under the assumption and would ask the LAO to help us to draft SRL that would allow us to work towards that date. With that I will. Thank, please. Department of Finance?

Yes, Justin Freitas is the Department of Finance. I would just like to add that the conversation we're talking about prioritization and so on, I think it's something that we should all probably discuss as we're going through committee hearings and so on as well, because every year there's new policy that is passed that is in a prioritization and that changes it.

So I just want to make sure that all the hard work that the departments are doing with stakeholders and so on as well, they're doing the best they can. But also hoping that as we're going through, because the comments that were made by the stakeholder, I apologize, I don't recall her name, are true. But one of the challenges is the Administration and the Legislature. We add new stuff every year, and that just changes, pushes things, as she said, back to the backlog. So thank you.

Happy to. And it's Jen Tracy. It's all good with that. I will thank very much this panel, and we will move on to the next issue. Issue two is on the recently released Little Hoover Commission's report titled a system in Distress, caring for Californians with developmental disabilities. We will have the following speakers on this panel, beginning with Commissioner Bill Ellison. Excuse me, Emerson and Commissioner Dion Aroner, both who are former members of the Assembly, who will be representing the Little Hoover Commission.

Great to see you, Ms. Aroner, and Mr. Emerson.

Hello. My name is Bill Emmerson, and I'm a member of the Little Hoover Commission, an independent oversight agency charged with investigating state operations to promote efficiency, economy, and improve service. Earlier this month, after a seven month investigation, the Commission released a report on the state's developmental disability system entitled a System in Distress Caring for Californians with Developmental Disabilities. In this study, we heard from hundreds of regular Californians who took time from their busy lives to tell us their stories.

These stories too often involve fighting for programs their family Members deserve but did not receive. We heard countless experiences involving linguistic barriers, confusing bureaucracy, and, perhaps most notably, unfair treatment that varied based on where someone lived and the color of their skin. We learned that compared to white populations, people of color are more likely to receive no services at all. And when they do get access to programs, expenditures tend to be lower, even when controlling for need and other factors.

We heard that location matters even within the same region of the state. For example, per patient spending at South Central Regional Center and Harbor Regional Center varies by $5,000 per year, even though both are adjacently located in Los Angeles County. We want to thank the Californians who shared with us their fears, their anger, and their frustrations, and who showed us their bravery. They helped inspire our report, which outlines seven ways to improve the state's developmental disability services system.

Dion Aroner, my colleague and fellow member of the Commission Subcommitee for this study, will now describe our recommendations.

Good afternoon, everyone, and thank you for allowing us to present to you this afternoon. As Bill mentioned, I'm Dion Aroner. I'm a fellow Commissioner, and Bill and I chaired the Subcommitee that was responsible for producing the report. But I do want to acknowledge that our staff, and particularly Tamar Foster, who's our Chief Deputy, wrote the report for us and captured, which were very, it was interesting. We had three hearings and one stakeholder press, one stakeholder meeting. We heard from hundreds. Right.

I think probably this is the most that the Commission has ever heard from on one of our reports, if I'm not mistaken. All right, that tells you the interest around this particular issue, around the State of California. As Commissioner Emmerson mentioned, our report outlines seven recommendations, one which is to increase the consistency in client experiences across Regional Centers. This should include developing a standardized client intake process, establishing requirements for Regional Center websites, and identifying a set of core services available at every Regional Center.

The second recommendations is to target and reduce ethnic and racial disparities in treatment and access to services. To do so would mean creating standard categories to better measure client demographics, improving data monitoring and analysis, and requiring Regional Centers to report on additional metrics such as denial of services. Third, we want to bolster the state's oversight by granting the Department of Developmental Services Authority to issue general directives over the system of Regional Centers. There seems to be some barriers there that we couldn't quite understand.

Fourth, we think you should modernize the antiquated data systems the Department currently relies on to track financial and client data. This goes back probably 25 years, right where I remember sitting up where you're sitting and discussing the computer systems that the Department had at that time and the attempt to modernize it even then, and the failures that subsequently happened. Updates should include functionality to provide real time financial and client data, improving the department's ability to provide effective oversight.

Fifth, we believe you should standardize the process for service providers to gain entry to the system. This would help ensure a broader availability of services throughout the state. There are thousands of providers around the state who don't have common out don't, who literally cannot access service, access programs in other counties, that kind of thing, because each Regional Center decides for itself who the service providers are.

Sixth, we believe you should strengthen and enhance support for Regional Center governing boards to ensure they operate independently from Executive staff and operate without fear of retaliation, but also to ensure that they don't receive special treatment because they sit on a board of a Regional Center. We want to ensure that board members are fully equipped to participate in board decisions. As you might know, members of Regional Center boards very often include consumers and their families, right? These are complicated systems.

We believe that everybody that sits on a board and has the responsibility of governing one a Regional Center, should be prepared to understand what the issues are and what the decisions are that they're going to be making on behalf of the consumers in their Regional Center. And seventh, we would like to see improving service coordination by requiring the Department to convene a task force to streamline the complicated processes for accessing generic services.

What clients go through in many Regional Centers, because of the way the statute is written, they have to use generic services, meaning services that the state might provide through other departments or other agencies. Before that, they can use the services of a Regional Center, or actually not the services of the Regional Center, but to use the funds of the Regional Center to provide for services that aren't available through a generic service.

It would be nice if we could all be clear about how those generic services are defined by the Regional Centers and how they're handled and how decisions are made in regards to when a client or their family Member has actually done enough work to be able to prove that the generic service is not available. Because we heard incredible stories from clients that had to go through terrible times. Right. Trying to prove that that generic service had been denied. Lawmakers should enhance navigation services. Right?

And you've heard that word navigator probably recently, right. It's becoming a popular word in trying to figure out ways to help clients, not just in this system, but in other systems, figure out how to work those systems so that they can be effective for them. We believe the state has an obligation to remedy the disparities in the system. These recommendations would help ensure that all Californians who are entitled to services receive similar access to care.

And the only other issue that I'd like to mention also is that for years now there have been caseload, caseload descriptions. In other words, 1 to 62 per case worker, I don't know, a Regional Center in the state and there are 21 of them that meets that guidance any longer. Right. We heard from workers in the agencies regarding the fact that some of them carry 100 cases at a time and then also very often have to cover the uncovered caseloads when there is one. Right.

There needs to be a way for the Legislature to deal with the caseload issue at this point. So I just wanted to mention that at the end and we're open to any questions.

Thank you very much. We'll continue with the Director.

Thank you. Thank you to the Committee and appreciate the report out on the good work of the Little Hoover Commission and the careful and thoughtful and respectful work. Our appreciation, I've been asked to be focused on a couple of questions. One is the recommendations of the Commission and kind of our viewpoint of that. I first will just say that we welcome the report. The report or any overview of how we are delivering services to those we have responsibility for is extremely important.

We have frequent engagement with our stakeholders. And while I think we do a pretty amazing experience and job of listening to our community, there's nothing like having an external body to be able to hear things maybe differently, or to make additional recommendations. So we really welcome that. We are committed to continuing our work to address shortcomings to the Developmental Services System because the work that we do and the individuals that we serve are incredibly important.

Right now we're supporting approximately 400,000 individuals in California who have an intellectual and developmental disability. And it is a very diverse population. Our population is changing. As noted the Regional Centers, as they've been in operation for over 50 years, there's been changes. And looking at the rate structure as an example, or taking a look at kind of caseloads, what's kind of the right approach to looking and serving to break down those barriers and inequities has been a priority of ours.

We're doing this in a number of ways. We're looking at it from the rate model implementation because we recognize in our rates, it was noted, between Harbor Regional Center and South Central, the inequity of spending. We noted through the rate study that we were seeing the rates, the actual rates for service providers, for example, between Westside Regional Center and South Central. And those were the things that we were wanting to address.

Very pleased to see that we are moving forward with the implementation of the rate models.

We've been doing it on an incremental cycle and so we're going to continue to measure are those kind of initiatives and that large investment in doing that, is it really affecting the change that we're desiring to see. Additionally, recognizing standardizing efforts across the state, one of the questions that I've been asked to address today is what are some of the things that we can do with specifically for intake and then the person planning the IPP as it's often referenced to.

But I also just want to note a couple of things that we also in taking a look at improving the experience of individuals and their families, because we have heard this ourselves over a number of years, we do have a number of initiatives, and I wish I had a magic wand to implement overnight. It does take some time for implementation, but I'm really happy to report some of those initiatives are actually coming to fruition.

An area that has been a particular priority that I've heard that I've put forward is saying that we need to be able to make sure those who are entering the system that are trying to see if they're eligible, that they have standard information that is equal across the state. So for the last two years, we've been working on an early start in a Lanterman information packet.

I'm happy to report that we're anticipating by Friday, but I'd ask us till next week just in case something comes up, that the information packet for early start is going to be public. It's in six languages that's been translated. We are also in the process of doing an ASL video translation of that information packet. Regional Centers will be required to provide that across all 21 Regional Centers for anybody who is asking for information about Regional Center services.

We're also then looking to release the Lanterman version of that over the next couple of months. Additionally, when we take a look at standardizing efforts. When we're looking at some of the intake and measures, our performance measures are prioritized intake as well as the individual program plan or the individual person services plan. And I have some very tangible things that we've been working on in both of these areas.

For intake, we have been working with the Association for Regional Centers on what does that process look like. We are aware that there's 21 different ways right now in which intake is being completed. So in addition to the information packet, now we're taking a look at, and what we've done is since January, we've collected all of the different procedures and policies that Regional Centers have for intake. We're reviewing those. We've identified some of the key things where two things are standing out for us for deliverables.

One is identifying the procedures and the process. The other one is the form. If you go to one Regional Center, you may have an application that looks different than another one. And we're working with ARCA to be able to standardize that. We do anticipate having a structure to that by June of this year. As far as implementation, that certainly takes longer because once we have that, we're going to have to put it into our electronic record system, our process.

So once we do that and we'll have to do training. So my target date to be able to implement is looking at either late December or the first quarter of 2024 because we want to do it right. Doing it fast isn't always the best way, but I'm really happy to report that we already are in that process for the Individual Program Plan or the Person Centered Services plan. Very similar. We've been collecting all 21 different IPP's. We've worked with ARCA.

We've identified a couple of really great practices. There's some that have some really good elements. What we're doing is identifying those best practices, putting forward a number of recommendations.

We're going to be working with our stakeholders, so that means those who have lived experiences and family members and then also others in the community advocates to review what we're proposing, having them provide us input and feedback on looking at it from the federal requirements for the federal rule, but also then through the family and individual with lived experiences lens.

And from that, then we'll identify a standard form and then we'll again have to make sure that we're putting it into the structure that we have in our existing IT system. And as it was noted that we have a very archaic system. So we may have to do this with a little bit of finesse. But what's really nice about that, we've been working on what we call CERS, our Client Electronic Record System, and UFIS, which is our Uniform Financial System.

And thank you to the Legislature and supporting our efforts to be able to modernize both of those systems. It is a task. It's a very large task, but each of these steps that we're doing right now is really going to feed into that new system, because now we're going to be able to say, instead of let's create these structures, we're going to be able to work on it even within our existing system, and then go ahead and modernize and put everything in.

And we're working through the policies now, which is really good. So again, really just want to say thank you to the Little Hoover Commission.

We're very committed to working with those with lived experiences and our families, but also the Legislature to make sure we're continuing to improve the access and removing those barriers so we can make sure that we're delivering the services to individuals and making sure that we're not only measuring purchase service, but I also want to make sure that we're breaking down the barriers to timeliness to services, making sure that we're looking at an equity lens that's bigger than just a purchase of service, that we also want to make sure that their experience is also a positive experience. So thank you.

Thank you very much. Now we'll have Mr. Anderson.

Ryan Anderson with the Legislative Analyst Office. We're still in the process of reviewing and evaluating the Commission's report. I'll say surely a lot of the concerns and issues that they raise are the same concerns that we've heard in our conversations with stakeholders. So I think there's a lot for legislative interest in there, but we don't have an independent take on the recommendations at this point. Thank you.

Mr. O'Neill. Did I say that right?

Yeah, that's exactly right, Mr. Chair. So Chris O'Neill with the Department of Finance. Nothing further to add to the presentation. Thank you.

Thank you all very much. We're going to just have a series of questions here. The first one is for the commissioners and for the Director as well. What are the best specific metrics that can be used to measure progress toward disparity, reduction and greater equity? And I'm specifically looking at recommendation number two. I believe that's strategy A on page 10 of the agenda. If you can elaborate on what implementing the recommendation would actually mean, what it would look like.

Dion Aroner. Once again, I'm not a data person. Okay, let's be clear. I took stat in college, right. Did not do too well. But I think the idea is that right now, the issue regarding the data collection and the inequities has been around for maybe a decade now at least. Right. And this is not the first time the Committee has heard this issue. And so the question becomes one of what's been going on in the last 10 years or so. Right.

Why don't we know and can understand what the inequities are and what the breadth of the inequities are? All right. We took testimony from hundreds of people, many of whom came forward on this particular issue. And so it seems to us that since the issue has been identified, then why doesn't the Legislature say to the Department. Right.

Part of the problem here is with the 21 Regional Centers, who has the power to say to the Regional Centers, we want to collect the data to find out who you're serving and who you're not serving from the very beginning of when a family comes into the Regional Center asking for help, because one of the issues is how many people are turned away because they supposedly don't meet the eligibility standards. Right. There's no data, as far as we know, there's no data on that.

And so for us, I think it was, we'd like to see the data throughout what a family, the living, what did you call it? The living life experience.

Yeah. Right. That's a new term for me. And so what's the life experience through the Regional Center for that family and that consumer? Because there are many points of contact. One of them is just originally just coming in and asking for help. All right. What happens then? What's the data show that happens in regards to, are there differences depending on what the color of your skin is or where you live? Right.

And it goes on, whatever those steps are, we think that data sets should be able to be put together using common terms so that the Regional Centers understand what they're to be collecting. Right. Because there seems to be some difference of opinion within Regional Centers regarding how they interpret things. I get that. Right. But that means the Department needs to be very clear about what is the data set we're looking for.

What are those points that we are interested in hearing about as to what goes on when someone comes in, what's their experience with their IPP? What's their experience of whether or not they're going to get services, what those services are? I think we want to know that. And then what's the experience of the services being delivered as well? Okay, so I think that's kind of an idea.

Yeah. Thank you. Nancy Bargmann, Director of DDS. I love the example of intake. I think this is a really good place to start a conversation about how do we measure. I do believe that measuring the average expenditures per person is one area of measurement.

I will say that what's going to be important is to also make sure that we're taking a look at it in breaking it down a little bit deeper, because the difference of expenditures for those that are over 22 is going to be different than potentially expenditures for somebody who is involved in the education system. And there's so many different variables that go into that and we've broken this down. Is there more work to be done? Absolutely. Part of it is data limitations.

And I will often say we can't wait for the perfect because if we do that, we're going to be missing an opportunity for learning something, but we need to use what we have available to us. So we're pushing ourselves and we're pushing our research team to continue to drill into detail so we can take a look at.

I'll give you an example of an area that's incredibly hard for us to have visibility into, that we're working to improve in our data integrity is that we pull data right now, and the Regional Centers report on ethnicity, so we've been using the same categories of ethnicity. I'm going to go out on a limb here, but probably 40 years, I may have some update along the way.

I'd have to go back and look, but our culture is different today, and so we need to take a look at our other category right now is, I think it's close to 20-25%. So when you take a look at the fact that we really don't have visibility into that category, it's hard for us to fully understand all of it, but I don't want to wait for us to have it.

But we are working with ARCA and the Regional Centers to say, let's identify so we can really drill into more of that category to get visibility. But we already know that we have individuals that are not accessing services based on what's currently being reported. So getting to the point of intake as an example, and I think to your question of metrics, what are we going to be measuring?

So even beyond the purchase of service, measuring what is the timeliness to access to services, and that's where we're looking at identifying through this intake process defining that point of entry. So that point of entry right now, I thought for a number of years that everybody had a common understanding of what that point of entry was. Well, there's not. So that is part of peeling back that onion that we're seeing that we need to identify that.

So is it from the point of the phone call or the contact with the Regional Center? Another Regional Center may define it as when they actually had completed an application. Or there's different areas and definitions. So we need to get to one definition. And this is the metrics that we can get to, is to say when we identify that point, then we're going to be able to measure from that point to assessment to eligibility determination.

And we can measure that based on ethnicity, we can measure that based on language, so we can really break down those barriers. But it's complicated. So I think we can come up with some metrics that we can measure, but I'd encourage us to allow us then some time as we get more information than to refine that measure, because we're going to have more information. And I'll give you one other example in that.

So let's say we put in a procedure that says that, okay, after so many points of contact, you can go ahead, Regional Center, and inactivate a case which inactivation of a case is really a thorn in my side. I don't like it.

I want to find out what's occurring with the family, because there may be a family who doesn't have access to transportation or doesn't have access to childcare to be able to follow through every situation is very individualized, but we need to know where our data points are so we can drill into kind of the quality of that experience.

But I think that gets to the equity lens of making sure that we're looking at individual experiences and the influences of other factors in a person's life that may be a barrier to accessing services. So I hope I at least acknowledge the value of being able to do the metrics and we can identify those things. And then I think we can build on it as we have more information that will be valuable in building on that.

Thank you. Hand it back to the chair.

Thank you and apologies. We have to be in multiple places this time of year. At the same time. I will follow along with recommendation two. I believe we just asked about two A. I'd like to now ask about two B and two C. And within it, it mentions a robust analysis that I'd like to understand what that would look like. And as well. What would additional metrics be or mean?

That's in two C, hoping either the Commission could discuss what a robust analysis would look like or what those additional metrics would be.

I think we maybe answered it a little bit in the previous question, to be honest with you. Okay. In looking at mechanisms, and also I think the Director mentioned that, yeah, so.

So many different data points, and where we fall and begin at is, I think the answer to that question.

I will move on to recommendation three, then. Strategy A. Within it, it mentions that currently it recommends that the Department have an amendment to a statute which would give you the authority to issue general directives over the system of Regional Centers. Do you currently not have that authority to give out directives to all of the Regional Centers? And if not, why not? And should we consider providing this authorization?

Thank you, Mr. Chair. So on the directive authority, currently there's a targeted directive authority that the Director that I have at this time for issuing, one is under health and safety that was recently added into statute in the last few years that when there is an issue of health and safety that's been identified by the Director, a directive can be issued. The additional is under particular initiatives before regulations are developed. Self determination is one. The rate reform is another one.

So really key initiatives, the areas that we are proposing through budget process that we've done with the specific initiatives, has granted the authority that the Administration has identified as the need. The other area, I would just highlight that there's other authorities that we can use or mechanisms to be able to put in affecting change. It's the Regional Center contract. So there's additional areas in which we rely on, on existing authority to do so.

And so within our current authority, the things that we've already put forward are the things that we've proposed to be part of our directive authority.

I like to come back to our comments on modernizing the core staffing formula, if I can. I had made a request for updated estimates on our February 22 sub one hearing, and I'm wondering if that information is forthcoming to our office or Subcommitee staff soon. And are you able to provide a date by which we can expect that?

Yeah, I apologize. I wasn't prepared to answer that question, but happy to get back to you. I know that our staff are aware of the request and been working, and so our colleague here from finance may be able to assist.

Yeah. Thank you, Mr. Chair. Chris O'Neill with the Department of Finance. So DDS staff have been in communication with ARCA on their requested proposal. I mean, their proposal, they put forward on the core staffing formula and providing technical assistance where we've been able to. But we can circle back on the status of those conversations.

For the commissioners, if I can. I was really struck by the volume of interest that you had within this report, and I'd like to understand what are the processes after the Commission releases a report. Is there any follow up after some elapsed time to see if there was any action on the recommendations that you made?

It's our intent to follow up on the study within a period of time. We haven't determined that at this point. We certainly want to give the Department adequate time to come up with some changes and some proposals. But, yes, we will be following up on that with subsequent hearings.

That is a usual thing that we do, Mr. Chairman, actually. Right. As we complete a report. Right. Then the Commission will look at possibly say, let's bring it back at a certain time. Right. It depends on what we see happening, that kind of thing, what the interest in this building is. All right. You might be aware that there's a major piece of legislation that's been introduced that pretty much reflects a lot of what's in the Commission report. Right.

I think we've taken a support position on that Bill and be testifying on its behalf. And so the question really is always seeing what kind of interest we get from all of you. Do you have follow up issues that you would like us to look at? Right. While we choose our issues on our own, because we're an independent commission, we obviously are interested in hearing from legislators as to what they're also interested in, and particularly around this particular issue.

And so I think we are contemplating follow up that certainly has been when listening to the hearings. Lots of the commissioners are interested in knowing. So you raise these issues and know what's going to happen.

It would be important. Mr. Emerson, I believe your comment was that communities of color were more likely than not to not receive supports, and if they did receive supports, they received less. It would be important to consider this as a point in time and to see how that's evolved after a number of years. And there is an interest from the Legislature to stay attentive to the needs to provide equitable options for all Californians with disabilities.

With that, I will thank very much this entire panel, and we will move on to the next issue. Thank you, Mr. Emerson and Ms. Aroner. Issue three is regarding the interim evaluation of the service access and equity grants, also called disparity grants, from Georgetown University. We have the following speakers on the issue.

Tawara Goode, Director of both the Georgetown University National Center for Cultural Competence and the Georgetown University Center for Excellence in Developmental Disabilities, and was the lead for the review of the DDS service Access and Equity grant program, followed by Director Bargmann. Ms. Goode.

Thank you.

Chair, if I could. Oh, thank you. I appreciate that. I'm just super excited to have Professor Goode here with us today. And so if I could just provide a little bit of an overview. I appreciate the chair's consideration, as noted and as correctly identified and outlined in the agenda that several years ago, DDS and the Legislature had actually really wanted to be able to have an independent review of our disparity grant program.

Service access and Equity program is what the grant program is identified as today, and we welcomed that opportunity and issued a request for proposal, and we're very pleased to see Georgetown respond to that. And through their work, we had asked them to do several things.

One is to analyze the impact of the service access and equity grant program, really through the lens of qualitative and quantitative measures, and then making some recommendations for metrics and other ways to be able to report out or to measure the success of the projects that were funded through the grant program, but overall looking at recommendations to improve it. There are two fiscal years in which they had approached their review and with their partner mission analytics, to really dive into the data.

So data review was really key, but also a participatory approach in engaging conversations, not only with Regional Centers and the staff that had been working on many of the initiatives and the grants, but especially also the community based organizations. And this work is continuing. This is an initial preliminary, and there's continued work that's going to occur through listening sessions, and there's going to be continued work that will occur before the final report that's going to be issued.

I just want to kind of also share with you, because one of the questions for the department was, are there some of the best practices? Were there some things that we've identified? And I'll just want to highlight a couple of those and acknowledging the chair's comment just now as to the equity lens.

And I think it's just really important to recognize that the service access and equity grant program that we have is just really one of the initiatives that we use to improve service access and equity for the individuals that we support. I have been saying for a very long time it's so important for us to look at all policies and initiatives through the lens of equity and making sure that we are making very decisive decisions to be able to break those barriers.

Very happy to see that there are several of the projects that we were able to, with the support of the Legislature, to fund as ongoing that really demonstrated positive outcomes. And that was the low to no purchase of service where we were able to Fund all 21 Regional Centers for the reduced caseloads for those individuals. We now have all 21 Regional Centers that have targeted caseloads for the individuals with low to no purchase of service, particularly those that are non English speaking.

The other one is a navigator program which is now at all 21 Regional Centers through the family resource centers, but also, I think, largely the bilingual pay differential that is available that we're implementing now for the direct service professionals within service provider communities so we can really broaden our aspect. We want to make sure that we're looking at this as a systemic abroad, opening the door to break down those barriers and have access.

But we also had a number of other areas of making sure that access to information is really critical. The information packets is a great example of making sure we have access to information. Making sure that we're looking at maybe a standardized vendorization process. We're in the process of working on that. Looking at the number of initiatives that we did, provisional eligibility, we recognized that communities of color were not advancing through the intake or eligibility and we were having individuals come back into the Regional Center system.

So some of those really key initiatives have been really valuable. Lastly, I'm really happy to say that when we're taking a look at that information packets, we're looking at information so that individuals have access to information is an opportunity to break those barriers and that equity lens. We just released a request for offer for the Lannerman act to be translated into Spanish. And so we're continuing to evaluate. How can we now, we're very early in that stage.

We're going to see what the offers and the responses are, but really looking at ways that we can make sure information and seats at the table can be continued to be enhanced and build upon. So with that, I'm very pleased to have Professor Goode join us today, and she's going to provide some overview as to what's in the initial report. And thank you, chair, for letting me step in.

Good afternoon. Thank you. I'm Tawara Goode and I am very pleased to be here on behalf of Georgetown University Medical center. It's a very long title Center for Child and Human Development, and specifically the National Center for Cultural Competence. So I thank the California Legislature and the Department of Developmental Services for this opportunity to provide and share with you observations in our preliminary and I want to emphasize that preliminary findings from an independent evaluation of the service access and equity grant program.

And for brevity, I will just call it SAE. Throughout the remainder of my testimony, you've already heard from Director Bargmann describing some of the methods and components of the evaluation and our response to the RFP. We submitted an interim report on April 5, 2023 and I really want to note that our evaluation examined the years for which there were completed data sets. And so at the time, again, that we responded to the RFP and that the contract was initiated.

This would be years 2018-2019 and 2019-2020 really looking at project implementation, and it was especially 2019-2020 was significantly disrupted due to the onset of the Covid-19 pandemic. So we really want to acknowledge that the department has made numerous changes to the SAE grant program since 2020. They are not reflected in the data sets that we have looked at overall, and I think that's important to be able to note.

First, I will review what our national center was requested to do and the lens of how we responded to RFP. So I would outline three we chose to analyze the impact of the SAE grant program using data generated by the grantees and administrative data from DDS to identify changes that would improve the grant program's effectiveness in increasing access and reducing disparities.

The second were asked to develop qualitative and quantitative measures designed to assess the impacts and outcomes of future SAE grant programs administered by DDS, and the third is to develop recommendations for metrics that can be used to prioritize areas of focus, populations, and the types of interventions that will have an impact on disparities reduction. And we chose to look at that at the individual level, the family level, the community level, the organization and systems level. So those are the things that we've been working on.

So I'd like to really begin with a summary of program achievements that we note thus far. And I still want to emphasize this is the interim report. This is not our final report. The California State Legislature and the Department are to be commended for centering efforts to address racial, ethnic, linguistic, and cultural disparities for persons who experience intellectual developmental disabilities, their families, and the systems to provide them with supports and services.

I speak with great confidence that there is no other state, not one nor territory, that has enacted legislation and allocated fiscal resources to begin the process to confront and address these types of racial and ethnic and linguistic disparities, specifically in intellectual and developmental disabilities. And we've seen this in health, but not necessarily intellectual and developmental disabilities. So I would say that California leads the nation both in legislation and allocation of funding. I want to speak to this notion of equity.

Developmental disability systems nationally lag far behind in defining the concept of equity, how to measure efforts to achieve equity across the complex array of supports and services within these systems, and how to partner with communities, populations, and families that are disproportionately affected by inequities. Data collected thus far, again by us, that DDS has not yet established a shared definition and framework for advancing equity. Nor is this concept well understood within the service provider network and among key constituency groups.

It is important to note that the SAE grant program has been successful in advancing equity nonetheless, and I would say in several ways. First, the insight from the department and subsequent amendment to legislation which made the SAE grant funds available to community based organizations. That's a huge step toward equity. These CBOs otherwise would not have not have directly benefited from these fiscal resources and the opportunity to demonstrate the deep knowledge they have of their own communities and ways to partner in disparities reduction efforts.

The SE grant program is consistent with one of the five elements of cultural competence at an organization and system level, specifically, the capacity to adapt to the diversity of populations served in terms of values, policies, structures, and practices. Our preliminary data indicate that regional Senators reported that the SAE grant programs enabled them to improve community outreach, establish more meaningful relationships within identified racial and ethnic communities.

There were gains in employees' knowledge and understanding of disparities and also the contributing or root causes of disparities, as well as culturally competent practices. These are things that were reported to us. Two programs in particular, and I concur with Director Bargmann in particular, demonstrated that they can be considered promising practices and quite frankly, really looking at that, to look at moving to the next step of evidence based practices, again being able to reduce service access disparities among specific racial and ethnic groups.

These programs are the Enhanced Case Management program, which you heard before, and the Navigator Pulmona program that the Regional Centers have incorporated in their contracts. I'd like to move to the considerations for restructuring the SAE grant programs. So our preliminary analysis indicates that the SAE grant program definitely merits continuation. I want to emphasize that it definitely merits continuation. The diverse communities and families it is intended to support can benefit in many ways.

However, our analysis thus far indicate that the SAE grant program should be restructured to optimize its impact as it relates to disparities reduction. So I will share some of those disparities reduction and corresponding initiatives to address them within dds are not limited to the SAE grant program, nor should they be.

One dedicated grant program, even funded at $11 million annually, simply is not capable of addressing the entrenched and complex array of disparities that disproportionately affect persons who experience intellectual and developmental disabilities and their families, and, quite frankly, the communities in which they live in California. While disparities reduction and equity are related, they're not the same. DDS understands this, and our evaluation documents the numerous other efforts within the department.

Moreover, an analysis of root causes of racial, ethnic, and linguistic disparities within the context of intellectual and developmental disabilities is necessary and a system wide basis, not just SAE grant program. The primary measure to evaluate and demonstrate the efficacy of the SAE grant program has been purchase of services.

While POS is a solid measure of who is accessing services by race, ethnicity, and language spoken, it should not be the sole measure because what persons with intellectual and developmental disabilities need and prefer in terms of supports and services change over time from infancy through old age. So what may be necessary in early intervention and the cost parameters are one thing.

By the time someone is aging, their needs are going to change significantly, and if we're only looking at how much money is spent, we're missing the boat. So there will always be disparities in expenditures based on numerous factors. The current POS measure does not discern root causes and if people are actually getting what they want and need. Moreover, POS only tracks who is in the system, not those who may be discouraged because services supports are not available accessible acceptable to them, thereby affecting utilization.

So going forward, the SAE grant program needs to make better use of evidence and disparities reduction, including the capacity to require and embed cultural and linguistic competence as an evidence based practice. We know this. It's well documented across all grant areas, so it shouldn't just be limited to some areas. This also includes the use of logic models, theory of change frameworks, and technical assistance needed for CBOs and Regional Centers to collect and report data to document the effects of their intervention.

So this is something that we saw. So this whole notion of data collection is the type of data that would be collected is really key and critical, and both cbos and Regional Centers needed support in this area. Since disparities are the product of inequities, it is important that the SAE grant program is structured to respond to the question disparities in what?

Using a disparities framework that I developed and is available in the published literature, it is critical to discern if the disparity is in the availability of supports and services, if the disparity has to do with the accessibility of supports and services, if the disparity has to do with acceptability of supports and services.

And I say that in earnest because a service may be accessible, it may even be available, but it may not be acceptable to me because it's not provided at the time that I can get to it, it's not provided in my language of choice. And so these are things that we need to take in consideration.

Also, we look at whether or not there are disparities in the quality of supports and services, and someone may say that it didn't meet my need because it wasn't in my language, and so therefore look at the quality is a problem for them. And then lastly, all of this relates to utilization. So if we look at accessibility, acceptability, availability, utilization overall, that that is going to impact what you have been measuring as purchase of services, I'll be done in just a few minutes. Okay.

The current evidence in other fields, particularly health, indicates that disparities reduction is a developmental process that occurs over time and not in the one to two year intervals as the SAE program grant program is currently funded and currently structured. And I guess I understand from this as results of budgeting and policy, and I understand that things are funded per year, longer term, focused implementation of grant that have the greatest likelihood or track record of reducing disparities will be important going forward.

Additionally, in support of advancing equity, some of the grant areas should continue to include the kind of community engagement and parent education that we see. However, the metrics and outcomes for these programs needs to be adjusted for the purposes of the grant. So that would not be POS, that would be increased knowledge, increased understanding, but that does not always directly relate to increased pos.

And so we would want to know that are these programs helping to build trust and knowledge within communities over time so that they indeed can access the supports and services that are needed and therefore begin to impact purchase of services. So our evaluation isn't completed yet, and I attempted to distill from the volume of data that we collected and trust me, it's a volume. These are preliminary factors that we've been able to share with you today. I'm happy to take any questions.

And again, I thank you for this opportunity to testify before this distinguished body.

LAO.

Ryan Anderson, Legislative Analyst Office we look forward to reading the final report and appreciate the insights today, but have no comments at this time.

Department of Finance.

Christopher Odneal. Department of Finance, nothing further Mr Chair.

Bring it up to the dais if there's any members' questions, we'll begin with Dr. Jackson.

Thank you very much. I'm really fascinated about the idea, know in order to, the cycles don't sync up in terms of the life cycle of the grant and the life cycle of when we should actually expect change to occur. Right. And it's one of those things where systems are not sometimes making decisions based upon the reality of how things happen. What do you look at?

Can you talk a little bit more about that in terms of why does it take longer than two years to be able to see the type of outcomes we want to, that we're looking at, looking for?

Thank you for your question. I want to start with the fact that this is a single grant program.

Yeah.

We're looking at racial, ethnic, and linguistic disparities that are entrenched and have been around for a very long time. So I just ask, how is it possible that one funded grant program, $11 million a year, however generous, but you have a multibillion dollar system. How in one year, could there be substantial reductions in disparities?

And so I think that if there were to be able to look at the evidence that shows, for instance, and health disparities, it's well documented, significant evidence about what it takes to reduce racial and ethnic disparities, health disparities. But we've not drawn upon that. And the work that we're looking at for the SAE grant program, and it's not just California, it is across the nation, because we're just really looking at inequities by race, ethnicity and language spoken within development disability systems.

So I think that the POS measure, again, is a very broad measure, and it's saying that this is, we're going to look at to see whether or not, and measure whether or not something is successful. It's too broad of measure for the type of multiple life experiences and disparities that we see across racial, ethnic and cultural populations in this state. So there has to be another way to begin to look at what can we do to reduce disparities over time.

It needs to be evidence based, informed, and there needs to be capacity within community based organizations, within the Department, and also within Regional Centers to collect that data, be able to report that data again over a period of time. So that needs to happen.

Director, when you hear that. How do you react to that?

I welcome the opportunity to have those conversations because we know that measuring purchase a service and there's different layers to it, and I really appreciate that many advocates and others have started to not looking at it on the aggregate because much of the measures have been on the aggregate of our purchase of service.

So if you take a look at statewide, an example of that is that when our population is changing, the majority of the individuals who are Hispanic are under the age of 22, and the majority of the individuals that are in out of home residential services, which is one of our higher cost categories, are predominantly white.

And I don't want to just say, hey, because of that, we're always going to have an inequity of spending, but we should take a look at what are the other supports, what are the other factors to the accessibility for services that meets the needs where the individual and the family are? For example, we talk about respite, social, recreational services.

There's a number of services that are under the age of 22, we know, and as the Lilla Hoover Commission had noted as well, being able to navigate systems is very difficult. It's harder for some and it's still hard for others, but knowing that's why having the permatura or the navigator not only to navigate through the Regional Center system, but also the other systems that families depend on.

And so that's why I do think that having the opportunity to look at things from a broader perspective, not discounting the purchase of service, but being able to say, how are we going to be measuring progress on either access to services, say, through intake? Access to services.

Once somebody is through intake, as we're moving forward to have, say, a statewide provider directory, are we able to then take a look at in the State of California, across Regional Centers, which providers are available in each of those geographic areas, that we can go ahead and have access to services. So I actually welcome the conversation.

This is a chance for us to take a step back and say, how are we going to redesign not only the grant program, but how are we going to define equity in Developmental Services? This is a new breaking ground nationally, and I'm excited about the fact that we're being challenged to take this on, but it's complex. It's going to take us some time to do some of this work. So hope I answered your question.

I'm excited that you're excited. Yeah, right. I mean, I think the idea is that when we talk about inequities, this is compounding effects.

Yes.

Right. And what I'm excited about is the opportunity to say that if we are going to do this grant, that it should reflect the realities and the expectations that come with it. Right. And sometimes I think that we even have an expectation to our grantees that within two years, did you do this?

Yeah.

We're giving them expectations that we're putting a requirement on them that it's impossible to meet sometimes. Right. Does that mean we should not do the grant? Or should it mean that we need to reform the grant and make sure that the requirements reflect and the timelines reflect the type of change or the timeline of the change in which we should be expecting it to occur? Right.

Also, the definition, when we talk about the definition of equity, of course, I have a Bill to actually set a statewide definition of equity. And we say equity so much every day. Right. There's been over 2700 bills that has the word equity in it, but there's no definition. It's time for us to go back to the basics and fill in some gaps here. Right.

And have the courage to do it so that we can actually have something to actually hold ourselves more accountable and begin to set metrics and true expectations in which people can meet, instead of it being metrics that we all have in our head somewhere that can change by depending on how we feel that day. Right. So I'm looking forward to the final report. This is exciting stuff.

Yeah, I'll bring it back to the chair. I'd like to focus on one of the final bullets that we have in the write up in the agenda that's on page 15 in which you state that you want to encourage applications for those who provide services during nontraditional work hours. I'd like to know what that would mean specifically. For example, would this mean widespread Regional Center Hours that would be in the early morning, late evening, or weekend time?

And I'm asking through the lens of equity here, representing farm workers who oftentimes are at work before the sun rises, and how when you aren't providing services or only providing them during nine to 5 hours, it makes it awfully hard, as Dr. Goode says, to find those services acceptable. So I would love to hear a response about what you think that means.

Yeah, and I'll certainly defer to Professor Goode as it pertains to the report, because we get pretty excited about kind of the conversation and have to remember that this is really about the equity service access and equity grant program, but also taking a look at the community based organizations.

And I will say that what I so appreciate about some of the recommendations is looking at the service, access and equity grant program of, okay, what are those measurable metrics, but also honoring some of the really grassroots work of the community based organizations and being able to see those relationships and being able to build on their trust within their community.

And to your question, it's really, then I'm looking forward to seeing the recommendations that Georgetown is going to be presenting that we can incorporate and build into our guidelines that will say, okay, we prioritize those grants that look beyond a five day a week, eight to five, what are those things that are meeting people where they are?

Ms. Goode. Dr. Goode. Excuse me.

I would say that as we look at the grant program again, it's designed to help reduce disparities by increasing access and then moving toward equity. And I think sometimes we get stuck on the equity part, which is problematic since it's not been well defined, nor have there been systematic metrics that will look at what it means in the intellectual and developmental disability space.

And so I think just in my preparation for this testimony today and training that I did yesterday, when I look at the demographic makeup of California in terms of race, ethnicity, languages spoken, it is very diverse. And then when you look at that within the context of the lives of individual families, it's a huge spectrum. And then we're looking at that within the context of persons who experience intellectual and developmental disabilities.

So sometimes service systems need to be able to change so that if a significant majority of people are working multiple jobs that you can only have, I would say, speech therapy services between 9 and 4, that's going to leave out a lot of people. So how is it that we begin to look at the needs and interests of the populations and to be able to respond to those effectively?

And I think that that is, I would say it's a significant challenge because we're looking at staffing and we're looking at doing something that may be very different than before. I can think about community health centers in particular. A model that was indeed used is that there were weekday services and supports. There were also weekend services, supports during particular periods of time, and they were actually able to find staffing that were wanting to be able to do that.

So as we think about the interests and needs across California and the racial, ethnic, and linguistic groups that have been disproportionately impacted, we may need to look at different service delivery models.

I'll just add, if I can, that that which is not measured cannot be improved and believe it's important, if we're not going to use any single source, that we come up with a bevy of metrics and really are looking towards the Administration and the department to help us to craft that and shape that as we're going forward.

I appreciate the commentary that none of this is going to happen overnight, and yet we need to have faith that we are working in the right direction and that comes upon agreed upon metrics. I'd like to switch a little bit to discussing the final report that will be coming. We really are interested in the lessons learned from the Georgetown report and how these can be amplified and applied to our system overall.

Will the final report be able to provide that with some concrete recommendations that could be actionable?

I would say that I really want to preface this, that we are only looking at the SAE grant program. Our contract was not to look at disparities system wide. So I think that's important because what can be achieved in a grant program is very different than what can be achieved if you're looking at an overall system. I also think that looking at something system wide really does require root cause analysis. I think it really is key and critical.

We did ask those questions during our evaluation, and so I think with that said, I'm thinking of my colleagues who want me to be very clear that we will only provide things for which we have evidence. So I would say that what we may recommend for the grant program indeed may be able to extend system wide, but we will be very clear what that may be.

So, for instance, if we know the promotora program and enhanced case management have great promise, then we're going to speak to that and to say, yes, it started within the SAE grant program. It's living other places, perhaps that should be expanded. But I don't want to make recommendations until all of our data are in.

And with our team, with mission analytics and my colleagues at Georgetown, before we step out and make those recommendations, I think we want to have all that data available to us so that we're sure, absolutely sure, before putting that on.

The table, I will start by thanking all of our panelists here today before we move on to the next issue. I will make a recommendation, if I can, from the chair, that we do come up with some specific and concrete practices from SAE that can be adopted system wide to make progress towards equity, those promising practices that you spoke about.

I am hopeful that your report will guide state policy in a more fundamental way and do appreciate all the time and evidence that you are going to be providing and giving to us. But we are looking for next steps. If we are out leading the way in this field, we want to look towards researchers to make sure that we're moving in the right direction and hope the final report will reflect that.

Yes. Thank you for this opportunity.

Thank you. We will now move on to issue four.

Issue four is regarding efforts by DDS with the State Council on Developmental Disabilities to phase out sub-minimum wage practices. We will begin with Mr. Carruthers when you are ready.

Thank you, Mr. Chair Aaron Carruthers from the State Council on Developmental Disabilities. And with the chair's permission, I'd like to give the microphone to Assistant Secretary Cooper to give the overview of activities and timelines. Great.

Thank you. Good afternoon, Chair Arambula and members. My name is Debra Cooper. I'm an assistant secretary for program and fiscal affairs at the Health and Human Services Agency. Thank you for the opportunity to speak with you today about the efforts coordinated between the State Council on Developmental Disabilities, which I'll refer to as State Council Department of Developmental Services, which I'll refer to as DDS, and additionally the Department of Rehabilitation, as I'll refer to as DOR to phase out some minimum wage practices.

The administration applauds the passage of SB 639 and supports phasing out sub-minimum wage. This support for ending sub-minimum wage is reflected in the current and longstanding efforts led by DOR and DDS in partnership with other state entities and stakeholders, to provide a variety of employment services for Californians with the most significant disabilities with the goal of achieving competitive, integrated employment.

While the administration appreciates the work of State Council and the recommendations reflected in their report on SB 639, the administration is invested in accelerating the effort to phase out subminimum wage and is cognizant that it may take years to establish and staff a new state office and develop a new plan as recommended in the report.

Alternatively, to further accelerate these efforts and support the mandates of SB 639, DOR and DDS will each designate an existing executive level staff member to serve as a dedicated leadership to advance the ending of sub-minimum wage and successfully transition and expand employment and other opportunities for adults with IDD. This approach could be set up in a matter of weeks and amplify existing efforts, including some strategies in alignment in the recommendations in the report developed by State Council.

This approach also rightsizes the use of state resources for the task at hand, rather than committing ongoing resources to establish an additional governmental structure. The administration's approach leverages the existing expertise, coordination, collaboration, and partnership between both departments and enables a nimble approach to escalate initiatives already underway and accelerate initiatives that could be activated. Health and Human Services Agency will continue to collaborate with DDS and DOR to implement the provisions of SB 639.

The executive leaders will be tasked with the immediate deliverable of a feasible plan that could be executed in the less than two years window to achieve the phase-out of sub-minimum wage for adults with IDD. The executive leaders will routinely meet with the separtment directorates to ensure progress, receive guidance, and reflect support at the highest levels across the departments and agency. Each organization plays a unique role in expanding statewide capacity, providing education and information, and assisting with the development or refinement of services.

DOR's existing employment services already only support competitive integrated employment outcomes. In addition to these existing efforts, DOR is looking for opportunities to further advance competitive integrated employment efforts with three areas, business engagement, upstream interventions, and increased paid work experience opportunities. DDS and State Council are working together on the state plan and strategy for phasing out subminimum wage and offering competitive integrated employment to every individual served by regional centers.

State Council participates on DDS's employment workgroup. The workgroup assisted with the development of guidelines for $10 million in employment grants to expand employment opportunities and is assisting with the development of a new career pathway service to assist individuals to move towards integrated employment, paid internships, higher education, and other individualized options. DDS participates in State Council's Employment First Committee. This committee is responsible for identifying and promoting strategies that increase the number of individuals who engage in competitive integrated employment.

Aaron Carruthers here can speak in more detail from State Council can speak in more detail to the following, but separate from and in complement to the efforts underway at DDS and DOR, State Council activities include benefits training for people with developmental disabilities in their families as well as regional center staff, community of practice, and national expertise.

Additional efforts that these entities are coordinating on include data collection and sharing, discussing the establishment of milestones for the transition of individuals prior to the January 2025 deadline, and tracking outcomes. On data collection, DDS is looking at the data elements that are required under SB 639 and determining what data are being tracked by current data systems and ways to collect the data that are knowable.

The administration will work as appropriate, with state partners, stakeholders, and the Legislature lecture to track and report out regularly on progress and milestones towards successfully meeting all of the mandates of SB 639. While State Council's report recommends reducing by half the number of individuals receiving some minimum wage by January 2024, the administration recognizes that setting benchmarks along the way and achieving the complete phase-out will be difficult because it does require individualized career pathway planning and attention to each individual's needs and choices.

The administration is confident, though, that the statutory deadline to end sub-minimum wage by January 2025 will be achieved. All of these strategies are, to varying extents, a continuation of longstanding efforts preceding the passage of SB 639. The administration, through the executive leadership assigned to this effort from DOR and DDS, will continue to engage with State Council and other stakeholders on the needed efforts in tracking progress towards ending sub-minimum wage.

We appreciate the progress and recommendations that have been made towards ending sub-minimum wage, and the plan of reproach is a reflection of the intent of agency, DOR, DDS, and State Council to move faster and more boldly towards achieving the goals of SB 639 and fully realizing employment first in California. Thank you for your time.

Thank you, Mr. Chair Aaron Carruthers of the State Council on Developmental Disabilities. And as you and the committee know, the State Council is an independent state department. We're not under any other Department or agency. But I really want to thank Assistant Secretary Cooper for reflecting and representing the work that we're doing along with the work with Department of Rehab and Department of Developmental Services.

Because it is an all-hands-on-deck effort, everyone's individual efforts are working, coordinated in collaboration to get to the goal that's in statute, everybody out of sub-minimum wage by January 2025 and do it in a way that it creates the best outcomes for the individuals who are leaving those work settings. There's comments that the assistant secretary made that I really want to underscore. They're good ones, they're strong ones, we support them.

One is the number of efforts that are underway and the thoughtful way that the departments are bringing current programs, current efforts to bear on this specific task. The next is regarding data. The departments have systems and improvements to those systems that are underway, but those improvements likely won't manifest until after the deadline of 2025 ends. People are leaving the sheltered workshops now, and we want to know what's happening with them now.

And in conversations with the administration, I think there's really thoughtful ways underway to figure out how to make sure that information that we need to make sure there's good outcomes for individuals is not lost. So the assistant secretary spoke to that. Generally, I want to reinforce our optimism in that happening.

Not only does it matter because we want to make sure good things happen for individuals, but also because the statute requires the State Council to report back on a number of data measures annually beginning in January 2024 through January of 2027.

So I want to reinforce that while formal data systems can only capture so much and there's not much that can be changed to capture additional data elements, the departments are being thoughtful to make sure no information is lost or as much information as possible can be gleaned. Additionally, I really appreciate the assistant secretary's comments regarding a timeline, strong awareness of January 2025, recognition of our recommendation that half of people be out by January 2024, but also the human reality that we are working with individuals.

And the best work that's done is by a person-centered approach, individual person-centered approach, which takes time. And so the strong push now will allow for the time to work with the individual and what happens for them. So the numbers, I hear the recognition and embrace the recognition. The numbers may not fit as neatly as a half out by January 2024. I do hear the strong commitment of everybody out by 2025.

So thank you to the assistant secretary and agency for the representation on the coordination of efforts and timeline. I do want to take a moment to highlight a few recommendations from our transition report. One is the number one recommendation that there be an employment first office that's created with an agency.

I appreciate that the agency is actually here representing today and presenting as evidence of the need from our point of view, not speaking for you from our point of view, evidence of the need for there to be an office that's outside of the implementing departments, that is cross departments and able to speak to other agencies because the issue of employment is not just the responsibility of one department. So want to push that forward.

As Senator Durazo has a request in front of the Senate, she is the champion and the author of this specific policy and this is the one implementation recommendation she continues to champion just to highlight the importance of it. So I hear the agency stating we can get it done without it. I can imagine how much more they can get done with it, especially since we're talking about two questions really and your agenda and the questions to us reflect that.

What are you doing to make sure the right transition out of sub minimum wage and what are you doing to ensure employment first? Overall, I hold when we get the one right when we get the transition out of sub-minimum wage right, we get it right for employment first for all. So this office would be needed throughout. Additionally, just some creative conversations that are happening that may not show up in the agenda, but one is looking at current resources that exist.

So for example, the department has $15 million they give out each year for HCBS compliance grants. This is smart money that helps people transition into what those federal deadlines are. And really the transition out of HCBS non-compliant programs is one lens we could look at this policy through. A recommendation from the report is to create a technical assistance temporary technical assistance resource for individuals, families, providers who are transitioning out. So could part of those monies be identified and set aside specifically for that transition?

I'm not sure that it's something this committee would need to act on, but something that we've put in the ear of the departments and agency and likely vary within their administrative discretion and flexibility under those funds. Additionally, I want to underscore one additional recommendation and how important it is that we create a pilot program for individuals who have higher support needs in employment. We've heard in closing out sub-minimum wage families come to us and say, who will hire my child?

And that's there in my heart. I feel it, I know it. And to the extent that there's a gap in our service delivery system that's not meeting that need well enough, we need to make sure that we really have concentrated efforts on that. So thank you.

Mr. Winfield.

Thank you, Mr. Chair. I'd just like to also express the department's strong commitment to ensuring that everyone with intellectual and developmental disabilities has the opportunity to work in a competitive way that the phase-out of sub-minimum wage that commitment as well. Certainly working very closely with our partners in all of that work, and I think through our quality improvement program, which is on the service provider side as well as on the regional center performance measure side.

In working with our stakeholders, they have certainly voiced that they want consumer employment to be right there at the top of the list and to be incentivized. And so through both of those programs, we've worked with our stakeholders in doing just that.

We also have a number of service options that are available to individuals and to include the new career pathway service that we are developing with stakeholder input that will assist individuals in developing a more individualized career pathway that will lead them to paid employment, to paid internships, to higher education, or whatever career pathway they want to go through. So we are very dedicated to this work, and again, we will certainly meet that deadline. Thank you.

LAO.

Ryan Anderson, Legislative Analyst Office. We've been doing a lot of work to ourselves to try and understand the transition and the phase-out process that's going on here, the needs of the individuals who are served. I'd like to highlight the comments that were made about data limitations as being very important there. Certainly, if we're looking at the phase-out of sub-minimum wage employment primarily through the metric of just will we get to zero employment in those fields, that's certainly an achievable goal.

In fact, we've already made tremendous progress in that before we even passed a law. If you track what data are available to show employment in those fields. We've already halved that employment over the last five years. Largely what happened during that time is that nonprofit service providers who provide a wide range of supports for individuals with developmental disabilities, including at some time offering employment under sub-minimum wage contracts, decided not to offer that employment option.

Most were forced to close down, at least temporarily, during the COVID-19 pandemic, and many of them decided not to come back. We've reached out to a lot of these former certificate holders because they had great interest because they offer these wide suite of services and continuing to serve those folks who used to be employed and the stories that we heard about. The second question is, what becomes of folks who no longer have this specific option? They're mixed.

There's been some success anecdotally in shifting these folks into other employment opportunities, but there's been a lot of consumers who have ended up in day programs, and perhaps that wasn't their first choice. Right? They may have been receiving a lot of benefits from their previous employment, even at a low wage.

With all that in mind, the reality that we have very limited insight into the remaining population that is employed under these sub-minimum wages is concerning the reality that we don't have a lot of insight into what are the particular barriers to employment, what is their interest in competitive employment because a lot of competitive employment is in many ways not as attractive as sheltered workshops.

It may pay more, but you may feel less comfortable in an environment where perhaps you are the only person with severe intellectual or developmental disabilities, where transportation is not provided to you, where the sports that you would have in that former environment are not available. We don't have anything approaching full insight into that, into the remaining individuals, which makes it difficult when you approach the phase-out from the specific question of how do we ensure the best outcome for those individuals. So we'd just like to highlight that as a particular concern. Appreciate all the insights that have been shared.

Department of Finance.

Thank you, Mr. Chair. Chris O'Neill, Department of Finance. Nothing further to add.

Bring it up to the dais. I'll begin. Mr. Carruthers, right where you ended regarding those with complex needs, I was moved with Ms. Cooper's testimony that the goal is for all of Californians with IDD to get employed, that I'd like to have you elaborate a little bit on what you would want to see within a pilot that would allow us to meet the complex needs of some of those within IDD.

Thank you, Mr. Chair. A pilot would, I believe, fully embrace the state's current policy of being an employment-first state, which is we begin with the belief that everybody can and wants to work and then we move from there. So if there is somebody who has more needs for in an employment setting, more support needs, we devise a program that will provide those needs based on their success in the position and the success for the employer.

I appreciate the comments from the LAO regarding, but really what I hear is the concerns that are expressed in the community. They're concerns we need to be mindful of. They're concerns we need to manage and plan around, but they're not concerns we should be governed by. The governance is clearly set out in the name of the core of our funding, the Home and Community-Based Services, which is that everybody is in integrated community settings to the best of their ability. And this I believe will further that even more.

Can I have the department comment? Your first recommendation from the state center had been on the employment first office. Is that something the administration is considering or contemplating?

We are dedicated to having an existing position from Department of Developmental Service and Department of Rehabilitation to work together in coordination with the agency rather than standing up a new structure within agency.

With that, we request that you keep us informed as we are working through this transition and phase out and all other issues on this item will be held open. We'll thank the panelists and we will now move on to issue five. Issue five is regarding the pending report on the CalWORKS work participation rate and Cal optimization workgroup. We will begin with Director Johnson when she is ready.

Good afternoon and thank you, Mr. Chair. Kim Johnson, California Department of Social Services. I want to again just acknowledge and appreciate the tremendous engagement in this effort from various stakeholders and also the leadership of yourself, this committee, as well as the consultants involved in this conversation. Absolutely meaningful to help inform our recommendations as we're moving forward.

And I want to just outline to the committee's question around the high-level comments we received in those conversations included the desire from the workgroup for a full repeal of the federal work participation rate or WPR penalty pass on greater accountability in the form of our CalWORKS outcomes and accountability review, performance measures or other metrics to be further explored and established, adopting reforms to increase supports for families, such as reform to reduce the overall number of sanctions and reduce the financial impact and duration of sanctions for the family.

That's again the high-level recommendations that we received in those conversations. The administration and the workgroup were aligned with regards to our collective goal, strengthening the CalWORKS program to ensure that barriers for individuals and families are removed and that they are able to utilize the program to build the foundation and path towards self-sufficiency or economic mobility. The report is currently in the very final review stages within the administration. We are planning to release this soon.

Unfortunately, I can't speak to a specific date yet, but we'll absolutely do so as soon as possible, and we absolutely look forward to engaging you and the Legislature after the release of this report. I just want to again recognize the leadership of this committee and the priority that this is in terms of the work we are continuing to do together to improve the program.

LAO.

Ryan Anderson, Legislative Analyst Office. Nothing to add. Our office participated in these stakeholder groups, and I think the director's summary of the comments fits with our understanding.

Department of Finance.

Jenean Docter, Department of Finance. Nothing else to add.

Bring it up to the dais. I don't think I need to state it, but this is a huge priority for us, and I am eagerly anticipating the report at the May revision so that we can act on the steps needed in the budget to help us to improve CalWORKS going forward. With that, we will hold this item open and appreciate this panel.

Thank you.

We will now move on to issue six regarding the CalWORKS single allocation methodology and proposed funding levels. We will begin with Ms. Troia when you are ready.

Good afternoon, Mr. Chair. Jennifer Troia, on behalf of the Department of Social Services, it's good to be here with you this afternoon. The subcommittee heard issues related to the CalWORKS single allocation as part of a March 8 hearing and asked us to return today and have some further conversation about that. As a reminder, the single allocation refers to funding provided by the state to the counties to support administration of the CalWORKS program.

The components of the single allocation include funding for eligibility determination, administrative costs, and employment services. Those funds within the single allocation are fungible, meaning the counties can move the funds flexibly between the intended purposes. We began to use a new funding formula in 2018-19 which increases or decreases administrative funding in increments based on caseload changes, recognizing that counties can't rapidly change staffing levels in response to changing caseload. During the pandemic, the caseload decreased significantly, which normally would have triggered funding decreases.

However, those decreases were suspended for the last three years, and in fact, the state provided both ongoing and temporary increases and augmentations to the administrative funding. The governor's budget includes a one corridor reduction, one increment to align the funding with the recent caseload declines and also recognizes a shift in administrative funding related to some cost-sharing agreements between programs.

After the hearing in March, you asked for the administration, legislative staff, and the County Welfare Directors Association, or CWDA, to meet and engage with each other to discuss some concerns that were raised by CWDA with respect to the application of the methodology. We all agreed that the methodology had been applied in good faith as it was written, but there were concerns from CWDA about the resulting adequacy of the funds. Those requested engagements did occur.

During those meetings, the Department of Finance highlighted that the actual caseload from 2018-19 to 2022-23 has dropped by 15% and the expenditures for eligibility administration during that same period have grown by 20%. So, in other words, the average monthly cost per case has grown by 52% during that period of years.

CWDA shared a different perspective for how to look at the data and its view that there are unfunded increases in inflation along with increases in the shared eligibility costs and a steady number of applications that they do not believe are accounted for in the methodology that result in their view that the funding is not adequate to meet required activities and timelines. Your agenda finally asks if the methodology will be reevaluated and these conversations will continue.

And indeed, existing law does require CDSS, in consultation with CWDA and representatives of counties, to reevaluate the funding methodology during the 24-25 budget process. We anticipate that those reassessment conversations will begin this summer between the separtment, CWDA, and representatives of the county welfare departments.

LAO.

Ryan Anderson, Legislative Analyst Office. We've also participated in these conversations between the administration and CWDA. I think DSS's characterization of those exchanges is accurate. There's still a lot of work to be done to get alignment between those two views. It seems like a major issue here is the question of the increase in expenditure per case.

There is another perspective that our office has an open question about, which is, given the fungible nature of the single allocation and some of what we heard about how employment services and demand for those services has changed since the pandemic, we are wondering, is there a buffer within the single allocation where the counties can reasonably expect that there are funds within the employment services component that will not be expended? And if so, how thick is that buffer? We think that's important context, especially given the overall budget climate right now. That question is outstanding, though.

Department of Finance.

Yeah. Jenean Docter, Department of Finance. The common cost eligibility was briefly mentioned by the chief deputy director, and I just want to touch on that for a moment. So I just want to emphasize that that's actually a net neutral across the three programs, CalWORKS, CalFresh, and Medi-Cal, and therefore it doesn't represent any reduction in spending that counties have across those three programs.

I'll bring it up to the dais. I know that these conversations will continue as the operational costs for CalWORKS continued to be reviewed, but I'd like to ask for the LAO's help here to weigh in, please, once we see what is included within the May revision. With that, all issues will be held open. Thank this panel.

We will now move on to issue seven regarding the federal Family First Prevention Services Act, implementation of parts 1 and 4, and the pending report on disproportionalities from the legislative analysts. We will begin with Ms. Troia when you are ready.

Thank you, Mr. Chair. Again, Jen Troia, on behalf of the Department of Social Services. In follow-up, also to a March hearing related to Child Welfare Services and foster care, the subcommittee requested that we provide a summary overview of implementation of parts 1 and 4 of the Family First Prevention Services Act, which I'll refer to as FFPSA for ease, and also address some questions related to disparities in the child welfare system.

FFPSA, as a reminder, is a federal law that was enacted in 2018 with the goal of enhancing support services to families and reducing the use of congregate care. On April 20, fairly recently, we submitted a report to the Legislature with detailed updates regarding implementation of FFPSA in California. So I will respond to your questions in the order of part one and then part four and answer the questions about implementation that was timely, as well as areas where there is challenge or delay along the way.

The report will go into great or does go into greater detail about all of these components. So with respect to part one of FFPSA, this is the piece of the law that gave states the option of receiving federal reimbursement for the provision of prevention services that are provided in accordance with requirements of federal law. In terms of progress for implementation, we're very pleased to note that California's five-year Title IV-E prevention plan was approved by the Federal Administration for Children and Families. Thank you.

On April 7, as it seems like you may know, this was a long process with extensive community engagement and quite a bit of back and forth in terms of edits, so we are very pleased to have that approval. As a result of that approval, counties can begin claiming Title IV-E administration funding back to October of 2021.

For the child and family-specific services, FFPSA contains a number of very detailed requirements for specific data to be tracked, as well as for states to have model fidelity to any evidence-based practices and to ensure that Title IV-E funds are the payer of last resort. The administration is working diligently to address these complex requirements and anticipates that functionality for tracking those prevention services at that very detailed level will be included in the scope of version one of the new cares automation system.

We are also working with the Department of Healthcare Services to develop guidance related to those payer of last resort rules, and we're in the process of developing a contract to ensure the model fidelity that's required with respect to evidence-based practices. At the same time, the state invested $220,000,000 in the Family First Prevention Services minus the act program. So the FFPS program is available to county child welfare agencies, tribes and probation departments.

It's an optional program and a bit of a bridge of investments as we work toward FFPSA with additional resources as well. It required a letter of intent to receive those resources and the development and submission of a comprehensive prevention plan, or CPP, to participate. As of March 2023, 50 counties and the two tribes with whom we have IV-E agreements have opted into the program.

46 of the counties are partnering between child welfare and probation to jointly develop their comprehensive prevention plans. In terms of areas of challenge beyond the additional detailed requirements that I referenced and the work that's ongoing for those, the counties have asked for and we're working to provide additional clarity on some of the CPP requirements with respect to engagement of tribes, individuals with lived experience, and the community.

The counties have also identified challenges in some instances with the ability to deliver the evidence-based practices due to some limited capacity. So we are working with them to identify which ones can be utilized and ramped up too quickly, and also to support the inclusion of additional evidence-based practices in the clearinghouse so that they can qualify.

Finally, we're collaborating with counties to address the challenges they've raised about how to implement some aspects of the optional community pathway, which will allow families to enter into services through the partnership of a CBO or a family resource center as a point of entry. And so that concludes what I wanted to summarize with respect to part one, and I'll shift to part four.

Part four of FFPSA established a number of new requirements for placements in congregate care settings, or referred to as childcare institutions or QRTPs, in order to continue to receive federal financial participation. The policy intent was to limit reliance on such settings and make sure that states utilized family-based settings as much as possible. There were a number of specific requirements that I can address each in turn and just mention where we are briefly, with respect to implementation.

The first requirement is for a qualified individual, we often refer to it as the QI, to provide an assessment and to indicate that the congregate care placement is necessary and there is not an alternative placement that can meet the child's needs. CDSS and DHCS have engaged extensively with counties to provide TA, providing webinars, conference calls, a dedicated email inbox to address questions in the rollout of this new process, and the beginnings of a training curriculum.

In addition, the Federal Government has approved a waiver that we requested to allow the QI, who is performing the assessment, to be an employee of the Title IV-E agency or connected to the placement setting. That said, this waiver only applies to who serves as the QI. It doesn't change the functions or requirements associated with them.

Implementation of that waiver is taking some time, given a lot of feedback from stakeholders and some additional back and forth and questions from ACF, so CDSS and the Department of Healthcare Services are working jointly to get guidance out on those wavered QI programs this summer. Another aspect of part four is the requirement for congregate settings QRTPs in the federal law to have the availability of an access to licensed nursing. California implemented this requirement in a timely fashion.

We built upon prior requirements that nursing be provided when a child had an identified medical need and additionally implemented a statewide contract for 24/7 nurse hotline. Additionally, FFPSA part four requires the provision of six months of family-based aftercare services after discharge from a congregate facility. In the first phase of our implementation of this requirement, we have operationalized it by requiring placing agencies and mental health plans to jointly provide and arrange for those six months of services.

During an upcoming second phase of implementation, state law will require high fidelity wraparound, more specifically to be our model of aftercare, and that will take effect 12 months after the release of guidance to the counties and providers. We anticipate that guidance to be released by both our department and DHCS in the second quarter of 2023. FFPSA Part Four also requires some case planning documentation by the counties, as well as court oversight and approval of placements into congregate settings.

For implementation of those provisions, CDSS and the Judicial Council have issued guidance and rules of court and provided technical assistance to support implementation. That concludes what I wanted to update you on part four. I can answer the question about disparities as well, or okay, I'll move on to answer the question about disparities in the child welfare system then. We also discussed this in greater depth at the March hearing, and as we acknowledge then, there will be many similarities to the conversation that you just had with DDS.

There are some significant and long standing racial and ethnic disparities and disproportionalities in our foster care system. In particular, the disproportionality is extremely pronounced with respect to the overrepresentation of Black and Native American youth. These disproportionalities and disparities begin at the time of initial allegations and continue at each significant decision point and experience in the child welfare system. We are committed to eliminating those disparities and disproportionalities at all points in the continuum. At CDSS, we do have a definition of equity.

I know Dr. Jackson raised that that was important to him. We follow our belief that equity will be achieved when a person's race, gender, sexual orientation, gender identity, ability or disability, national origin, language, or any other aspect of their identity can no longer predict life outcomes, and outcomes for all groups are improved. We understand equity as both an outcome and a process.

In the March hearing, Director Johnson highlighted several of our efforts related to equity and some recent legislative changes, and I will just briefly highlight a few of those before concluding. We established at CDSS an office of equity in 2019 to lift up these issues and increase collaboration across the department. We are doing work with the Capacity Center for States to reduce inequities in seven specific outcome areas that have associated measures and demonstrate improvements in those federal outcome measures with respect to disparities.

With respect to Indian children in consultation with tribes, we're in the process of implementing an Indian Child Welfare Act, or ICWA state plan. The comprehensive prevention plans I mentioned earlier from the counties will all specifically address how the counties will be working to eliminate disparities and disproportionalities, particularly with BIPOC communities. We are implementing trainings such as cultural humility and implicit bias trainings.

We have formed within our children and family services division a racial equity working group as well as a SOGI working group, and we are working on the very beginning of a process of developing an equity action plan, which we will eventually engage quite heavily with the community. Related to. In terms of those recent pieces of legislation, I would highlight two the first is SB 354 by Senator Skinner.

This was a bill that increased the authority for criminal record exemptions for relatives in certain cases when appropriate, and AB 2085 by Assemblymember Holden, which clarified that mandated reporters should not be making referrals based solely on economic disadvantage. We anticipate both of those bills having a positive effect on the disparities that we are so concerned about achieving. Equity is going to require community-based, culturally responsive services and programs to prevent entries into foster care and, when necessary, to reunite children quickly and safely with their families.

In terms of some of the measures that we already keep track of and that we do track by race and ethnicity already, I want to highlight that we are aware of the disproportionalities at all entry points into the system, allegations, removals, reunification and that we can stratify those by race and ethnicity. Similarly, we have a variety of safety, permanency, and well-being measures.

So an example of the safety measure would be the recurrence of maltreatment or an example of a permanency measure is first, placements with kin or time to reunification. We stratify all of that data currently by race and ethnicity as well, and in our work with the capacity center and in our work on the equity action plan process that we are beginning, we expect to set more specific targets in partnership with community in the path between here and that ultimate elimination that we are aiming for. As I think you put it on the last panel, we don't expect this to happen overnight, but we absolutely have faith that we are moving in the right direction.

Ms. Short with the LAO.

Thank you. Angela Short with the Legislative Analyst Office. Today we were asked to first provide any feedback or other considerations regarding the FFPSA report, and then also to provide an update on our forthcoming publication related to child welfare disproportionalities. So I'll begin with our comments on the FFPSA report. So today I'm happy to share some of our initial higher level takeaways from this report that the department just provided an overview of.

I would just note that given the report was quite recently released, this just represents our best understanding to date, and we will certainly work with the department going forward on any questions that may arise. So, to begin with part one, as was clear from the overview, we are still in the very early implementation stages for our state's prevention services program.

For example, as you heard, county's comprehensive prevention plans, or CPPS, which will detail the specific services and interventions that counties plan to implement, will be due this coming July. So at this time, we don't yet know any specifics as to the contents of those plans. That said, we appreciated that the report did include a meaningful progress update as to where counties are in their planning process.

For example, the report noted that of the 50 counties that intend to opt in, excuse me, 24 are working on plans to address disproportionalities, 27 reported that they have sought community feedback as they're developing their plans, 14 reported being in the process of developing specific goals, strategies, and work plans for their plans. So we just appreciated that level of detail that was included. In addition, we appreciated that the report shared key challenges that counties have been facing.

For example, as you also heard in the overview, some counties have raised concerns about their ability to provide certain services given the limitations of providers or community-based organizations in their areas, and we find that this type of update helps just provide more tangible context around how process is progressing and will be helpful for the Legislature to better understand where challenges remain.

So, moving on to part four, overall, we found that the report demonstrated most of the newly required elements around ensuring the necessity and appropriateness of congregate care are in place and are being fully implemented. One note we would highlight, as you also heard from the department, would be high fidelity wraparound, which is the state's chosen model for meeting the federal aftercare requirements to provide six months of family-based aftercare when a youth is discharged from an STRTP.

For high-fidelity wraparound, as you heard, our state is taking a more phased-in approach to implementing this, so we anticipate that DSS and DHCS will be providing detailed guidance around high-fidelity wrap in the coming month or two, and then statute dictates that implementation of this model would be in place 12 months thereafter. So we do anticipate that counties will be implementing this model within the next year or so, and in the meantime, counties have been relying on their existing wraparound programs.

However, our understanding is the standards for these programs may vary by county, so it's unclear to us the extent to which the current models are really meeting the requirements at this time. In addition, although most elements under FFPSA part four are in place and are being implemented, as you know, implementation is an ongoing process the administration is continuing to monitor. We also will be continuing to monitor to be able to highlight any new implementation challenges that may arise.

One example of a challenge we also just wanted to raise today that became apparent throughout the report was that counties really continue to face challenges around complex care and systems of care. Specifically, the report highlighted some difficulties that placing agencies may be having around being able to find suitable congregate placements and necessary services, particularly for our youth with more complex care needs.

And the report also noted that youth in congregate settings are more likely to experience frequent placement changes, which is not ideal for the youth's ultimate goals. Of course, these challenges extend beyond FFPSA, but we just wanted to underscore that those were clear throughout the report, and we think this highlights the need for the state to continue focusing on finding solutions in these areas. And then one final point for part four. In general, we would note that quantitative data is limited at this point.

For example, regarding qualified individual assessments, there's no statewide aggregated data. Currently, that data is just local within the counties, although the report does note that DSS, in consultation with DHCS, is working to develop data collection and assessment processes moving forward. Similarly, for new court reporting requirements, the data is reported on local county forms, but our current child welfare system doesn't have the capacity to aggregate that data at a statewide level, so we aren't really able to speak quantitatively to statewide trends at this point.

So those are the comments on the FFPSA report. I can now provide an update on our office's forthcoming publication on child welfare disproportionalities, as has been shared with this committee. Of course this is related to or this report will be a product of longer-term research our office has been undertaking the past couple of years. We most recently provided an update on the focal areas of our research and key questions we are exploring through this research at our March 22 hearing.

Today, we're unable to provide a specific publication target, really, given our priority budget analysis work, particularly in light of the approaching May revision and budget finalization process. However, we have been continuing to make progress on this research and we intend to be able to return our focus once our budget work has subsided. And of course, we will be sure to keep the committee updated once we can provide a clear publication date. Thank you.

Department of Finance.

Justin Freitas, Department of Finance. No comment at this time. Happy to answer any questions.

I'll bring it up to the dais. First, Ms. Troia, I appreciate that you said the goal was to eliminate all disparities, as I believe it's important to have a North Star. And while I know we can't get there overnight, it is important for us to have a target and timeline, and hoping you can comment a little bit. I understand we're on the right path, but how will we measure it? When do we expect to start to see improvements working towards that North Star?

Thank you for the question. Share your sense of urgency. For sure. We in the child welfare system actually have quite a bit of data that we track, and we do already stratify most of that data by race and ethnicity, and we do publish it online. So it is one of the areas where I think transparency is a little bit greater than it is in some of other state programs.

So that is a blessing for us in the sense that we have the opportunity to use those outcomes to set goals along the way. That said, I think it's important to acknowledge that we intend to engage not just with our federal partners who are currently providing us technical assistance, but also with the community with respect to how we set some of those goals.

So as we embark on the equity action planning that we're doing within the department, we're going to be doing some initial work ourselves and then also bringing that into the community for engagement and using that as a way to set some of those benchmarks, milestones, goals along the way for that path.

I know they're not present here, and it may be a question we ask offline, but you had stated that it was both Child Welfare Services and probation that was interacting with the county partners. Are there disproportionalities that are within the probation system? Are they aligning with what we find within the child welfare system so that as we're focusing on prevention, we're working towards those same goals? Hoping you can provide some comments on that.

Yeah. With respect to probation for us, what I'm generally referring to is the probation-supervised Child Welfare Services. So these are children and youth who are in foster care, but they have a probation officer rather than a social worker coming from the child welfare agencies. There may also be, and I think there indeed are disparities within the larger juvenile justice system, but I wasn't referencing those with that.

We will thank all of our panelists here today and hold all issues open. We will now move on to issue eight. Issue eight is regarding human services issues only for CalHHS and April budget change proposal for the Office of Systems Integration. Let us begin with Ms. Wertin when you are ready.

Good afternoon. Thank you, Mr. Chair, and to thesSubcommittee for hearing us today. My name is Deanne Wertin, and I'm with the Office of Systems Integration. There I serve both as a chief deputy director and I'm also the deputy agency information officer. So I'm very happy to be here today to talk to you about the issues that you have asked. We have three that we're going to speak to. The first is really a technical program issue, and I'm going to defer to my partner from Department of Finance to address that, and then we'll return to the other two.

Nina Hoang, Department of Finance. The first item is the employee compensation technical program adjustment. And this is just shifting 71,000 from the Center of Data Insights and Innovations program to the Office of Patient Advocate. And this is really just a correction of a coding error.

All right, thank you very much. The second is, I'd like to provide a brief overview of the April BCP request that we provided. OSI is requesting three positions and $600,000 in expenditure authority to further extend and mature the new service offerings that we started providing last year. Thankfully, to the general funds that we received for positions at that time. The three positions that we're requesting, two are really very directly related to that. One is a technical manager to lead the consulting and the COE efforts.

Last year, we received some staff level resources who have done a tremendous job and shown great value for our departments. But we've been providing that largely in an ad hoc way. And if we're going to mature and grow it, it's necessary to have some leadership.

The second position is not related directly to the Center for Excellence or the consulting, but through the work that our enterprise architecture resources have done also provided through general funds last year and through conversations with our departments, we've identified a need and an interest in shareable services, shared services and other means to accelerate their work to reduce the resources needed to provide common skills and common capabilities across our departments.

So things like this would be business process automation tools, or more strategically and more interestingly, some of the strategic capabilities that we've identified as necessary across the majority of our departments, eligibility, enrollment, case management, licensing, those types of things. So we have no positions related to that today. This would be a leader to come in and help us establish that program.

We have done a little bit of work in that area, but that's been through pieces, parts of resources and passion, and we see more demand and more opportunity there. The third position is a communications strategist. This is not directly related. It's a position that we identified as wholly necessary when we combined OSI and OAIO last year and really saw the large volume of communications that currently are being put together by, frankly, folks that are better project managers than communications folks.

And we're very interested in having a common voice, a common perspective, and having a resource that can help us respond to the many, many documents that we need to prepare, APDs, SPRs, just inquiries, and those things. So that's the third position that we're looking at, an SSM two-level. The question was, how many resources do we have related to these efforts today? As I mentioned, no positions are currently related to the technology manager that I mentioned, nor the communications strategist.

We do have five resources, again funded through last year's work, that have been delivering services and creating tools and templates and providing support to our departments over the past year that are part of this effort.

LAO.

Brian Metzger, LAO. We have no major concerns with OSI's April 1 budget change proposals or spring finance letters at this time. This item does include the short-term general fund loan authority for cash flow language, and we would just note that the $200 million maximum general fund loan threshold represents about one-third of OSI's currently projected budget authority. So it's a pretty substantial amount as a mechanism to address cash flow issues that are associated with delays in department reimbursements.

However, a general fund loan with a relatively short repayment timeline seems reasonable to avoid the need for significant general fund loans that might approach that 200 $1.0 million maximum. However, the Legislature might ask OSI to explain how it plans to improve forecasting of department reimbursements to avoid the need for those more significant general fund loans and consistent with the staff recommendation, that response could be provided in writing.

Department of Finance.

Department of Finance, Nina Hoang, nothing further to add.

I'll bring it up to the dais to see if there are any member questions. I'll keep it here at the chair. I'm hoping the department can explain the need for the $200 million authority. I didn't hear it in your first testimony. Can you explain why you arrived at this amount and how we can improve forecasting as was suggested by the LAO?

Yes, absolutely. And thank you, Brian, for your comments. The loan authority is related to the reimbursements that we receive for all of the work that we do, and the departments that we service receive their funds in a variety of ways, federal funds being a significant portion.

At times there can be many different things that can occur, federal reimbursements, priorities, just a variety of things that can happen and that can leave us short with regards to paying our vendors and the Prompt Payment Act and that other items. So we are in the process of putting in an enterprise resource planning system to help us improve our forecasting capabilities.

That's scheduled to go live in the spring, but there will always be some ebb and flow from a cash flow perspective on that, the 200 million at a third of our cost seemed representative of history in terms of the margins that we are operating on. So that was the way that we came up with that number. It.

Brian Metzger, LAO. We do have precedent for using the General Fund for cash flow loans in case of, for example, I'm thinking of the financial information system for California fiscal, where you may have departments that need short term cash flow loans because their revolving accounts are not very large. They may need to have additional time to know payments for fees or for fines or things to actually finance their operations. So this isn't an unusual practice.

But in terms of the amount itself, and just trying to make sure that we are being prudent about forecasting the receipt of those kind of revenues and making sure we don't have significant loans that are being made, I think it would just be helpful to have information about that forecasting.

We'll be happy to provide that in writing.

Thank you. And can you explain the oversight that would be retained in your proposal for the Joint Legislative Budget Committee, and does it deviate from the notification and timing which we normally provide to the JLBC for the review of administrative actions? I'm just trying to make sure that we have parity.

Yeah, I'd like to get your written response on that as well, because it's not an area that I'm as familiar with.

Thank you. And seeing no further questions from the panel, I will thank this panel and move on to issue nine.

Thank you.

Issue nine is regarding the CDEA April 1 finance letter and the April BCP. Let us begin with Mr. Beckley when you are ready.

Good afternoon. Mark Beckley, California Department of Aging we have three BCPS that I will be presenting today and two language items. The first BCP is for CalFresh Healthy living program expansion. The California Department of Aging requests an increase of 3.2 million in reimbursement authority to support five permanent positions, as well as provide additional funding to our local service providers to operate CalFresh healthy living programs in their area.

This funding comes to us from the Department of Social Services via additional federal grant funding that they've received to operate SNAP programs. This funding increase will allow CDA to expand our services to five additional planning service areas in the state, representing eight counties. CDA provides this funding to our local area agencies on aging who operate Cal Fresh healthy living programs.

The funding will be used to increase client counts and services in their area, as well as targeted outreach to diverse and underserved populations in the state, including communities of color, immigrant communities, LGBTQ, tribal organizations, and veterans communities. We're also requesting the positions to provide additional training and technical support to the AAA's to support their programs.

LAO.

Thank you, Mr. Chair, Ginni Bella with the Legislative Analyst Office. We have no concerns to raise with that issue at this time.

Department of Finance.

Hersch Gupta, the Department of Finance. Nothing further to add at this time.

Mr. Beckley, I believe there are two more proposals for you still to cover. Sorry, let's cover them all.

Okay, I'll just go roll through them. Okay, great. The second BCP is a statewide no wrong door feasibility assessment. So this request is for federal expenditure authority of 411,000 to enable CDA to receive federal grant funding to establish a statewide no wrong door system statewide leadership council. The no wrong door system, I'll note, is a critical component of the state's master plan for aging.

During the development of the master plan for Aging, a key concern that was consistently raised by stakeholders and by our partners throughout the process was that finding and accessing services and supports for older adults, persons with disabilities and their caregivers is a very confusing and frustrating process. It often requires an individual to navigate duplicative and complex intake assessment eligibility processes and navigate a maze of different agencies, organizations and eligibility requirements, often during times of crisis.

Through this no wrong door system, what we hope to establish is a single access point for all individuals throughout the state to receive information referrals for services and supports in their area. During the grant timeframe CDA will be researching best and promising practices used in other states for their no wrong door systems, identifying and meeting with key state and local partners that should participate in a no wrong door system.

These partners, you know specifically are those that provide services to older adults, individuals with disabilities, as well as their caregivers, and collaborating with these partners on practices and processes for a seamless system of referrals. The project has two key objectives. The first is to develop a structure for collaboration and oversight for the no wrongdoor system statewide leadership council and to build connections and pathways that support older adults, persons with disabilities, and their caregivers, to successfully and seamlessly access support and services in their area.

The grant work will conclude in October of 2025. The next proposal is an efficiency proposal. CDA requests budget bill language to streamline the distribution of funding and alleviate cash flow issues for local area agencies on aging. Currently, CDA enters into separate contracts with each of the 33 AAAs in order to provide them with funding as well as the terms and conditions that accompany the funding sources.

This is a very labor intensive process that requires CDA contract and fiscal staff to develop annual contracts for each of the 33 AAAs and for the AAAs to send the contracts to their local boards of supervisors, JPAs, and nonprofit boards for approval. The entire process can take three to four months to complete, and funding sometimes does not reach the AAAs until September or October, after their contracts have been approved and executed by their local boards.

What we've found is that the terms and conditions of the base program funding typically doesn't change from year to year. So what we propose is to put the terms and conditions into a separate MOU that would only need to be amended and approved locally.

If there are changes to the federally driven program requirements. This proposal would allow us to directly allocate the funding to the AAAs at the start of the year in July, and then it would enable the AAAs to get the funding faster, enter into a contract sooner with their local providers, and avoid any disruption to program services. Other programs, such as channel support, use this model.

The second part of this proposal would enable CDA to increase the amount of funding advances to the AAAs from one sixth to one fourth. On a standard basis, CDA advances the AAAs one twelfth of their allocations on a monthly basis. However, some of our smaller A's, especially in rural areas, have requested larger advance amounts to accommodate large equipment purchases. For instance, in the department's current nutrition infrastructure program, the AAAs are purchasing large meal vehicles and refrigeration units that usually require large outlays of capital funds.

The current allocation levels simply aren't sufficient for our smaller AAAs to make these purchases, and they don't have the cash to float these purchases until they receive additional reimbursement from the state. So this proposal would address their cash flow needs. And then the final language item is a technical adjustment. We're requesting some year changes to allow our statewide ombudsman program to receive up to $1 million from the state health facility citation penalties account.

As soon as that fund balance exceeds $6 million a year, they're eligible to receive this funding and they use this funding to help operate their program, which is to identify incidents of abuse and neglect in long term care facilities and to address an advocate for the needs of the residents. And that's my presentation.

I will bring it up to the dais to see if there are any members'questions. I will keep it here at the chair. I'd like to get an understanding with the administrative efficiencies for the AAAs. Are the AAAs supportive of this proposal since they weren't invited to be here today?

Yes, very supportive. Yes. We heard from C4A's as well as a number of individual AAA directors that they are very happy and embrace this change, as it will allow them to get the funds to them sooner.

Lao any comments?

Thank you, Mr. Chair. Ginni Bella with the LAO no concerns with these proposals to raise for the Subcommitee.

With that, I will thank very much this panel and we will move on to issue 10. Issue 10 is regarding the DDS April 1 finance letter and April BCP. Let us begin with Ms. Castaneda when you are ready.

Thank you, Mr. Chair. Carla Castaneda, Department of Developmental Services. DDS has four spring finance letters before the Committee. We'll go in order that they are in the agenda. The first request is a position authority only request, in the 2001 Budget Act, DDS received a number of augmentations for new initiatives and 44 positions of the 71 requested would be supporting that. An additional 27 positions have been reconciled as we have redirected to address new workload. Those are the positions that have been in our blanket.

The second request we have is compliance with the federal home and community based services requirements. Three of the positions in the request are limited term today and would expire at the end of the year. They've been providing technical assistance as we get towards the compliance and we see that workload ongoing. Additionally, given the ongoing workload, there's an additional six positions to also be providing that ongoing training for Regional Centers and monitoring. Given the additional settings that fall into the compliance.

The request also includes 50 positions for Regional Centers and that would just be to address the expanded settings that are subject to compliance and happy to address any questions on that one. Our third request is for information security office support. In Governor's Budget, we had a request to address some of the needs of the Department. This would build on that request and also help with Regional Centers and some of their assessments in improving security of their systems.

And then our last request is one position for an associate construction analyst, and this would be supporting the workload of Porterville Developmental center. Currently we have a retired annuitant who's been working part time, but over the years the deferred maintenance and capital outlay continues to increase. So this workload would be addressed by that individual. Happy to answer questions.

LAO.

Ryan Anderson, Legislative Analyst Office. No comments or concerns to share at this time.

Department of Finance.

Chris Odneal, Department of Finance. Nothing further to add Mr. Chair.

Bring it up to the Dias. Seeing no Members questions, we will thank very much this panel and move on to issue 11. We will hold all issues open on this item and move on to issue 11. Issue 11 is regarding the DOR April 1 finance letter and April BCP. Let us begin with Mr. Duron when you are ready.

Good afternoon, Mr. Chair and Members. Thank you so much for your time. Victor Duron with the Department of Rehabilitation. The Department is requesting $11.2 million in additional reimbursement authority over the next four fiscal years. So approximately $2.8 million per fiscal year through 2026-2027 in support of a federal grant that we prevailed in acquiring the California sub minimum wage to competitive integrated employment project, which will abbreviate as CSP. This federal grant is 100% federally funded, no state match required through the Federal Rehabilitation Services Administration Disability Innovation Fund.

And the purpose of this grant is to launch and study a number of comprehensive interventions in support of people with the most significant disabilities who may be in or are contemplating sub minimum wage settings, and support them in economic self sufficiency and acquiring employment in integrated settings at competitive wages. Happy to take any questions.

LAO.

Ryan Anderson, Legislative Analyst Office. No comments or concerns.

Department of Finance.

Omar Sanchez with the Department of Finance. Nothing further to add.

Bring it up to the dais. Seeing no Members questions, we will hold all issues here open and move on to issue 12. Thank you to the panelists. Issue 12 is regarding the CDSS April 1 finance letter and April BCP. Let us begin with Yang Lee when you are ready.

Thank you, Mr. Chair. Yang Lee with Department of Social Services. So front of you, we have four budget proposals that are part of the April 1 finance letter. The first one has to do with just a fund shift between fiscal years, and the last three are related to IT projects that we're currently working on, developing, or close to finished developing. So let me start with the first one, it's fairly simple. We're asking to shift $500,000 in state operations funding from this fiscal year to the next fiscal year. This has to do with our promised neighborhood program that was included in the budget and the 22 Budget Act.

We are working on contracts at the moment and trying to finalize it. So we need a little bit of time, which is why we're asking for this shift in funding so we can spend it next year. The second issue pertains to the Cal systems. We're asking for a little bit over $900,000 in General Fund and to support two printed position and to convert three limited term positions to continue to implement and support the CalSAWS systems.

Like I said, CalSAWS folks are very aware of the system, so I'm not going to go into much detail into it. The third proposal pertains to the facility management systems. We're asking for one permanent IT manager position and to reappropriate $22 million from the 20 Budget act and the 22 budget act for the next two fiscal years so that we continue to support develop the facility management system. Right now, things are moving along.

We're in stage three of the ballot process and we're hoping to start the procurement in middle of 2023 for this project. The last proposal pertains to the statewide verification hub. In this proposal, we're asking for one time $2 million over two fiscal years for vendor contract services to support the continued planning, designing, and implementation of the state verification. And we're also asking for $12,000 ongoing to reclassify position. Happy to answer any questions.

LAO.

Brian Metzger, LAO. We have no major concerns with any of these proposals and finance letters just on the statewide verification hub. In reviewing the proposal, noted the additional that more one time General Fund is being requested in this proposal as a share of total funding than was requested in 21-22 when planning resources were last requested.

We would just suggest that maybe the Legislature could ask DSS to confirm the accuracy of the General Fund and federal Fund amounts to make sure we're getting the right information and provide that to the Subcommitee in writing.

Department of Finance Gabby Santoro, Department of Finance no further comments, but happy to answer any questions.

Bring it up to the dais. Want to give the Department an opportunity to respond to that?

Yeah, definitely. We'll take a look at that and get back to you.

Thank you. With that, we will hold all issues open, and this ends the discussion portion of our agenda for the afternoon. We will now move on to public comment portion of the hearing. I'll begin by thanking very much all of our panelists here today.

We have a number of people who would like to provide public comment, so I want to urge you, if you can, to try and keep your comments brief. We will start with in person public comment in the hearing room. If you can come forward to the microphone and make your comment, please begin.

Chair and Members, Kathy Mossberg, representing the Area Agencies on Aging, appreciate you asking the question. We do support both of those efficiencies that have been put forward by the Department and really appreciate them doing so. Thanks for your time today.

Thank you.

Good afternoon. Mr. Chairman and Members, Carl London here representing the alliance supporting people with IDD. I want to express grave concerns about the discussion item that you had relative to sub minimum wage and the deletion of the sub minimum wage program in California. I think that what came out from the LAO's comments are comments that we all ought to heed, that is that we are not doing a good job of tracking data and what is happening for employment in the state for people with IDD.

10 years ago, we adopted an employment first legislative strategy for the state in California, and yet you're not getting, I don't believe, the information you need to be able to make good judgment calls about which way we should go unemployment in this state.

The people that are going to be affected by the implementation of SB 639 and move from their sub minimum wage positions, there is no good answer today on the table for what's going to happen to them and how they're going to be moved to new employment opportunities. Most will probably go to day programs, which, by the way, are more expensive for the purposes of budgeting.

So I want to borrow a phrase from Ms. Rubio at the hearing we had on this previously, and that is hope is not a strategy. I would seriously urge you to consider looking at moving that implementation date of that legislation, which you could do through a trailer Bill by at least a year until you get brought back to this Committee Subcommitee. Better ideas, firm ideas about how we're going to move people forward.

The State Council, for example, today said very directly to you that we'd like to run a pilot that suggests to me that we do not have a firm grip on what we're going to be doing to move people out of current situations where today they are employed and they are employed at a place of choice by the IPP that they have signed or their families have signed that are sitting in a Regional Center file in 21 different Regional Centers in the state.

They have elected that choice today. We're going to take it away from them. We decided to do that legislatively, but nobody here is giving you a great answer for what that next phase is going to look like. So we literally are going to not have employment first for that group of people any longer.

And there's no great policy that's on the table today other than you should hire four more people and put them in a Department that already can't tell you what's going on in employment very well today. I would urge you to seriously consider holding the implementation of that off by a year. You could move that date by one year.

You don't get rid of it, but make people come back to you with real ideas about what they're going to do with a population that is being displaced from the IPP choice they made that's sitting in their Regional Center file. I'd love to talk to you further about this. We have a number of providers who do this. The other misunderstanding, I'd just like to point out to you to consider. People continually refer to sub minimum wage as a workshop model. It is absolutely untrue.

14 C is used throughout the State of California as part of a spectrum. Some people, yes, work in a workshop style model, but 14 C is also used to put groups of employment opportunities out there for people, any group setting. And then it's also moved for individuals.

For example, if a person goes to a job that would normally pay $16 an hour as a prevailing wage, and they are measured under 14C, the sub minimum wage provisions of the federal law, and it shows that they can only do about half the job roughly, they would be paid $8 an hour to work in an integrated setting in the community if they move forward and get better at the job. Most people with IDD do just like everyone else.

If they move to 60%, their wage goes up. If the wage for that job goes up, it must go up. They're forced to be remeasured every six months under federal law. A lot of that is being lost in what's being translated to you every single day. And we are going to displace 3000 to 6000 people. I'm not sure it's really, we have a clear number on that. They're going to be moved out of jobs into nothing unless we get a firm, committed policy.

So I want you to really take seriously that you may not. And what the Leo said is you may not be getting the best data to make an informed decision. The other last point I'll make, you have on the books tens of millions of dollars that you were asked for under the paid internship program and under competitive integrated employment. Those are both woefully undersubscribed right now. Why is that?

In a state where the number one thing that we're supposed to be doing is offering employment to people with IDD, how can that be? So? You have an example here very clearly of a Department that's not doing a terrific job of this today, or at least we're not doing it well in every single community around the state. And the question ought to be how are we going to get a commitment that this will be better and actually see that before we commit to displacing more people. Thank you very much for your time.

Thank you.

Good afternoon. Linda Wei with the Western Center on Law and Poverty. Firstly, regarding CalSAWS real, not perceived, lack of meaningful stakeholder engagement, we align our comments with Ms. Tracy. We also continue to urge CalSAWS to allow people to sign up for benefits Cal without an email as is done in CalHERS.

This will increase usage by people who need it and is especially timely considering the public health emergency unwinding appreciate the project for prioritizing language access by committing to add the last six threshold language by September of this year, which will help thousands of people renew their Medical in their own language.

And finally, we appreciate CDSS's engagement with stakeholders on the workforce participation rate in CalOR workgroup and look forward to providing more detailed comments following the report release noting our recommendations are outlined in the chair's AB 310 and appreciate the chair's leadership. Thank you.

Thank you.

Good afternoon. Amy Westling from the Association of Regional Center agencies working with and supporting all 21 of the state's Regional Centers. ARCA is working with Regional Centers to increase consistency in client experiences in intake and vendorization, and we look forward to continuing this work, which is consistent with the conversation this afternoon.

We support and appreciate the Little Hoover Commission's recommendation to improve the process for exhausting generic resources, and we look forward to exploring various ways that this can be accomplished for the benefit of all of those that we serve. We agree that a key question is how is equity defined? And believe that the DDS statewide measures that include purchase of service and other items that have already a history of being reported upon serve as a good jumping off point for this conversation.

And we agree that the service access and equity grant work can highlight promising practices. Additionally, we would like to see those promising practices become more broadly available in all communities in California. We appreciate and support the administration's exploration of translation of the Lanerman Act as equal access to information enhances equal access to services.

We support the comments of several speakers noting the need to continue short and long term data system reform and appreciate the administration's proposals in this area, as well as the Legislature's ongoing support of funding for this project. We appreciate the administration's commitment to real world HCBS compliance and the proposal for the resources to support the workload associated with that. And finally, note that all of this work requires sustainable funding models for critical service coordination and vendor services, and appreciate this Committee's time. Thank you.

Thank you.

Hello Chair and Members, Yesenia Jimenez with GRACE End Child Poverty in California to speak on issues five and issue 12. First, again, want to thank you Chair and Members, for leading the incredible effort on reimagining the CalWORKS program and opening up conversations regarding the WPR. We thank the Department for meeting with advocates on addressing this issue with stakeholders, and we look forward to the report back as well.

As shared by Director Johnson, our CalWORKS Coalition shared continued support to repeal the WPR penalty passed through as a part of a comprehensive, family centered approach. So just want to thank the Director for addressing that. We do want to uplift a recent report by the California Budget and Policy Center identifying that about 60,000 children already living in poverty are pushed further into poverty as a result of CalWORKS sanctions. And so again, further emphasizing why we need a comprehensive, family centered approach. On issue 11.

We appreciate the department's swift and effective implementation of the promised neighborhood grant programs and support the department's request. And we further ask the Budget Committee to prioritize the current it takes a village proposal to establish the permanent grant program that would build on the department's effective implementation already underway. So thank you for your time.

Happy to. We will now go to the phone line for public comment. As a reminder, the phone number to connect is on the Committee website and should be on the screen if you are watching over the Internet. The number is 877-692-8957 and the access code is 131-5444 operator, we are ready to begin public comment.

[Spanish] 159, your line is open. Please go ahead.

Thank you, Mr. Chair. And ladies and gentlemen, if you wish to comment on this, please press one, then zero. At this time we'll start with line 151. Please go ahead. 151, your line is open. Please go ahead. Okay, we'll try. Line 159, please go ahead.

[Spanish]

Line 163, please go ahead.

[Spanish] Next caller, please.

Hello, my name is Mary Buenas. I support the Little Hoover Commission report. Thank you very much.

Thank you. Next caller, please.

Line 165, please go ahead.

Hello, my name is Fidel Ayala and I strongly support Little Hoover's Commission report.

Thank you. Next caller please.

Line 146, please go ahead.

[Spanish]

[Spanish] Next caller, please.

Line 175, please go ahead.

[Spanish]

[Spanish] Next caller, please.

Line 177, please go ahead.

[Spanish] Hi, my name is Grisell Estrada, mother of Juan Perez, who is a consumer of the Ballet Mountain Regional Center, and we support the report of the Little Hoover Commission. Thank you.

Thank you. Next caller, please.

Line 166, please go ahead.

Yes, good afternoon. Fernando Gomez. I'm the parent of a young man served by the Regional Center system and the co founder of the Integrated Community Collaborative.

Mr. Chair and Committee Members representing communities served by the Regional Center system. We are grateful for the very important issues that are being discussed today. On issue three, the Little Hoover Commission. We thank you for a timely, insightful, and important study. You managed to capture the very essence of key issues representing our community, and we are also grateful for your support of AB 1147. Issue 4, we thank Director Bartman for continuing to listen to our community with her announcement of translating the Lanterman act into Spanish.

It's something that the community has been asking for, and we thank you for moving forward with that. Dr. Good, with Georgetown, as a parent and self advocate led CBO ICC is asking that as you finalize your report, that the evidence based perspectives start with a person centered approach, followed by the perspective of the community, and then backs into compliance by the Regional Center system. Today, that evidence based services represents to our community barriers and challenges in obtaining ethical services.

[Spanish] Next caller please.

Line 145. Please go ahead.

Hi, my name is Sue Gavin, and I'm the parent of an adult served at Regional Center fully in support of Little Hoover Commission's report. And I do believe that DDS needs to have better oversight of the Regional Center system to correct all the racial, ethnic, and geographic disparities so that all can access services needed, regardless of which Regional Center provides those services. Thank you.

And on issue five, we agree with Director Carruthers on a person centered approach as well for CIE. Thank you very much.

Thank you. Next caller, please.

Line 157, please go ahead.

[Spanish]

Thank you. Next caller, please.

Line 156, please go ahead.

Hello. My name is Dora Contreras, and I have a grandson, 30 years old. As a client of the Valley Mountain Regional Center, I'd like to thank the Little Hoover Commission for their very thorough report. Especially for listening to our lived experience navigating a very complex system. We welcome reform of the Regional Center system. It's antiquated, just as the IT system is antiquated at DDS. Policies need to be standardized. Core services should be provided. Regional Centers should help access generic services equitably.

And I can give a very good example right now in helping families get a medical waiver. Another name for that is institutional deeming. The system is not standardized at all of the Regional Centers. At some centers, some families get a lot of help filling out a 12 page documents that need to be sent into several agencies, especially our Spanish speakers and our Latino families do not have that experience of having to fill out forms that ask for a lot of information.

That is just one of many inequitable services that are provided at the Regional Center. They need to be standardized. People should be able to get help everywhere they go because they have a child that is a client of a Regional Center, and geographically and racially, all people should be treated equally. Thank you.

Thank you. Next caller, please.

Line 183, please go ahead.

Hello, Mr. Chair and Members of the Committee. Robert Harris, on behalf of FCIU California. First of all, I'd like to associate myself with most of the comments by Amy Westling, who is with ARCA. Importantly, I think in the Little Hoover Commission pointed out the flaws in trying to get people with no experience to navigate the generic services.

It's a mind boggling backbreaker for people, and then it's a waste of time while they apply and then have to appeal for hearings. We'd also like to say that we're really happy to hear the Department of Finance is providing technical assistance to the Regional Center's request for adequate funding for case managers. They're the intake system for the whole thing. And when you have 100 people and you have deadly timelines to meet or reporting, then you can't do your job, which is what they like to do.

They like to help people get services, but when it's all about reporting and timeline, they can't, especially with caseloads of way over 100. We're also happy with the Georgetown report that they're suggesting to look at the macro issue of inequality and inequity instead of the micro issues that they were only hired to look at. The fact that they looked at the need for more case managers. The other thing they talked about was generic services that we think is really important. The other thing is the Department sometimes hires interpreters who, according to our bilingual interpreters, don't understand two things.

They can speak Spanish, but they can't actually speak DDS, right? So you've got to be able to do both. But we ought to look at that, we think, as a long term thing that needs fixed. Thank you very much.

Thank you. Next caller, please.

Line 149, please go ahead.

Hi, my name is Anna Vatrez. My son is served by South Central Regional Center, and we strong support the Little Hoover Commission report.

Thank you. Next caller, please.

Line 185, please go ahead.

Okay. [Spanish]

[Spanish] Next caller, please.

Line 158, please go ahead. 158, your line is open. Please go ahead.

Yes. Can you hear me? Hello, my name is Ruby Saldana. I'm a mother of three child with disabilities severed by South Central Regional Center, and I'm here to support Little Hoover Commission report. I really think that Regional Center must be accountable and have transparency. Thank you.

Next caller please.

Line 151 please go ahead. Line 155 your line is open, please go ahead. Okay let's try line 150. 155 are you there? Okay 150, one five zero, please go ahead.

Hello, my name is Ruby Saldana. i am a mother of three child with disabilities served by South Central Regional Center and I am here to support Little Hoover Commission Report. I really think that regional center should be held accountable and have transparency. Thank you.

Thank you. Next caller, please.

Line 188, please go ahead.

88 [Spanish]

[Spanish] Next caller, please.

Line 151, please go ahead.

Hello, my name is Henry Topeta. I'm a mother of two clients of the regional sentence, and I'm very supportive of the Little Hoover Commission report, and I'm also very supportive of the SB 1147. Thank you.

Thank you. Next caller, please.

Line 155, please go ahead. 155 your line is open. Okay, we'll go to line 190. Please go ahead.

[Spanish]

[Spanish] Next caller, please.

Line 187, please go ahead.

Hi, good afternoon. My name is Martha Valdez. I have a kid with special needs. He is in Santa Rosa Regional Center. So I'm calling because I really want to give my. I'm sorry. I just want to say that I be with Commission Little Hoover. So they are providing information for all the families and give us all the tools that we need to work in this system. So sometimes we couldn't do it correctly because we don't know how to start and how to follow all the instructions.

So I'll be with them with this Commission, and I said, just please help and provide them all the tools that we need. So thank you very much.

Thank you. Next caller, please.

And, Mr. Chair, we have no one else in queue at this time.

Thank you, operator. I will take that as the conclusion of public comment for the day. I will appreciate all of our panelists, the Administration, the directors who were present and stayed here all the way till the end. Director Bargeman and Director Johnson, the Department of Finance, LAO, the sergeants, techs, and the staff who prepared the agenda.

But most importantly, the public for improving our public process and making this the people's house. With that, we are adjourned for the night. Have a good night.