Assembly Budget Subcommittee No. 2 on Human Services

We will call this hearing to order on the Assembly Budget Subcommittee Two on Human Services. First, let's. Madam Secretary, please take the roll.

[Roll Call]

Today we will be discussing issues and programs related to the Department of Rehabilitation and the Department of Developmental Services. Before we start with our panel, I will just make a few introductory remarks and open it up to my colleagues if they would like to do the same. First, I would like to welcome all of our members, Assemblymember Lee and Assemblymember Waldron, as we have formed this new budget Subcommittee Two on Human Services.

Secondly, I want to frame the work and mission of this committee that serves the communities most in need of investments and support, and most often forgotten and, frankly, neglected. As we find ourselves in the middle of an increasingly challenging budget problem, the overall vision of this subcommittee is to turn our survival programs into thriving programs and ensure that our systems are meeting the current needs of our population. Surviving is not enough.

However, the most important priority of the committee is to ensure that the budget promotes the stability of our population. The committee will also work to ensure that current policies within its purview aren't creating instability amongst our most vulnerable populations. We must learn from the Great Recession and the pandemic in order to avoid those mistakes of the past. This committee will not be able to support proposals that lack sufficient information.

We will not be making cuts blindly, sufficient information about what these proposals do, and a thorough explanation of how those proposals will affect the people that they serve. We have to be clear. It takes more money to bring our population out of crisis than it is to keep them stable. And we as a state cannot afford to have these communities fall into a state of crisis.

The challenges facing Californians in our safety net programs today are real and very tough, and we are here to provide the state leadership to prioritize the most critical issues and chart a path toward progress wherever we can. This is certainly not a season for expansion, but it is an opportunity for reform and to make sure our systems and programs are more efficient. This committee will not dampen its ambitions in terms of these goals. Not all of these goals require more money.

It may require shifts of money or shifts of systems in order for the money that we do have to be more efficiently used. And so I look forward to having the conversations that we've agendized for today regarding the Department of Rehabilitation and the Department of Developmental Services. And with that, I would like to offer an opportunity for my colleague to say a few words if you would like.

Thank you so much, Dr. Jackson. It is my pleasure to serve on budget sub two in our inaugural budget hearing, our first budget hearing. And as the policy chair for human services, I think we share a strong priority to make sure that the supports that we give to our most vulnerable community stay intact as much as possible. Owing to our budget uncertainty.

There are going to be a lot of tough choices out there, but this is a budget area that we must protect as much as possible. And to echo the sentiments of the chair, we have to be more efficient with achieving outcomes and really looking hard at how are we actually delivering for our communities and making sure they're getting the services they need.

So it's going to be very important that we look at how our programs are working and also think critically when proposals of cuts come that actually don't have a lot of merit to why they're being cut, too. So I look forward to many oversight hearings to come and challenging some perspectives. And with that, let's hear from folks.

Thank you, Assemblymember Lee. So now we will start listening to the panel speakers for the issues and the agenda, and then we will take public comment after all of the panels have concluded. Each person providing public comment will have 2 minutes each to make your remarks. There will be no votes taken in today's hearing. I'm going to ask for the first panel to come forward. It looks like they are already in place. And take your seats. Hope you like your seats. They're comfortable, maybe not.

Please introduce yourself before you speak, and let's try to go in the order listed in the agenda. And so, first off, we are talking about the Department of Rehabilitation, department overview, and we will first hand it off to Mr. Xavier.

Good afternoon, Chair and members. Good to be here. Good to see you again. Always welcome the opportunity to be here and to present the work that we do to you and, of course, answer any questions that you have. Joe Xavier, former consumer of the Department of Rehabilitation, a former business owner, and of course, now the director of the Department of Rehabilitation for a number of years. So very proud of the work that we do with the department.

So the agenda does a really good job of outlining our overview and talking about our budget item. So I just want to lift up a couple of the key elements of the work that we do within the Department of Rehabilitation. So, as you may know, our mission is to provide employment services and services to individuals so they can live independently in their community and collectively across all of our programs, we're serving about 130,000 individuals each year.

When we talk about employment services, we serve individuals with all disabilities, individuals with sensory, cognitive, physical and mental health, behavioral health disabilities. So the full spectrum, full range of disabilities. And what's important to keep in mind is we're not just talking about today's individuals that have disabilities. We're talking about the individuals that will acquire disabilities. Child who was born today with a significant disability.

The individual going home tonight who regretfully is in a severe vehicle accident and tomorrow morning is a quadriplegic or a traumatic brain injury survivor, someone injured, in service to community, to state, to country, that acquires their disability. And the individual that because of illness, might lose their eyesight, lose a limb, acquire any other debilitating condition, and frankly, also want to lift up the individuals with the invisible disabilities that are often living in the shadows of isolation.

And while each of these individuals may have a different experience and a different path, they all seek the same thing, which is an opportunity to be employed, to provide for self, to feel like they belong and provide for their families. And I often say this. This means at the Department of Rehabilitation that we work very hard to ensure that no one is left behind, that there is no ejection rejects in the work that we are doing. Employment services is prevention. It's intervention and it's recovery.

It creates that sense of belonging. It gives me, as a person with a disability, the opportunity to provide for my family, feel like I belong, and I am a member of society. The social connectivity, of course, that comes with all of that. We know that employment is an essential pillar in the determinants of health. What are those phases of obtaining and retaining employment? It's from birth. Individuals exposed to the expectation that they will go to work. The only question being where and when.

It's the opportunity for them to develop the skill set that is refined when they get to those transition-age years so they are better prepared for their workplace. But it also means that downstream, after these two segments, there is a hiring manager that provides the opportunity for that individual to be employed and earn that family-sustaining wage. We know that individuals are experienced differently by each individual, even if they have the same disability.

So myself, who is blind, and somebody else, who is blind, we both experience blindness, but we will experience it in different ways and have different needs. And so we individualize to that degree to meet the individual's unique needs. What's important about this is to keep in mind that the path to employment and the duration of that path does vary and ranges because we are working with every individual, as I described.

And just as an example, think of the individual who was working at Intel and loses their job, now they're pursuing another job, versus the individual that I described earlier, who tomorrow morning acquired a traumatic brain injury, and what it may take for that individual to navigate back into the place and space where they're again employed. So today, the unemployment rate of people with disabilities remains stubbornly at some 70%. This means we still have a lot of work to continue to do on all of these fronts.

And all of these services are aimed at getting the job, keeping that job, and advancing in that job. So within employment services, we serve about 100,000 individuals a year. Pre-pandemic, we had about 10,000 individuals that obtained employment. We're delivering services through 14 regions throughout the State of California and some 80 offices. We also provide services to youth starting at the age of 16, and it is really about better preparing them to be ready for the employment opportunity.

That includes job exploration, counseling, work-based learning experiences, postsecondary counseling, workplace readiness training, and self-advocacy training. Competitive, integrated employment is the end goal for every consumer, for every individual with a disability that we serve. So a little bit about our independent living programs, they advance the homestead decision. They provide the opportunity for individuals to live in their community of choice with purpose and dignity.

We deliver those through a range of programs, and the services include ensuring that individuals are kept out of institutions and that individuals who are institutions are transitioned out to be living in the community. So there are 28 independent living centers in California with some 49 different offices that are providing a range of services to support individuals traumatic brain injury program. With the HCBS funding, we have 12 programs that are delivering services across parts of California.

We have older individuals who are blind program, 17 providers that are providing services across the 58 counties in California. We have our community living fund, $10 million that we received that provides for services to help individuals transition out of institutions and to stay out of institutions. We've served over 250 individuals through that program. We're partnering through 30 community-based organizations to deliver those services. So glad to stop there and take questions or jump into our agenda item.

No, you may continue to finish your testimony.

All right, thank you. So the next agenda item is our budget change proposal for the voice options program.

No, actually, I didn't know you were reading that one. Yeah, we're going to hold on that one. And then first we're going to give an opportunity for the Department of Finance and then the LAO to make their presentations. Department of Finance.

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

Okay. LAO.

Good afternoon. Karina Hendren, LAO. We have two takeaways to share for the Department of Rehabilitation. The first takeaway is that the governor's budget does include one budget solution, and that is related to service provider rate reform in DDS. This solution provides about $1.5 million in savings in 2024-25 from the general fund. And the savings occurs because the Department of Rehabilitation contracts with job, rather job coaching service providers whose hourly rates match those set by DDS.

And we will discuss service provider rate reform in much more detail during the DDS portion of the agenda. Our second takeaway is that the administration submitted one BCP that it proposes to Fund from a special fund. We have reviewed the BCP and have no concerns with it.

Thank you very much. Questions from members? Seeing none. Can you tell me, Mr. Xavier, have you seen any demand for your services increasing over time?

We have. In fact, I think in this year, most recent year of data that's available to us, I mentioned we serve 100,000 individuals. We are seeing increases in our applications, we're seeing increases in all of our indicators. So we're up to about 117,000 individuals in the employment services, much more with the pre-employment transition services that I described as student services. I think there collectively you were upwards of 130,000 individuals that were receiving. Of course, the pandemic dampened a lot of the individuals ability to go to work, but it also reduced the flow of individuals we're serving. So we're seeing that all moving in a very positive direction.

And in your biggest program, the vocational rehabilitation, are there any access or equity issues that the department may be working to address?

We're always looking at our access issues, and we're always looking at our equity issues. One of the things that we're focused on right now is the community of the individuals with behavioral health disabilities. We started looking at not only the individuals that are coming to us for services, but how they're exiting in those services.

And so, as an example, when we started taking a hard look at this data, we saw that if you were Black or brown, you were exiting with earnings that were less than if you were caucasian. So we have intentionally set up an initiative that targets increasing wages for all consumers with behavioral health disability, but specifically provides interventions to our Black and brown communities so that they're all exiting with the same earning capacity, regardless of their circumstances. So that's an example of how we continue to look at the equity and inequities in the programming that we do.

And as we are trying to increase the amount of opportunities that members of the IDD community are participating in employment opportunities. When we look at that, the state has its own goals in terms of the percentage, and we seem to not be able to even lead by example. And as the state, when it comes to fulfilling those goals, how can we do a better job in reaching the goals that we've set out, even ourselves?

So I really appreciate that question. This takes me back to the conversation we had at the Select Committee in December. And as I shared then, and we'll share again here, we ourselves at the Department of Rehabilitation, our parity rate for individuals with disability is around 30%. Leadership is around 40%. So we are modeling what we believe every other department will be able to achieve.

To support that, we are providing technical assistance, we provide trainings, we help bring the talent to the hiring manager across all of the workforce systems, specifically in this case, the state as the civil services. We have a number of initiatives that support that. We partner with our colleagues at developmental disability services for a state internship program that specifically targets individuals with IDD so that they can acquire the list eligibility to then be able to apply further permanent positions.

We provide for paid internship programs so individuals can do two things. One, they can go into the workplace, continue to develop their competence, their skill set. Certainly we all do that every single day, so nothing unique there. But it also exposes the hiring manager and the rest of the workforce to the potential, to the talent that individual brings. And we're seeing where that individuals are being hired into those permanent positions.

So, of course, that puts them on that path that I've been describing about the employment and family sustaining wage that everybody is seeking. So that's just a few examples of how we engage in ensuring that we, as the state, continue to lift up and advance employment opportunities.

Thank you very much. Seeing no additional questions or comments. This is an information item, and so no action is necessary. And so I want to thank this panel, and we will move on to the next issue. The next issue is the governor's budget change proposal on voice options program. And with that, Mr. Xavier, you may begin.

Well, thank you. So this budget change proposal is really for the purpose of providing the speech-generating devices that enables access to communication, to communication networks for individuals who otherwise are not able to use their voice. Starting in February 2023, the Public Utilities Commission made this voice options program permanent. We administer this program through an agreement that we have with the Public Utilities Commission. It is $3.6 million that is transferred from PUC to the Department of Rehabilitation to administer this program.

And it's 3.75 positions that we use to administer this across the state. 1260 individuals we anticipate to be served by this program. The number that is set here was determined by year three of the pilot that we were in that allowed this program to become made permanent. So let me tell you a little more specifically how this materializes for the individual. I'm going to share a couple of real-life use cases.

Let me start with Riley, who is a little girl that was autistic, is autistic, but had never spoken, was not able to communicate her wishes, her needs, just like anybody else, would be able to. She was provided with an iPad that had these apps that enabled her to generate the speech, to communicate what she was wanting to convey. As soon as she recognized the capabilities of this iPad, you can imagine the smile that she had on her face.

And I can't help but wonder if going through her mind was finally, I'm able to communicate what I'm feeling, what I want people to understand. That's the power of that device for this little girl. Now, she is able now to communicate with her family, to be able to share what it is that she wants them to understand. And so that communication has been unlocked in her case. Let me talk about Mina. Mina had been able to communicate, but because of.

I'm going to butcher this one, I apologies because it's medical term. The tracheostomy that she received caused her not to be able to communicate. So while she was in treatment, she also was exposed to this iPad with a speech-generating device on it, and what the potential applications were that were available to her. She then began to be able to communicate both in typing and through the other apps functionality that are on there with her medical providers and be able to unlock her communication again.

But it also enabled her to be able to communicate with her family, who spoke Swedish. So this had the ability to not only verbalize what she wanted to be verbalized but also to do so in another language. Right? Now, when I talk about these speech devices, I think the simplistic way, but very powerful way to look at this is for Riley, it enabled communication for the first time, it unlocked communication. For Mina, it restored her ability to communicate.

And we certainly can anticipate that as technology advances, the ability to communicate with these devices and other devices that will come along will continue to advance not only these opportunities but other use cases that, you know, are out there. So these are just a couple of examples of that. So I will pause my comments on what this BCP is here.

Department of Finance.

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

LAO.

Karina Hendren, LAO, reviewed and no concerns.

Thank you. Members, is there any of the general fund involved with this budget change proposal? Department of Finance?

No, this is coming from the, it's coming from the Deaf and Disabled Telecommunication Program fund, so no general fund.

Okay. And would the Department of Rehabilitation expect that the number of people requesting long-term speech-generating device loans would increase over?

We certainly, of course, will certainly want to meet all of the demand and obviously inherent. Your question is what would we do about that? Well, obviously we'd work with our partners at CPUC and then through the Administration and obviously should that need arise to, you know, meet that need.

Okay. Thank you very much. Seeing no other comments from members, we will hold this issue open and we will move to the next issue, which is the Department of Developmental Services department overview. The next panel folks will come on up. I know some of you already have your permanent name tag at your table seat, and again, we will go in the order listed on the agenda, and you may begin when you're ready.

Thank you, Dr. Jackson, and appreciate the time of this committee and the committee members. I'm Nancy Bargmann. I'm the director of the Department of Developmental Services and I'm very pleased to provide you an overview as requested in the agenda today on the Department of Developmental Services. A little bit of background about myself. I've been working in the field of Developmental Services since 1985. It's been an absolute honor and pleasure to be part of an incredible community.

I've learned a lesson every single day of the opportunity that I've had working with our system partners, but more importantly, those that we support and their families. So as the agenda correctly notes, and thank you to staff for providing the detail that's in the agenda, page 14, it provides an overview of Department of Developmental Services. We are responsible for administrating the Lanterman Act early in the 1970s or the late 1960s is really when the Lanterman Act established a statutory requirement for the entitlement of services.

And it's been an incredible landmark and legislation that we've been able to support over the last, over 50 years. This has been an incredible opportunity to provide individuals with intellectual and developmental disabilities lifelong supports through the Regional Center system. There are 21 Regional Centers in the State of California that provide the services. They're nonprofit organizations that the board of directors are mostly individuals that are represented with lived experiences, family members, but also community members. The system has absolutely undergone significant changes over the years.

I'm just going to highlight a few of them because I think they're incredibly important considering the agenda that we have today, but also just really making sure that we understand kind of the impact. Growth, it's been noted in the agenda has been certainly increasing over the years. We're projected, as it's noted in the agenda again, that we're looking at providing services in our next budget year to 458,228 individuals. That is a growth over our current year of approximately 430,000 individuals.

And I'll talk in a little bit about what we're seeing as driving some of that growth. But with some of the changes going back and later in the agenda, you're going to hear from my colleagues talking about the impact of the Great Recession and the things and the cuts that had happened during that time. That was definitely a change in impact to services and how we're delivering services as we kind of advanced out of the Great Recession.

Really important times in our history is the historical announcement of the closure of the developmental centers in 2015. During that time, California really did something that was unprecedented and not something I've seen that's been done in other states. We actually closed three developmental centers at that time.

And so having all services for individuals in the community. This is really important because as we take a look at offering services and really preserving the philosophical importance of supporting individuals where they are and making sure that we're doing it in a way that is very person-centered and family-centered is incredibly important. We've also started moving away from a compliance-based system to an outcome-based system in 2015. We had also some actually going back to 2013.

We started the pilot and statutorily was required to move forward with self-determination program. Being able to provide individuals and families the opportunity to self-direct their lives is really incredibly important. We also do that through participant-directed services, and we've been able to expand that over the years. That's really been something that lifted up as part of the pandemic during the time that we had faced in our system.

It's been an incredible impact, those three years during the pandemic, as we had to really take a look at creative ways to provide services to individuals and families. The community absolutely came together to take a look at what were the flexibilities that needed to happen. And one of those was increasing participant-directed services where individuals could actually make the selection of who's going to provide those supports.

But we also started seeing some flexibilities where we were able to continue and we were allowing for remote services for infant service delivery. We're able to extend remote services for some day services because people got to experience life in a different way. But we also started seeing where we had to kind of come back and take a look at the things that were some of the negative impacts, what are the things that we had to do? Workforce was certainly an impact prior to the pandemic.

We still have seen some impact within a shortage of workforce. Incredible investments over the last several years have been really important. We're currently working on about 60 different initiatives that are really centered about how do we enhance and improve the lives of the individuals that we support. Workforce initiatives include stipends that we were able to implement and have been doing over the last year and a half. We also have a career pathway that we're looking to expand for workforce.

I think these are really important initiatives that we're going to be able to implement, but certainly not addressing all of the issues. I will just share with you that one of the training stipends that we were able to do, and we certainly appreciate the investment that we were able to do with some of the funding that came forward during the difficult time of the pandemic that we've achieved about 40,000 direct service professionals that were able to go through the training and receive an incentive payment.

We're extremely excited about the way that we were able to touch this important workforce. Lastly, I'll just share that we want to make sure that we are continuing to highlight and make sure that the focus is on addressing the inequities in our system. Many of the initiatives that we've had, we've been able to change eligibility and early start. We added a different eligibility for provisional eligibility to make sure we're not leaving individuals behind.

We also implemented implicit bias training for every single regional center service coordinator and staff. But we've also highlighted some things that we wanted to make sure we were doing. And certainly one of the agenda items is talking about the rate study or rate implementation of those rate changes.

That was an important factor that we had implemented through the rate study in 2019 when that was released, and that was to address some of the areas within our system that had not been addressed for many years, to include some geographic differences. So with that, I'll go ahead and touch on the question that was in the agenda regarding what's driving that caseload growth.

We know, and we've seen that continued growth, and certainly everybody is aware of it because each year that I've come back to this committee and to other committees to say we're projecting an average growth, I used to be able to say we're showing an average growth of about 18,000 individuals this year. I'm talking about a growth of approximately 22,000. One of the areas to consider, though, is that while that number is going up, we still are maintaining average year-over-year percentage growth of right around 5%.

In 22-23, we are seeing an increased average going up, but the pandemic had an impact on, as I said, on many things. One of the areas that we had an impact during the pandemic is that we had a slow kind of assessment period for individuals. They were not contacting the regional center. We had talked about many of the actions we wanted to take for early start because we saw a significant decline of those children going to regional centers.

We recognized a lot of people weren't going to their doctors, pediatricians. Recognizing that there were delays, we estimated about 40,000 children were not entering into a regional center system during that time. So the projected average growth that we're seeing year over year, that for 22-23 is elevated. What I will say is that we don't know exactly yet if this is a new trend or is this recovery. I suspect that we have quite a bit of recovery that is driving some of the current increase.

We need to monitor it, and something that I would recommend that we do. And with your indulgence, I'll just highlight some other drivers that we know that we have to continue to monitor, but also know that it impacts our caseload. In the last 10 years, individuals with autism has definitely grown. Those under 21, we know we've grown with individuals with autism by 74%, and we recognize that this continues to grow.

We're seeing about 70% to 80% of the individuals with autism are under the age of 22. We know that that's going to continue to grow. Another area that we know is a driver is our aging population. So when we look at the individuals that are 55 years and older, we have seen a 27% increase over the last 10 years. So as we're certainly seeing the dynamics change within our population, you're going to see the dynamics change then, based on the caseload growth. Happy to answer any questions.

Department of Finance.

Chris Odnea,l Department of Finance, nothing further to add to the presentation.

LAO.

Karina Hendron, LAO. We've been asked by the subcommittee to provide an overview of our analysis, including our findings and issues for legislative consideration. So today we have four key findings to share, and we do want to note that our analysis was released on February 14. It's available on our website. And so anyone who would like to read the full analysis is welcome to do so online.

Our first key finding is that the proposed delay in service provider rate reform would help the state budget problem, but the Legislature may wish to consider alternative approaches. So, just to provide a brief background on rate reform for some context, in 2016, the Legislature initiated the rate study partially because the historic rate structure didn't support an adequate supply of providers, and this resulted in service delays for individuals served.

In 2022, the Legislature accelerated the implementation of rate reform due to stakeholder concerns about a shortage of direct care staff. The tradeoff associated with this proposal is that it would result in continued delays in service provision to individuals served. The Legislature could therefore consider a scaled-back approach that provides targeted funding for the final phase of rate reform in 202425.

But it is important to note that even this type of scaled-back or targeted approach would still require budget solutions in other areas of the budget. Our second key finding is that the administration's proposed master plan for Developmental Services is an opportunity for legislative involvement. The concept of the proposal appears consistent with the administration's stated priorities, but nonetheless, we recommend the Legislature ask the Administration to provide more details about the plan's goals, intended scope, stakeholder engagement process, potential fiscal impacts, and ongoing oversight.

And our third key finding is that legislative oversight is warranted on three issues. The first issue is an evaluation of the Coordinated Family Support Services pilot program. We find that oversight is warranted here due to potential impacts on equitable service provision. The second issue for oversight relates to service provider compliance with compensation increases for direct care staff under rate reform. We find oversight is warranted to ensure that the funds spent to date align with legislative intent. And the third issue for oversight is the department's ongoing efforts to develop and implement quality incentive payments as part of the rate reform implementation. We find that oversight is warranted to ensure that the rollout of the final phase of rate reform aligns with legislative intent.

Thank you very much. Any questions from committee members specifically? Oh, okay. We'll wait till the next panel for that. Then. When we talk about trying to, always trying to look for places where we haven't totally spent out dollars and those type of things, are there any areas of underspending and purchasing of services that will also raise some concerns for the administration?

Thank you for the question, Dr. Jackson. When we take a look at our projections of where we are in our estimate for purchase of service, let me see if I can answer the question by just giving some background on how we're kind of developing our estimate when we're developing the estimate. We're really looking at trends. We're looking at trends within each of the service categories, what the expenditures are, what's driving some of those cost? Is it policy? Was there a change in policy?

Is it driven based on growth in caseload? Is it changing based on the growth in that population? We have many, many different service categories. And so when we're looking at the different service categories, because there is a question in the agenda today about kind of the, kind of the non-expended funds that over the last several years, not only has the pandemic, when we've taken a look at our caseload trends, has really kind of caused a disruption in our ability to do some projections with some of the cost as well.

So while you'll see that in some of the different categories where we've not had the projected expenditures related to what we had projected in our estimate, part of that also has to do with that. We wanted to make sure that as we were unwinding from the pandemic, that we were not unwinding faster than what our community was really ready to do. I'll give you an example. Respite.

When we look at the expenditures for Respite during the pandemic, it increased by a high level of percentage, made sense. Individuals were at home, individuals needed supports. So you really saw this increase. We also had lifted the cap on respite. But outside of that, this was really about providing supports during an incredibly difficult time. Well, at the end of the State of emergency, you don't have, all of a sudden, let's just stop those services.

There has to still be a very thoughtful looking at what are the needs. And so we are seeing a decrease kind of going to, it's going to be a new normal because we're not back to the trends prior to the pandemic. That's okay, because I think things have changed in people's lives. But we are seeing that we're not spending as much as we had estimated because we didn't know what that trend was.

So I just want to be careful in saying that while we may not be spending exactly what is projected in the estimate in one particular area, we are still seeing significant growth. We're still seeing year over year growth in expenditures and people participating in respite. We're seeing increased in support services. Some of the areas that we're continuing to monitor is like transportation. We're not seeing the same growth, say, in transportation that we had seen prior to.

So we're trying to understand what are those impacts so I just wanted to share with you that this is ongoing evaluation it's incredibly important for us to see what the new trends are continuing to report back to this committee to what we're seeing in those trends and what we're seeing not only in what is based on our estimate and projections in the budget but say even the year over year growth because I see those sometimes as two different things but.

Two important points and even if there's some unreal obviously I think it's going to take a while to get to a new normal so I understand the data right trying to create a more predictable formula there but I just wonder if even if there were times where we projected higher but we did not spend as much what is the administration proposing to do with that unspent dollars I guess that's my question.

So the governor's proposal reflects the proposal that is before you on what are projected utilization and projected use of those dollars and so.

But in those cases, there's no redirecting of those funds in any particular direction or just basically this is what we believe that we're going to do, even though from this current fiscal year, how does that match up?

So we do our updates. So, for example, even in May Revise, even though it's just a few months, there's--a few months of additional information for us is important. So you will have an update at May Revise on what we had projected then for particularly budget year. So you'll see that with new information, what are we projecting of some additional data that's going to inform us what that projection is going to be, and then we will update that so the Legislature, this Committee, will be able to see the difference between what was estimated and what that updated number is.

Okay. But obviously, when we're talking about other possible delays and things like that, this Committee will be very concerned if we see that some of those funds would be reverted back to the General Fund as opposed to redirected in other areas where we still need to make some progress in this particular systems area.

So I just want to make sure that this Committee is on the record of saying if we were planning on using it for this community, we would like to see it continue use this in community as opposed to reverting it to the General Fund. Seeing no other questions or comments on this item, this is an information item and no action is necessary, so we'll move on to the next issue, please, which is the Governor's Proposed Delay of Service Provider Rate Reform.

So will the next members come on up? And again, we will go into the order in which it states on the agenda. What we're going to probably do because I know there's not enough room for everybody, and so I believe for this particular panel, can we--Department of--

So just for this one, we're going to ask the Department of Finance and LAO to actually come to the end seats on the dais up here to make room, please. Yeah. There's one seat over there or two and then one seat over there or two. I appreciate it. And then, Chief Deputy Director, you may begin when you're ready. It looks like everyone is situated. Mics are working.

Mr. Chair, if it's okay, Christopher O'Neill, the Department of Finance. I'll start out for the Administration and then pass it on to my DDS colleagues.

Okay. Yep.

Thank you, Dr. Jackson and Members of the Committee. Again, Chris O'Neill with the Department of Finance. The proposal before you is driven by the General Fund situation and is one of a number of approaches included in the Governor's Budget intended to help address the overall funding shortfall in the upcoming budget year. The outlined approach will return full implementation of DDS service provider rate reform to the original timeline adopted through the 2021 Budget Act.

What this means is that the next round of rate adjustments and associated funding for service providers scheduled to occur on July 1st, 2024 would instead take effect July 1st, 2025. This approach maintains rates at their current levels through Fiscal Year 24-25 as well as funding for the Quality Incentives Program. And from here I'll pass it to my DDS colleagues. Thank you.

Thank you. Carla Castañeda with the Department of Developmental Services and building off that, we'll address the questions that are in the agenda. The first one was talking about Quality Incentive Program and what has been implemented to date. Pages 21 and 22 of the agenda list the activities so far and the measures that have been identified. What's in progress now for the 24-25 fiscal year is the provider directory.

These efforts began last spring in trying to identify what information to collect and how to design a collection for the information. So in progress now is a web-based portal to collect provider information. This measure is intended to lead to further developments that will improve access to information both at provider level but also a public facing model.

That work will continue, and we are looking at activities that are identified this spring, whether the measure is the Legislature adopts a fully funded rate model that will include a component up to ten percent or whether that is the Governor's Budget proposal, that is the funds separate from the rate. The next question was asking about some of the impacts of prior freezes and rate reductions.

As Director Bargmann mentioned earlier, during the Great Recession, the state had implemented many changes to maintain California's public services, but also established tools to help mitigate some of those future downturns. For Developmental Services, this included issues like reducing or changing eligibility for Early Start. There were caps on certain services like Respite. There were across the board rate reductions, and there were also, as recently restored, some of the social recreation camp services delay.

One of the other features that was long-standing was changing our eligibility for federal reimbursements, which helped reduce some of the General Fund impact. These changes were particularly longer standing in restoring. It took a few years. One of the first ones was changing some of the Early Start eligibility to return that in recent budgets that has been expanded as well to address some of the changes we saw during the pandemic. The caps in Respite were also restored in 2018.

As Director Bargmann mentioned earlier on our projections, looking at that information, there were data that were attributed to some of the changes in the cap, restoring, eliminating the cap, but then there were also changes that were behaviors during the pandemic. For providers who had experienced rate freezes, there are a number of flexibilities in current law. Some of the frequently used ones are health and safety waivers when a provider identifies the need for adjustment. Another flexibility is something that was established in 1993.

It does require a public hearing for the Regional Centers, but it does allow flexibilities to waive certain parts of regulations or statute. One of the more visible impacts during that Great Recession was between the periods of 2008 and 2010. While we saw the population increase for Developmental Services from around 237 individuals to just over 247,000 individuals, the purchase of service expenditures during that period was relatively flat at about 3.4 billion.

One of the other questions asked was about the impact on providers and given the current length of some of the workforce challenges, that's difficult to say. What we have in the current budget's authority, and what is currently in progress are some of the training stipends for direct service professionals. Those are in progress now, and as Director Bargmann mentioned, over 40,000 staff have accessed that.

We are in the initial phases of the Internship Program, so several Regional Centers have participated in where there were vendors who could readily access that service. And then there's a Tuition Reimbursement Program for Regional Center staff as well to support some of that service coordinator increase. Also in progress that had initiated before those workforce stability programs are ongoing programs for a Direct Service Professional Training Program.

That's a tiered wage program, as well as a bilingual stipend to help with direct service professionals who speak and can communicate in languages other than English, including American Sign Language. One of the last questions was asked about the number of providers in the system, and this is another area where it's a little difficult. Depending on your definition, you may have a different answer. One of the typically identified information is by vendorizations, and so currently there are approximately 46,000 providers.

This is compared to approximately 41,000 in about 2016-17. But as part of the Quality Incentive Program and that provider directory, we'll have better visibility into those numbers and whether vendors are providing different services and if there's changes over areas. Thank you.

LAO.

Karina Hendren, LAO. Our key finding on this item is that the proposed delay in service provider rate reform would help the budget problem, but that alternative approaches could be warranted. The proposal would help address the state budget problem by providing about 600 million in General Fund savings in 2024-25. Nonetheless, the proposal does involve trade-offs, the state accelerated rate reform implementation in response to stakeholder concerns about a shortage of direct support professionals or DSPs available to provide services.

The acceleration of rate reform has not yet been fully implemented, and so some degree of DSP shortage presumably still exists today. If the proposal is implemented, individuals served by DDS might not receive services as quickly as could be possible if the full rate reform were implemented in 2024-25 as under current law. The Legislature could consider alternatives, as we noted before. For example, it could target select service provider codes where the DSP shortages are most acute.

This would require working with the Administration to identify which type of targeted or scaled back approach would make the most sense administratively, and a key point for the Legislature to keep in mind is that any alternatives still require dollar for dollar solutions elsewhere in the budget. The LAO is available to assist the Legislature in identifying alternatives, and our office can provide technical assistance in evaluating trade-offs.

And we did want to note that aside from the proposed delay, our analysis also raises two oversight issues related to the ongoing implementation of rate reform. These are listed on page 24 of the agenda. We wanted to check if the Committee would like us to speak on the oversight issues at this time. Okay. Thank you.

Next.

Good afternoon, Mr. Chair, Assembly Member. My name is Barry Jardini. I'm the Executive Director with the California Disability Services Association, also one of the three co-chairs of the Lanterman Coalition, representing a statewide coalition of stakeholders. Honored to be here today. Thank you for the invitation. Appreciate the comprehensive agenda, Ms. Castañeda as well.

I think we sit here recognizing the very difficult budget situation in front of us. I don't think we come to this conversation ignorant of the fact that you all have to make very difficult decisions around where to spend state resources that are inadequate to meet the demands of all of Californians. So that requires us to really take a strong look and see where are those dollars going to be most meaningful? Where is the need most acute?

And we believe that this proposal, while it would save General Fund revenues, is the wrong decision for Californians with intellectual and developmental disabilities, the workforce that serves them, and the family members that love them. We have made some significant progress in stabilizing the lives of individuals with IDD over the last couple of years. With the first two stages of rate model implementation, we have helped edge our way out of kind of the Covid nightmare.

As it's been noted already, the acceleration was predicated on a dire workforce shortage. Our information showed that one of every five DSPs had left the system during the pandemic, and we wanted to find a way to bring them back. So the Administration, Legislature came together and wisely made the investment to not only fund the rate model implementation, but also to accelerate it in response to the need. That need has not gotten any less acute.

While I could say we've made some progress and we've been able to hire a little bit easier with those first two stages of rate model implementation, this last stage is the big one. It's the one that's supposed to get us to market rates something fairer and more competitive that will allow us to compete with other workers in other industries, and I'll touch on that in a moment.

But I think it's also important to just remember our history a little bit, and I know some of this has been covered. The rate study was done because the Legislature pushed for it after advocates said, 'we're underfunded, we're underfunded.' We said, 'let's validate that number.' It found that we were underfunded by 1.8 billion dollars annually. So this system has given back four decades, right? We have given back since the rate freezes. Every year we have not been fully funded, it's been a savings to the State of California, and the people who feel the impact are people with developmental disabilities every day.

And so looking at this proposal, while we understand why we're sitting here talking about it, it doesn't hit very comfortably when it means real things to real people who need the services. And I want to touch on just the individuals impacted by this proposal and why we're opposing it.

Individuals with IDD, their lives are destabilized. Today, even with the progress we've made, we still see waiting lists for services, individuals referred from Regional Centers to providers who say, 'we would love to serve you, but we don't have the staff to do it.' We have individuals who are in program now who are effectively getting rationed services in some cases where they're authorized for five days, but they can only come to program two days a week, meaning the other three days they're at home or maybe you can only come in the morning and the other half of the folks will come the afternoon.

This is strictly a workforce problem. We are in the people business, people serving people. We need to be able to fund the services at an adequate rate to recruit a workforce, to make sure that we honor the Lanterman Act.

We're the only state in the nation that has an entitlement to services for individuals with IDD, and I think everyone in this room should be immensely proud of that. I hear from colleagues in other states and hear about their allowable waitlist and feel very fortunate that I work in California where we honor the lives of people with IDD.

But to do that, we have to nurture it, we have to foster it, we have to fund the system adequately to make sure that we're living up to that promise every day. In order to grow and move forward, it's going to be absolutely imperative that we fund the system. It's the foundation, bringing the funding in, and so we can talk about all the great reforms, the great work the Department is doing on initiatives to address workforce challenges, to work on quality outcomes measures, et cetera.

But we must make the investments so that we can build, because without a foundation, it's very difficult to build. I want to note just a couple of other quick things around the workforce. DSPs do amazing work. They do it every day. The best measure of quality is with a competent, stable DSP serving an individual with IDD. That point of interaction and a stable and great relationship there is going to lead to the best outcomes.

That's not to say it's the only outcome measure we should take into account. It's not the only metric, but that is fundamentally when the system works best, that's what's happening. Right now, the workforce is struggling. They've expected perhaps wage increases to come with the July 1st increase. Organizations have budgeted to provide those increases to their workers, and now they are looking at a potential 30-month delay between the second stage of rate model implementation and the final stage.

In that time, the fast food workers minimum wage is hitting April 1st, taking fast food workers up to $20 an hour. Health care workers minimum wage may well go through depending on the budget conversations this year. All the while, DSPs are looking at rate wage expectations in the rate models, $15, $16, $17 an hour.

Some of the wage models are below minimum wage, and I know the Department is investing to address that, but it just doesn't feel right when DSPs who are doing this critical work are being underfunded and aren't being at least able to compete with workers in fast food. Nothing against fast food workers, but DSPs deserve a fair wage for an incredible job. So I just want to leave it with this.

Dr. Jackson, you started this hearing talking about the risk that we take. If we don't invest, we actually move backward. I fear that the risk of not moving forward with the currently enacted rate model timeline risks undercutting the progress we've made over the first two stages. It means rebuilding.

We've already spent a decade coming out of a Great Recession to try to rebuild. We're building back up towards it, but this delay could really hurt us and really hurt people with developmental disabilities. And so I appreciate your consideration and the opportunity to be here, and I'm happy to answer any questions you may have. Thank you.

Thank you. Our next one. Panelists.

Good afternoon. My name is Amy Westling. I'm the Executive Director of the Association of Regional Center Agencies, also known as ARCA, which supports and works alongside all 21 of the state's Regional Centers. I'm also one of the co-chairs of the Lanterman Coalition, and I appreciate the opportunity to be here today to share the Regional Center's perspective on the proposal to delay the last phase of the rate implementation.

As has been noted, California has a unique in the country entitlement to needed developmental services that was established in the Lanterman Act and clarified in the ARC versus DDS lawsuit in 1985. That entitlement belongs to the people we serve. It belongs to the individuals and families, and we all collectively carry out this mandate in collaboration with our service provider partners. Historic rate underfunding has made it challenging and at times impossible to carry out that responsibility.

The rate study once again promised to connect rates for services to the cost of delivering them, and especially the cost of developing and maintaining a direct support workforce, which is the linchpin of service delivery and, as Mr. Jardini noted, one of the strongest determinants of quality. There's no question that the labor market shifted dramatically during the pandemic, making it even harder for our service provider community to recruit the staff necessary to provide people with the services they need and are entitled to.

And this has resulted in weightless and rationing of available services, as was noted, for instance, providing two rather than five days per week of daytime support. This means people cannot use all of the services the Regional Center has agreed to fund and at times are offered less than ideal services to fill in the gaps. Let me be clear: no one is pleased with that reality. Two factors make this even worse.

First, the population in our system is growing incredibly quickly at a time when California's state population is stagnant. This means we're doing a better job at finding and identifying and onboarding people who desperately need support. But having a system that has grown 31 percent from a population basis just since 2019 means we need to not only maintain the service providers that we have, but we have to grow capacity. If we maintain the capacity we have, we're already way behind.

And second, unfortunately, as has been noted, many of our service providers must compete with the fast food industry for workers. The minimum wage for fast food workers will increase to $20 per hour effective April 1st, and that's a wage that's higher than assumed for DSPs in the fully implemented rate models, and we're now only halfway to implementing those rate models.

Without the implementation of the final phase of the rate models in July of 2024, as currently expected, our service providers cannot secure the workforce they need to meet the needs of those already in the system or of the additional 30,000 people and families we expect to add in the coming year. Without adequate funding for provider rates, the Developmental Services system cannot keep its promise to provide people with the services they need and are entitled to, and for that reason, ARCA urges the Members of this Committee to reject the Administration's proposal in this area. Thank you.

Good afternoon, Committee Chair and Members. My name is Mark Melanson, CEO of the California Community Living Network, CCLN. I learned today that Director Bargmann and I started the same year in our careers in 1985, and apologies if my testimony sounds duplicative. CCLN is a statewide membership association with approximately 100 organizations, large and small, across the State of California. Our members provide specialized services that support California's diverse IDD community to live more equitable and inclusive lives.

Our members provide supported living services, independent living services, employment services, coordinated family supports, personal assistance, respite, and we do housing advocacy. There's a famous quote that quality is defined at the point of interaction between the staff member and the individual with a disability. CCLN strongly supports the initiatives to identify quality indicators, quality measures, and quality incentives. People receiving services in their families deserve and should expect nothing less than the highest quality of services.

While there's been progress made towards these efforts, there still remains work to be done, but we've got to start somewhere. We echoed the previous testimony that highlighted the DSP workforce shortages. We're desperately struggling to attract, retain, and engage a sustainable workforce. We are nothing without our dedicated, passionate, and adequately trained employees. The current shortage in the direct support professional workforce has reached a critical breaking point. People are facing long delays in receiving services or going without services altogether.

Providers are struggling to engage job seekers to enter the field of the direct support professional for Californians with intellectual and developmental disabilities and their families. This will only get worse as other statutory required increased minimum wages are set to increase in April of 2024. If this delay stands, as of July 1st, 2024, minimum wage earners in the fast food service industry--yay for those folks--will be earning a starting wage that is 6,400 dollars more per year than we are currently funded to pay our direct support professional staff.

This essential workforce is being lost. In a 2019 Department of Developmental Services rate study provided a solid roadmap to evaluate service provider rates. A delay in implementing this year risks a delay for potential--for delays in future years. It's 2024 and we're talking about fully funding a 2019 rate study five years later.

Administrative delays in the lack of required updates to rate models are undermining the value of the rate study before it's even fully implemented. These rate models are a critical tool for you all, the Legislature, to support the provision of measurable quality outcomes for people receiving services and their families, the sustainability of the direct support professional workforce, and the system's capacity to ensure that individuals from all backgrounds have equitable access to the highest quality of services.

Implementing the rate models is all about direct support professional wages. Providers simply can't wait any longer. If they can survive, service providers are very eager to demonstrate quality and achieve their fully funded 2019 rates. Supported living providers and other residential service providers are already being hit as of Jan 1st with a new unfunded mandate, SB 616, a bill which increased sick time from three to five days for employees working five days or 40 hours, whichever is greater.

That typical work week is not a typical work week for us. Failure to comply will result in a PAGA lawsuit, Private Attorney Generals Act, which will be catastrophic for providers. The rate model accounted for five sick days in the rate model methodology. A delay will leave that mandated unfunded for 18 months, and providers are already paying a higher wage than the wages listed in the rate study.

We're excited that the Department of Developmental Services and CCLN have been laying the foundation of the important work ahead on the PAVE Service Outcome Project and direct support professional university. PAVE, Person-Centered Advocacy Vision and Education, will be developing data-driven measurement systems, research and evaluation, and direct support professional training. The PAVE Project focuses on two important components of quality metrics that matter to people served in their families: informed choice and user and family satisfaction. In closing, don't delay.

Fully implement the rate models on July 1st, 2024. Thank you, Committee Members and staff for the opportunity to provide testimony today and happy to answer any questions.

Thank you. We need to make some space for Ms. Mark.

Thank you. Hi, Assembly Member Jackson and Committee and Nicole. My name is Judy Mark, and I'm the President of Disability Voices United. Thank you for inviting me to testify today and to offer the disability justice perspectives of people with disabilities and family members.

When the Legislature was first contemplating the substantial investments to raise service provider rates, I testified at a budget hearing and I said what people with disabilities and families actually care about is that these rate increases end up going directly to the service providers who are working with us, who are working with our family members. And we also care that if we're going to put in rate increases, that they are tied to specific outcome measures that we care about. Well, the Legislature shared these goals.

The Administration shared these goals and placed them in trailer bill language and tasked DDS to ensure they were met. But we are far from reaching these goals, and we fear that moving back the implementation of the final rate increase will make this much worse. Much more needs to be done by the Department to ensure that rate increases are actually going to direct care staff. Starting in 2021, DDS conducted two staff stability surveys for which providers were paid $8,000 to take part, and still only 42 percent participated.

Tell you, if you offered families or self-advocates $8,000 to participate in a survey, we would definitely do it. But we are still waiting for the results of these surveys from DDS and we have no idea whether wages have actually gone up. And I did a very, very quick survey and looked at jobs available, and there are some providers who are still offering minimum wage jobs. And so we have to make sure that the rate increases are actually going to increase these wages.

And then last May, DDS sent out a directive that required service providers to use a significant portion of their rate increase to improve direct staff wages and required them to maintain documentation and could potentially be subject to audit. Yet we have seen no results. We don't have any idea whether there have been audits, and that would be something I would really want to know. So tying these rate increases to individual outcomes is the other major goal that we have.

The process that DDS has developed to create quality incentives for service providers has moved incredibly slowly, and so far it's void of outcomes that aim high for people with developmental disabilities. And I actually sit on the Quality Incentive Workgroup that's developing these measures, and I have to tell you, it's been a frustrating process. There is still little clarity about what constitutes quality for most service types. In fact, there are 65 service codes that are eligible to receive a rate increase--it's a little calculation I did on my own--and it looks like only eight of those service codes have a measure attached to them.

So most providers don't even know what to do to earn these quality incentives, which will hopefully lead to better outcomes for people. We believe that if you delay this another year, it's just going to exacerbate the problem because the providers will only get that extra ten percent incentive once the full funding of the rate increase goes into effect.

And I really ask the Legislature to provide oversight to ensure that we're moving forward with these measures. And I just want to also take just a second to talk about the new IT system because it is directly relevant to ensuring that people are having outcomes that they want. And it is really hard for me to see how we're going to be able to track people's outcomes without this IT system moving forward and moving quickly.

Thus far, DDS has issued a quarterly report to the Legislature which I read. It stated that there were 185 stakeholder sessions with Regional Centers, nine meetings with self-advocates and families, and only four with providers. So obviously it's been heavy on the Regional Center side, very light on the side of the people who are actually using those services. We don't really understand who's in charge of making this all happen, and we know it's going to affect us.

So we would really like more transparency in the process of developing the IT system. So I know this all sounds messy. I'm being like a little critical here, but what I want to say is even though it's messy, it doesn't mean we should delay anything, because if we delay it, it means the mess is just going to last for another year.

And so I think that if we continue to move forward with this June 2024 date, it's going to force the Department to work more quickly to develop these performance measures that can be incentivized by service providers, and we just can't keep kicking this can down the road because this road is leading to our future and our children's futures. Thank you very much.

Thank you very much. Mr. Lee.

Thank you so much to all the presentations and all the panelists. At some point, when it's appropriate, I'll keep alluding to having alternatives. So if there was any way to elaborate alternatives, I'm not sure now, but if you have alternatives, we are always all ears to alternatives to budget solutions. But I do want to ask the Administration this, and we hear this in various different Budget Committees and settings, that you said this cut is happening because we need a budget solution. But that's math.

The budget is about the prioritization of social values, and if you wanted to achieve the same mathematical calculation, you could close some empty prisons, you could not expand some freeways, you could stop tax subsidizing people's second houses. I mean, those are all things that are in the budget today. So I want to ask Administration, why is it that you looked at this one to delay the implementation? Is it because there was a 600 million mark that we could save some money or is there a deeper rationale to this than math?

Thank you, Assembly Member Lee. Chris O'Neill with the Department of Finance. As has been the theme, as you alluded to during this budget cycle, it's been about--the proposals before, you reflect difficult decisions and in weighing the different competing demands, and the Administration understands the concerns of the community, has been engaged in conversations with stakeholders throughout the onset of implementation. And we'll just reiterate that the Administration supports this initiative and the proposal to delay is driven by the budget situation and that due to resource availability.

But again, the Administration is committed to continued partnership with the Legislature and stakeholders to reform the DDS service system in a way that's outcomes-focused and centered on helping every individual achieve there.

Sure, I understand that. But what metrics or outcomes lead you to say, this is the thing that we target versus something else, even within the DDS world?

Assembly Member, this proposal is driven solely by the budget situation.

Okay. All right. Thank you. And then I did want to, if the Chair allow, I did want to follow up on some of the comments some of our other panelists made about--and this is alluded to in the agenda as well--is that whether or not DDS has been auditing or actually ensuring that even as we progress with the rate reform, is it being implemented on the ground? So have you been conducting any of that audit or that work to ensure the money is out there? And then secondly, if it isn't actually being realized, what happens to the money that we're saying we should be going out to providers?

Thank you for the question. Pete Cervinka. I'm the Chief for Data Analytics and Strategy at the Department, and it includes the audit function for the Department. We've done a number of things in our audit section that I won't go into, unless you want extra, extra explanation, but on this particular point of auditing to this requirement, we generally don't audit a provider until the fiscal year has closed.

We don't see that our audit protocol will include this until at least July of the coming year, which is only a few months from now. We certainly acknowledge that we were part of negotiating the statutory language that made this requirement. We've always anticipated commencing this audit activity. It just hasn't happened yet at this point.

But we don't have any audit information from 21 to 22?

This was first implemented in 22-23, and when that year closed, the increment was relatively marginal. So the short answer is no, sir.

So, though, accounting-wise, though, if the money isn't being realized to providers, what actually happens to those dollars? Where would they have gone?

Our audit protocol ensures that the funding is always spent according to applicable state and federal statutes. We haven't included in our protocol up to this point a validation that the language is quite technical, but that the amount of money applied, the amount of new money applied to the DSP wage is commensurate or proportional to the amount of the rate increase increment that's been applied. That makes sense to absolutely nobody. But we don't have it in our audit protocol at this particular time, but it's going to be there, and we intend to look at it as part of our ongoing review of vendors.

All right, thank you.

I think it's going to be very important for us to recognize that given the level of uncertainty and fragility of the workforce and given the continued economic pressures of less skilled but yet more profitable job opportunities elsewhere, poses a great threat to our system. And if we don't have the workforce that we need, therefore, we will be at risk of having this community fall into greater instability.

And due to that, and due to my firm stance on not doing things that will put us at risk of further instability, this Committee is opposed to this proposal, but we are looking forward to finding ways to, if we cannot fully implement the next phase, that we don't do a full pause, but we keep moving forward. I believe we need to have all options on the table until we absolutely have to make a decision. But let me be clear.

I haven't found any good news yet in the budget either. But we want to make sure that, again, we do not make the same mistakes that we made during the Great Recession, but that we are as surgical as possible, and that we are not making decisions blindly or in a way that causes us to make rushed decisions.

I have a question for the panelists, and I think the first question would be, are there any alternatives or will you be willing to provide this Committee with alternatives to a full alternative, to a full delay that will also, in many cases, might be able to bring down some federal dollars with that as well? And this is just a question for all the panelists.

Thank you, Mr. Chair, and the Department is open to those ongoing discussions to provide technical assistance on specific options.

He'll get to you.

Great. I'm not good at microphones.

That's all right, people. Just trying to figure out how to make this stuff work.

Mr. Chair, thank you for the question. I mean, I think obviously, our position at this point is to try to hold the line on the July 1st, 2024, but I think acknowledging the budget may not get better and it may get worse, I think we're very open to providing technical assistance and support as necessary to come up with some viable alternatives. I will note that the rate study found fairly comprehensive and across the board underfunding for services.

So from an implementation perspective, I think carving out particular service lines as opposed to finding ways to make progress across the board for all services could be problematic, but again, we are available and willing to help as much as possible on the technical assistance front.

Assembly Member Lee.

Yeah, I just want to clarify, too, because there is a federal component to this, what generally is the rate of reimbursement for every one state dollar? What is the amount of federal money that we get leveraged back? I don't know who would be best to answer this question.

Could you repeat the question? I want to make--

Right. So, as I understand with our rate reforms, there is a federal component to this. It's the reimbursement rates. Yes, reimbursement rates, but I don't understand what the rate would be. So for every one state dollar, how much--or how many cents or dollars back do we get from the federal government?

Sure. For purchase of services, the share of federal reimbursements is approximately 40 percent of the cost of purchase of services.

40 percent? So for every dollar, it's $0.40 back.

For every dollar, $0.60 is General Fund, $0.40 cents is federal reimbursements.

Okay. That makes sense.

Approximately.

And then secondly, as I recall too, in this rate reform process, there was some applications you had to submit to the federal government. Am I correct in this process? So if you were to delay to 25, do you have to resubmit or redo any federal applications?

Correct.

You would have to restart that though?

They would be a different proposal, yes.

And how long would it take to resubmit to the federal government if you were to delay it?

That depends on the changes that need to be included in the waiver.

Okay. And administratively speaking, because statutorily, the rate reform was supposed to be fully implemented by July of this year, is the Department still prepared to do that in the case that we arrive back to this decision and it wouldn't compromise any of our federal standing, right?

An amendment is currently posted for public comment that would be submitted later. Yes.

Sorry. What amendment is that?

Yeah, an amendment to implement for July 2024 is currently in public comment phase.

Okay. All right. Thank you.

As we continue to talk about the pressures in terms of the rates, I know that our most recent laws on sick leave have recently had some guidance come out that seems to be causing some concerns, and so do you anticipate that the most recent guidance of sick leave, do you anticipate that being an issue for our system?

It has been brought to the Department's attention, so we are evaluating that right now.

Any additional questions on this item? So I would like to make sure that I go on the record to request on a technical assistance basis that DDS and Department of Finance provide fiscal options to provide the rate increase that is currently scheduled to take place on July 1st, 2024 for those rate categories that would maximize federal financial participation, noting any programmatic or federal approval impacts of which the Legislature should be aware.

I also request that this information come back to the Subcommittee staff, the Chair staff, and the Legislative Analyst Office before or by February, March 22nd. Again, by Friday, March 22nd. In addition, I request that DDS provide information on when it plans to conduct the audit on providers to ensure compliance with compensation increases for direct care staff with a briefing on the findings once completed. As part of this, DDS should explain how it will coordinate with Regional Centers on this issue.

This information could be requested before or by Friday, March 22nd. Lastly, I request information from DDS about the anticipated timeline for finalizing quality measures and upgrading the Department's IT systems, and if these would both occur in time under any circumstance to implement the 9010 by the statutory timeframe of July 1st, 2023. Is the Administration amenable to all these requests by the allocated deadlines?

Mr--Dr. Jackson, Chris O'Neill with the Department of Finance. The Administration is prepared to engage in conversations on a technical assistance basis. For the first request, we would clarify that we're prepared to provide technical assistance on options or alternatives identified by the Legislature, and we could provide technical feedback on those options, but we would not be in a place to provide options other than what's currently in the Governor's udget proposal.

And can you tell me why that's the case?

The Administration's proposal is what's included in the Governor's Budget, but we are prepared to engage on a technical assistance basis on potential scenarios or alternatives that may come from the Legislature, and we could respond to questions on those.

Yeah, but also I just want to make clear that if we're going to come to any agreement that full participation is going to be critical because this will not be a situation where we just acquiesce to the proposal.

But this is clearly going to be something that if we don't believe or feel, if this Committee doesn't feel like there's full engagement and they want to come to a conclusion that I certainly think we can do that, that's going to definitely pose some issues into the future.

Understood, Dr. Jackson. Thank you.

I appreciate that. I want to thank this panel very much.

If you can, if possible, just ask them to move closer to the mic?

Yep. Thank you. We'll move on to Issue Five: Governor's Proposal for a Master Plan for Developmental Services.

For those in this audience, this is known as one of those marathon hearings. How long can you last? We will find out.

Oh, I love it.

I think we have everyone situated. You may begin when you're ready.

Thank you, Dr. Jackson. Again, Nancy Bargmann, director of the Department of Developmental Services. I'm extremely pleased to be here with you and the committee members to share with you information regarding the master plan for Developmental Services. I would ask for a little bit of guidance if you would assist me today, Mr. Chair, is there's two different questions.

So I have on the panel for Department of Developmental Services, which is in the agenda on page 27, and then I will also be responding for the questions on behalf of California Health and Human Services, which starts on page 31 and ends on page 32. My question is, would you like me to go ahead and go through both sets of questions now, or would you like me to just do the first one and then come back?

Just the first set.

Okay. Thank you very much. Again, I'm extremely pleased to be here, and I will say I'm always honored, but I'm here with such an incredible panel, and I really look forward to the conversation and hearing input. First, I want to share and going to the questions that are on the agenda on page 27. California's Department of Developmental Services we provide services, as I noted in my earlier testimony, for individuals in California who have an intellectual developmental disability, but as a system.

So when you take a look at providing services to Californians who are receiving services through Regional Centers, we really are a system of partners. We really are a system of partners not only within Developmental Services, but extremely important to recognize that we are deeply connected to other health and social systems. Individuals with IDD really depend not only on Regional Center services, but extremely important to recognize that the services accessed from various systems is incredibly important.

The master plan will connect these systems more intentionally, and we're going to be able to build on these new connections in a way that is very holistic, to serve people with intellectual and developmental disabilities so they can thrive just like any other individual who's in California or receiving services. This could be extremely transformational to the lives of the individuals that we support.

We recognize that we have an incredibly changing system and the needs of individuals, the individuals of the demographics, but also really a new generation is coming up. I really appreciated Director Xavier talking about the value of employment and looking at how we have kind of the integration and having the opportunity of expectations as early in life.

This is really one of those opportunities for us to take a step back, look at those transformational efforts that we can have as a changing in the reality of what we can have for life opportunities, not just in the day to day changes, but also for lifelong success. The master plan is about embracing the entitlement and the promise of the Lanternman Act. It is not about trying to take a look at what are kind of solutions. We recognize the critical issues related to the fiscal issues.

I have heard from stakeholders, I've heard from our community. Is this really about budget solutions? This is really about looking at a shared vision with our community, making sure that self advocates and families are lifting up their voice to what they are looking for in the future, but also making sure it includes advocates, the legislature. So as we look to the vision of what the master plan can be, it's something that we do together.

But what's really important, what's really valuable is that the 36 committee members that's appointed by the secretary, that they are really individuals that are going to be able to come to the table and bring forward the recommendations. And this committee is really driven by them. This is for them. It's bringing them, and then they're the ones that are the most important seat at that table. Of the committee members, two thirds of them are individuals with lived experiences or family members.

We also want to make sure that we're strengthening the opportunities that we have built in our existing initiatives. I shared with you that we've have a number of investments that's not to be put aside. We want to embrace those. So as we take a look at those incredible investments and the things that we've been able to do that we're still implementing, we're still in various stages of doing that.

So this is to build on that, to be able to bring everybody together to see what are the things that we're doing current investments, how do we leverage those investments, move to an outcome based that we're really focused on quality, the experience of individuals, that we're doing it through a lens of culture, humility and sensitivity, that we're really facing the issues of inequity in our system and having very purposeful conversations and making sure that we have recommendations that will be able to address it.

The plan will also be developed in partnership of input from our sister departments. So California Health and Human Services has incredible departments that are focused on supporting individuals.

We want to continue that great momentum and make sure that we are not leaving people behind in any system, that we make sure that we are having access to those important uses some of the questions is how are we going to be able to make sure that individuals are understanding what is Developmental Services, but also making sure that we're having accessible information for those self advocates.

We are going to make sure that the work groups and the information that's shared not only in the committee, but also as we do other planning in roundtable discussions and focus groups is going to be presented in plain language, and it's going to be reflective of languages, of those who have preferences in languages other than English. The stakeholder meetings are going to be open to the public. We recognize, and we've heard this is actually a good thing.

We've heard disappointment of not being appointed to the committee. I'm sad that people are feeling disappointed, but the level of interest is so good. And so we want to make sure that we open the door and make sure that public input is definitely there. So the committee is not the only place to be able to have input. We're going to be going out to the community. The intent is to make sure that we're opening the door and having people feel comfortable.

And one way, and really probably one of the most important ways of doing that is going where people are. So we will have roundtable. We're inviting people to make recommendations and kind of invite us to the community. We would love to work with the legislatures to know in various communities if that's something we can partner with. We would certainly welcome that on the California Health and Human Services website.

If you haven't had a chance to look at that for the master plan for Developmental Services, there's not only an email for information that you can send questions to, but there's also a link to be able to invite a roundtable in the community where individuals are going a little bit more into the implementation and asking kind of what the goals are.

The goals and strategies are really about a roadmap for implementing existing initiatives, as I have shared, but having a way to be able to measure those outcomes. Previous panelists have said, what are those outcomes? What are those meaningful things that we're measuring, that we can really see that we are benefiting and impacting individuals. But then the question is, what are we going to do with this plan? Is that something that's going to be evaluated and revisited? Are we going to be able to have more conversations?

One of the great things that we have within health human services departments is the Department of Aging. They have an incredible master plan for aging. We have lots of lessons learned that's going to be really good about that. One of the areas that they have been able to do is to have a follow up process.

So they have groups that are able to take a look at what are the recommendations that came out of that planning, being able to have conversations about after the delivery of the plan, what are those next steps? We're going to want to make sure that the committee that we're working with, that they are also making recommendations of, what does that follow up look like that they would like to be able to recommend?

So again, centralizing everything on the committee, making sure that they're lifting up the recommendations, that they're driving the process, but we're there to support them all the way. So in closing, I'm incredibly pleased to be able to have this conversation with you today.

I've been wanting to be able to have kind of a master plan, so if I sound a little bit excited about it, there's a reason why this is really incredibly positive for our community to be able to work together for a shared vision and make sure that the individuals and the families are the voices that are lifted up the highest. Thank you.

Just a little excited. Department of Finance.

Chris O'Neill, Department of Finance. Nothing further to add to the presentation.

Thank you. Legislative Analyst.

Karina Hendren, LAO. The key finding that we want to stress is the importance of legislative involvement in the development and implementation of the proposed master plan. We recommend that the legislator consider introducing legislation to ensure that the vision for the master plan, as well as the plan's ongoing implementation, reflects legislative priorities. Additionally, the legislature may want to consider potential future cost pressures of the master plan as it weighs the master plan against other funding priorities.

Given likely budget deficits through 2728 understanding the potential fiscal impacts of the master plan will be key, and we also recommend that the legislature ask the administration to provide more information about what it has considered thus far about the role of the legislature and ongoing oversight once the plan is off the ground.

Thank you very much. Next panelist. This makes sure that the microphone is sufficient, so we also need the interpreter to hear as well, by the way.

Thank you, Chairman Jackson and subcommitee members. My name is Sascha Bittner, and I'm a member of the New Master Plan Stakeholders Group. I'm honored to be a part of this I have served as chair of the State Council on Developmental Disabilities, chair of the regional Advisory Committee, area five, co chair of the Golden Gate Regional Center Self Determination Local Advisory Committee, and currently serve as President of the San Francisco IHSS Public Authority governing board and.

In 1973 The year I was born in California, the Landerman Act was expanded was expanded to include people with cerebral palsy like me. This legislation promised a new era for developmentally disabled people that would include the support we need to lead full, rewarding lives in our communities instead of being sentenced to nursing homes or state hospitals. While we are in a much better situation than the bad old days when we were locked up and out of sight, developmentally disabled people and their families can still face dawning barriers in securing needed services.

I hope this stakeholder group will help remove these barriers as we examine how to achieve crucially needed revisions to regulations, consistent practices across regional centers, a more streamlined process, sufficient funding and other reforms to ensure timely access to quality services. And that access should not be limited to people like me who have tireless advocates like my mom who has spent so much of her own life trying to secure needed support and services for me.

All clients, families and other advocates should find the system easy to navigate and responsive to their individual needs, with no barriers. As a result of disability, language, income, education level, lack of advocacy, training, race, or any other reason, it is not acceptable for any of us to get subpar services or fall through the cracks.

While I have been on many advisory committees that have focused on better meeting the needs of Californians with developmental disabilities, I'm very excited to finally have the opportunity to tackle the relevant issues so comprehensively. With guidance from clients, families, advocates, providers and others, I hope we will be able to use our combined knowledge and talents to find innovative, sustainable solutions to the problems that undermine the full realization of the Landerman Act.

And while I have your attention, I'm very troubled by the proposed delay in the implementation of the rate study. It certainly won't help the long existing long delays in securing needed services, much less alleviate the already dire direct staff shortage and for us to be able to actually implement innovative and viable new programs or reimagine the ones we already have. Our system needs to be fully funded with the ideas and action plans generated by this stakeholder group.

In conjunction with a sufficient level of funding for the developmental disability system, California can become an aspirational model for the nation. We can finally fulfill the vision of the Landerman Act in ensuring that people with developmental disabilities that people with developmental disabilities have access to need services and support the services and support they need to live full, self determined and inclusive lives in our beautiful state. And thank you.

Well, Sasha, I know we are lucky to have you. I know a master when I see one. And you fully utilized your time very well. And I want to thank you for being willing to provide us with leadership to make this happen. So thank you for being with us today.

Thank you for inviting me.

Thank you, Dr. Jackson and members of the subcommitee. First of all, for inviting me. My name is Marty Omoto, I am the founder of CDCAN California Disability Aging Community Action Network. And I've been an advocate and an activist for over 50 years. And that started, and most importantly of all, it started because of my older sister, Elena, who had a developmental disability, physical disabilities and behavioral health needs.

So like you, and I've heard you in many hearings, when you talked of how you brought you into this field and your commitment to human services is because of the crisis that your family faced and how you had to deal with it and what it meant to you and to your family. And I had the same commitment to my sister. We were close in age.

I was with her through the point of junior high school, special education, all the way through high school and all the years after and in seeing how her health eventually deteriorated and she passed away in her 50s, in 2003 as we were organizing protests to stop the suspension of the Landerman Act right outside the capitol. I'm also the father, the proud father of Alex, who has, he's 31 years old. He has down syndrome, is on the spectrum.

He's actually here in the audience. I've known him since he was seven years old. And I was a close friend of his mom's. His mom, as she was dying, pleaded with me. They had no family, no circle support other than me as a friend to take care of them. And so that's a promise I made to her as she passed away. And he's been with me ever since. He was 25 when she died and he's now 31.

And so that's a promise I intend to always keep. And that's also the most important reason why I'm here. I'm also a member of the master plan for Developmental Services and also served on many other task force with the State of California. Again, because of that commitment that I had towards my family that you also share. I actually see that there are models out there that, and the subcommitee analysis mentions this, that the master plan for Developmental Services can follow the master plan for aging.

I actually worked on that. I was a member, appointed member of two of the key subcommittees, and I also was an appointed member on another task force that I think this could be a model for. It was the future of developmental centers task force. Both of those stakeholder groups were focused to a specific goal. They were targeted, they were person centered and across systems.

And so I think those are good models for us to look at in terms as we take the next steps to develop and actually implement the master plan for Developmental Services.

And the other thing with the master plan for aging, which I think will be key for the master plan for Developmental Services, is that all of us as advocates on the stakeholder groups, came to an agreement that we had to put forward, not only to the administration, but also to you as the legislature, meaningful action steps that could be achieved in the short term and in the long term. So it wasn't just aspirational, it was actually action steps that could happen.

And there were action steps that were whole person centered, crossing different systems to actually make a difference to older Californians. The key foundation, I think, as we move forward with the master plan for agent, I'm sorry, for Developmental Services, is that it has to have the foundation, that it's whole person centered, that it is tied to the needs of the infants, children, and adults and older adults with developmental disabilities. That is tied to the whole person life of the families.

It's tied to the whole person life of the people who are deaf and deaf plus, who also have developmental disabilities, or maybe members of families. It's also the whole person centered focus on the people who provide services. And why is that so important?

Because at the end of the day, the master plan for development of services needs to take a major step, and this is something the legislature can do, and it's actionable, is to break the silos of different systems that create barriers, barriers to my son, barriers to the people out in the hallway who are listening to this hearing or in the next hearing room, or the people in the audience.

Barriers to accessing the housing they need, the transportation they need to have the health care, the supports and services, the behavioral health, the education and employment and the wellness services and so much more. My son Alex and my sister Elena had a complete life.

Even if my sister's life ended early and even if Alex lost his mom's life, the thing is, we need the State of California and we need all of us as advocates and policymakers to look at my son and everyone else in this room and outside as a complete human being. And I think you understand this because you spoke of that in previous hearings. It means that outcomes will be tied to the individual, and it means that you tie accountability to those person centered outcomes.

And that will then bring, I think, what you mentioned early at the start of this hearing, stability that families and individuals always hope for. And one more point, and so going back to the point raised by the Legislative Analyst, and I think it was also in the subcommitee analysis about the concern of moving forward on a master plan for Developmental Services during very bad budget times. And does it raise expectations, and how do you look at implementing something or steps when there's an enormous budget shortfall?

I think, if anything else, first of all, the master plan for aging was developed in good budget times, but when we worked on developing it, we recognized that those good times would not last. And the very fact that master plan for aging exists now underscores the need for a master plan because it provides a blueprint and a roadmap for you as policymakers and for us as advocates to really look at what's the impact of making certain decisions.

And you raised this earlier, whether it's the cuts or reductions or whatever it is on the individual rather than just on a system. And so if anything else, the master plan for Developmental Services will actually help us not only through good budget times, but through bad ones. As lastly, well, first of all, I just want to say, Sascha, I thought we were the same age, but apparently we're not.

So Sascha and I have worked together as advocates for like forever, but I guess I'm a lot older than her. I just want to say, lastly, the need for the master plan, there's a sense of urgency that a lot of us have as a family member and as a father. I'm going to be 70 years old this year. My dad died when he was 81. I know I'm running out of time.

I don't know how much time I have to fight for my son and to keep the promise I made to his mom. I don't know how much time I have to fight as an advocate for everyone else in this room and every other family in this room and every other individual who is desperate for services that they're not getting have that same sense of urgency because they're running out of time, too.

And so we ask you, as you're looking at the master plan, for Developmental Services to just ensure that it's meaningful, that it will make a difference, that it's not going to be just some document or report that no one will read and no action will be taken. And I think that can make a difference if the foundation is based on the whole person and that the needs of that whole person is tied to outcomes and that leads to accountability.

If that happens, good things can begin to happen for my son and for everyone else. So thank you.

Good afternoon, Chair, and Members. Thank you for this opportunity to testify today. My name is William Leiner. I'm speaking on behalf of Disability Rights California, and I also sit here today as the brother of someone who was served by our system. My comments today are informed by DRC's legal advocacy on behalf of the people we support, by a deep understanding of the structural barriers that our clients face and most importantly, by shared commitment to rise above those barriers. I have four points to make.

Three of them today are going to be about the substance of what we hope to see in the master plan, and the fourth is going to be about the process. First, we share the agency's, agency's vision that the Developmental Services System cannot and should not operate in isolation. But this vision can't be realized,

while our current structures seem premised on this belief that siloing is somehow necessary to comply with federal and state, we call them payer and last resort rules, where people are told that these rules mean that they and their families need to exhaust all sources of funding, all other services from other systems, before the Regional Center will step in and help.

It's at this point where we see people falling through the cracks, and the master plan must begin the hard work of sealing these cracks by putting the burden on our systems, on all of us, on systems, not individual people, but on systems to solve system level problems like, payer of last resort issues. So this means a few things, it means strengthening coordination across systems. It means closing the loop when referrals are made.

It means exploring no wrong door practices and funding models that are aligned with what Marty was talking about, California's vision of whole person care. It also means we have to include representatives from these other systems as partners in the master plan process. We can't do this alone. This brings me to my second point. We're talking about our relationship between systems, but we also need to look within our own system.

And in particular, the master plan needs to examine the governance structure of our system, structures that give Regional Centers what I'd call broad and perhaps nearly unchecked discretion to develop both written and unwritten rules about what services are authorized and for whom.

And we've seen that this patchwork of local practices in effect limit both the scope and the geographic availability of services in deeply problematic ways, including in ways that have racially disparate impacts on people, and to such a degree that I fear that we might be putting federal funding at risk. People often say in the system with a resignation, there's 21 different Regional Centers, 21 different ways of doing things. But you know what? I think we can do better than that.

And people deserve a system with service authorization standards that are ascertainable, that are transparent, that are equitable, and that shouldn't depend on whether someone lives in the Redwood Coast or the Inland Empire or anywhere in between. My third point is that we envision a master plan that builds on and ties together some of the good work that's been done so far. The work on the quality incentives program, the 9010 work on Regional Center performance measures.

For too long, our system has been driven by compliance based metrics that seem to care more about the volume of services provided rather than whether those services are actually effective. And there has been progress on that front. There has been, but it's felt fragmented.

So the master plan needs to ensure that these funding models at both the Regional Center and the provider level are aligned and shape a system where people are supported to achieve the outcomes that matter most to them, to have the ability to lead the lives of their own design. It's all the things that Sasha was talking about. And lastly, if people are going to trust the outcomes that arise from the master plan, they need to trust the process that gets to those outcomes.

So this means practices like using an external facilitator to build trust. It means developing a transparent decision making structure. It means bringing in technical and subject matter experts to help the working group as members identify what's the data that's out there? What are key gaps in the data, what are best practices that we can look at in other states? And most importantly, most importantly, it means inviting in people with IDD service buyer system, not just as consultants, but as partners in decision making.

And in closing, I'll add that wherever this goes, we need more than just recommendations. And Marty said it well, we need actionable changes that make a difference in people's lives. People have waited long enough. Thank you for your consideration. I'd be happy to answer questions as well.

Good afternoon. Amy Wesling from Arca. The last time this afternoon, I promise.

That's what they all say.

You can hold me to it. So, I greatly appreciate the opportunity to weigh in from the Regional Center perspective about the tremendous opportunity the master plan for Developmental Services offers our entire community. As Mr. Omoto noted, this effort naturally follows from the work of the first developmental center task force, which devised a plan for closing our state's institutional settings for those with developmental disabilities, and we achieved that.

And later the Developmental Services Task Force, which explored how to fill gaps in the community based system and laid the groundwork for new models of care and ultimately for more sustainable funding models for our service providers. Our system is one that is always evolving, and those changes are what drive us to do more and think bigger about what people served by Regional Centers can achieve. At one time, care and supervision outside of an institutional setting was visionary and cutting edge.

Now we support many people to live on their own and work in integrated settings with support, which is an outcome the founders of our system could not have even imagined. These changes have been driven by the personal experiences and passions of self advocates and their families, from whom we have learned so much and who deserve to be central to the conversation and driving it.

The questions the master plan should seek to answer are, what is our collective vision for the future and how do we get there together? In short, what is, as Director Bardman put it, our shared vision or the next North Star we are all striving to reach? The development of this plan must adhere to the following core principles. First and foremost, the preservation of the entitlement as we know it here in California. Other states claim to be entitlement states, but we know the truth.

We have the nation's only entitlement. That is true and allows those even who are not enrolled in the Medicaid waiver to participate in service delivery, equity and flexibility. We must ensure the equitable availability, including along racial, ethnic, geographic, socioeconomic, and linguistic lines, of flexible services, including those responsive to individual cultures, that people need to reach their own person centered goals. Community inclusion, we must support community inclusion and participation, including in employment, housing, transportation, and beyond.

We are at a place where we are striving to ensure that people we support are active members of their communities, which benefits not only the people we serve, but makes communities all the much richer. As has been mentioned, we have to break down silos and we have to streamline access to generic services. And we have to figure out how to do that without sacrificing federal dollars because we know that our system is heavily dependent on those funds.

We also know in that same vein, however, that the presence of disability in a family brings countless professionals into people's lives, and it should not be a full time job for families and for individuals we support to coordinate those services. So we've got to figure out how to break down silos and how to ensure that there is a more seamless experience for those we serve.

Technology and data we need as Ms. Mark said on the last panel, we need to ensure that our data systems continue to improve so that we know what outcomes we are achieving and where we still have room to grow. We also know that technology is changing the world around us, and we need to ensure that people with developmental disabilities are part of that equation, that we use technology in a way that enriches their lives and that brings them along in that process.

And ultimately, we need to plan for the future. We're not just building a system for today, but for tomorrow as well, by taking into account changing diagnostics and demographic trends and the things that we can see coming so that we can anticipate needs before we are failing to meet them. In closing, in order to bring the vision to life, our collective vision, that we will form through this process and ensure that this work doesn't result in a report that sits on a shelf somewhere.

The proposed strategies must also include establishing and maintaining sustainable funding for current and future needs and systematically addressing workforce capacity challenges. Thank you.

Questions for Members.

Thank you to all the presenters. I do think, generally speaking, this is a good thing, to have more institutionalized representation of those who are parents or those who are in the IDD community, broadly speaking. But as we talk about this in the budgetary context, too, and Lao mentioned this, what is the anticipated budget pressure or cost that could exist from this? Because in the past, when we did master plans for other things, the departments said it cost lots and lots of money.

So what is the price tag on this one? Anticipate.

Thank you for the question again, Nancy Bargmann, Director of DDS. As we're looking at the master plan, it is a long term view. So it's giving us a roadmap to look at what are the priorities, and the ability to have a roadmap and identify priorities, even during a time as we sit today, is incredibly important.

So this roadmap, the recommendations or the priorities that is going to allow for future conversations, whether it's this year, next year, or five years from now, because we now have a collective framework. The last, I'd say probably three to five years I've been Director since 2016. We've had incredible progress. Like I said, there's been many, many things we've been able to achieve.

Much of the areas that we've had focus on often has been in reaction to something, as opposed to a very purposeful, hey, here is our overarching how are we going to make sure that we're working with a vision going forward? And that's honestly the outcome of being able to have a master plan and those days where we can then have decisions of investments, because right now we have a number of areas that we're working on right now? Are we focused on the right areas?

We're not saying, let's take this opportunity to make a request for future budget requests. We're saying, are we doing what we need to prioritize right now with what we have? But it can also be for future discussions in the days that there are opportunities to target policy changes, investments, or shifting of funds or accessing federal dollars. One of the real great values, our federal reimbursements, is really what's kind of sustained for so many years.

But are we doing it in the maximizing the federal dollars in the way that we can? This is an opportunity for us to go and also revisit what is the reimbursements. Is there a way that other states are doing things? And that's where it's important within health and human services, other departments, like we already have commitments from other departments to support, be those expert panel supporters to help us navigate some of these important questions and forward thinking.

Thank you. Thank you for your question. Senator Lee, I just wanted to score that, the master plan for development. Marty Omoto CDCAN parent and father I just wanted to score the value of a master plan, if it's done right, like the master plan for aging, is that it looks at the individuals and crosses all the different systems that that individual needs and access.

The danger that we're in right now without having that for people with developmental disabilities and also the people who provide the services is that we're only looking at the impact in one Department.

So when there were massive cuts, and my sister, when she was still alive, they were only looking at how the cuts were going to impact her life in the services she got under the Department of Developmental Services didn't look at the cuts to Medi-Cal that she accessed, didn't look at the cuts at IHSS that she needed or behavioral or then called mental health back in the 2003's, even before that.

So the value of this is that if it's done right, if it's done in a whole person centered way, it will look at the individuals, all the needs they need in all the different agencies in California, whether it's housing, transportation, behavioral health or Medi-Cal or employment. And that's really important. And I think that can make the greatest difference.

It also allows you, Dr. Jackson, and this Legislature to make better decisions because you're going to know that if you make this cut, it's going to impact the same person three or four different times. You didn't have that information in 2003.

In fact, the reason I know that is because the undersecretary then of Health and Human Services was talking to the secretary then when they're talking about a variety of potential cuts, and she was asking how do we know that this cut to IHSS is not impacting the same person who's getting cut in SSI? And the answer was, we don't know. And I think we can have better answers than that and give you better information to make better decisions. So thank you.

But I think the question is, if I may, Mr. Lee, if we introduced a Bill to create a report, a plan, an idea, a thought, we would get a letter under our doors from the Department of Finance saying this would cost blah, blah, blah, blah, blah, and we have not seen the dollars amount attached to this item. So Department of Finance, what is this report master plan going to cost us?

Thank you, Dr. Jackson. I'll defer to the Director for this question.

Yes, thank you, Dr. Jackson. Apologize. When I was thinking about kind of the cost of like what's that outcome? But certainly appreciate the focused question of saying what's the process? What's the cost of the process? And appreciate that as I noted with all the number of initiatives that we've had, and again, Nancy Bargman, Director of DDS, that there's been some level of funding that's been available over the last several years on some significant kind of initiatives.

It's been our quality incentive program looking at some of the standardization that we're looking, the rate implementation. Administratively, this has been incredibly valuable to the Department to be able to see how we're going to coordinate, how we're going to be implementing structurally to have that happen. Why I bring that up is because it gets back to looking at this from a whole kind of system, Developmental Services.

So DDS, we had already started down the path of looking at having a strategic plan to be able to bring all these important initiatives forward and how we're going to move it. So we've already identified within some of those administrative fundings to implement many of the major policy and initiatives that the Legislature and the Administration has identified as priorities.

So we're using some of those funds to support the facilitation of the support to self advocates, and also then the coordination of having a coordinator, of being able to help us have that framework, the Independence that was asked for, making sure that it's outside of DDS, but still certainly under the direction of California Health and Services. So that's the funding of it. We can provide a breakdown. I apologize for not being here today with that much of it is because it's also with an existing contract.

And so peeling that apart as saying, okay, that work is only for the master plan when we also have the important work of quality incentive program and all these other things, it's this whole administrative navigation of doing all of the areas that we're focused on right now.

Mr. Lee, anything else follow up?

Yes. That information provided this Committee would be very helpful and what you're planning to do with existing resources versus what would probably need to be provided for in the future. But I think to Dr. Jackson's point, as we said, is that when we in the Legislature proposes these very similar things, it astounds us the cost that Department of Finance gives us. So then it secondarily amazes us to say that you won't need any money to do this.

So we reigned a bit skeptical that it will be as free as it sounds like. So if we could provide the information, that'd be helpful and then to our speaker's other know, it would have been helpful during this budget cycle to know if we would impact vulnerable populations if they're going to lose multiple different services. That's the kind of stuff we need for times like this. So broadly speaking, of course, it's always good to elevate these concerns, these opinions and to institutionalize them.

But we do want to know in light of the budget situation, what is the real dollars aspect to it. So thank you.

I appreciate. Thank you. And I will also note that we're also seeking some foundation dollars, but that's certainly not something that's been locked in, but wanted to just note that. Appreciate that Assembly Member, and thanks for the feedback and we'll follow up.

Additionally, obviously, as someone who has been a connoisseur of the master plan on aging, just understanding how important it is to be able and to create some sense as we encourage people to read it, some sense of building of institutional knowledge along the way, because a lot of these things is a long term action that has to happen.

But similar to the master plan on aging, there was also a Trailer Bill Language that was done for the master plan of aging as well to ensure that there was some connection to the Legislature in terms of oversight. We agree with the Legislative Analyst who makes the recommendation of making sure that we are doing our fiduciary responsibility as well. Does the Administration understand the request for us to be able to develop Trailer Bill Language and be amenable to making sure that we can get that done?

Yes. Thank you. Yes. While the Administration has not put forward Trailer Bill Language regarding the master plan, we would certainly make ourselves available to work with you regarding the areas that you'd like to focus on.

Thank you very much. The Committee would like to request assistance from the Legislative Analyst Office to begin to work on a draft of Trailer Bill Language in collaboration with legislative staff, emulating what was codified for the master plan of aging in SB 228 to be shared first with subcommitee staff and chair staff, and then with the Administration for their input, with a more developed draft coming back to the Subcommitee by Friday, February 22.

Additionally, the budget for the master plan workload has been requested, but this has not yet been shared. The Subcommitee has also requested a schedule of meetings planned thus far, which is also outstanding. And can this information please be shared with our staff by Friday, March 1? Is that this Friday? What day is it? My goodness.

You know, but the I. But the idea, of course, is as we begin, we just want to make sure we get as much information as possible. I think the key to all this is communication, and if there's an issue with any deadlines that we're requesting, the idea is just to be communicative so that we can make sure that we make some win-win situations for everybody. Does that sound okay?

Absolutely. And we absolutely are committed to working with this Committee and with staff and keeping that line of communication open. I will say probably March 1 may be a bit of a challenge, but if there's things that we can provide by Friday, we absolutely will do that. And we will connect and make sure that we're identifying those areas that you're wanting to have deliverables.

Well, this certainly is an exciting time. I do agree, and I think that, quite frankly, long overdue. And I'm excited to making sure that we also have sufficiently specific goals that are really tied to measurable outcomes. Right, because we sometimes believe that, especially with Members of the Legislature, where I'm chair this year, that doesn't mean I'm going to be chair next year, right? Hopefully, if I act. Right, but that never goes very well.

But I think the idea is that sometimes when we're creating these visions, we assume that people have the institutional knowledge to be able, and the expertise in these very measurable goals to be able to articulate how we get there. And so the more that it becomes a manual as opposed to vision statements, I think that it will go a long way in the long term. I want to thank this panel very much. Thank you. We will now turn to issue number six.

It need another chair.

And issue number six is the implementation of the 2023 equity, changes and goals and path going forward. Either place, we'll give everyone a chance to settle in and find their seats and then...Department may begin when ready.

Good afternoon, Dr. Jackson and Members of the Subcommitee. My name is Brian Winfield. I'm the Chief Deputy Director of program services for the Department of Developmental Services.

Let's just pause real quick. Interpreter, could you hear all that? Is that okay? Okay, just for the interpreter, just come bring it on up.

Okay? I'll do my best. I'm Brian Winfield, Chief Deputy Director of program services for the Department of Developmental Services, and I will be speaking to questions numbers 2 and 3 of issue six. And for question number one, I will allow my colleague Ernie Cruz to go before me.

Good afternoon. Ernie Cruz, Department of Developmental Services.

The first question is how implementation of the 2023 changes is going. Are there specific impediments or challenges? So the table included on pages 35 and 36 of the agenda provides an update on the department's progress implementing equity changes included in the 2023 trailer Bill. Language standardization in the areas of intake assessment, vendorization. Vendorization is the process specified in title 17 regulations to become a Regional Center funded provider of services.

Race, ethnicity, and language data definitions, individual program plan development and respite assessment are all underway, as well as an evaluation of generic services. The first deliverables are in the areas of race, ethnicity, and language data definitions and individual program plan development. We've been meeting with diverse stakeholders on these items with more meetings to come, and we don't foresee any obstacles to meeting the June 30, 2024 timelines for initial phases nor subsequent timelines.

If we encounter implementation challenges, we'll be happy to highlight these for the legislative staff during our quarterly briefings.

Thank you again. Brian Winfield, DDS for question number two. What does the data tell us about whether the system is improving or not? On narrowing ethnic, racial and geographic disparities? Working to address disparities within Developmental Services remains a priority. Investments have been made to this work and a lot has been achieved, but there is much work still to be done. When looking at purchase of service data, we continue to see inequities in spending in the aggregate.

We are seeing the needle move in a positive direction in a number of areas when controlling for factors such as age, living arrangement, and the type of services a person receives. As noted on page 39 of the agenda, data should be consistent and of good quality. An analyses should compare people with similar needs, such as similar residential settings. When looking at trends over time, DDS is looking at service delivery across many different population subgroups. Younger Hispanics are one of the largest growing subgroups.

They comprise 75% of them are 21 and under, while whites are continuing to age without a similar decrease in younger individuals. This is significant because Regional Centers spend less on individuals who are younger who are receiving many of their services through the educational system, while they spend more funding on individuals when they are adults. These differences in population growth cause purchase to service differences between the two groups to widen on the aggregate. There are indications that some gaps are closing. I will give you two examples.

The first example is in 2016-17. The difference in purchase of service among children and young adults ages three to 21 living at home has narrowed. In 2016-17, there was a 22% difference in purchase of service between Hispanic and white consumers in this three to 21 age group, and in 22-23 the gap in spending for the same age group narrowed to 12%.

Another example of moving the needle is in the area of employment services, and this is on page 46 of your agenda in the chart. In 2016-17 purchase of service was highest for consumers reported as Asian and @hite. Purchase of service among consumers reported as Hispanic was among the lowest. Now fast forward to 22-23.

The purchase of service was highest for consumers reported as African American, black, and Asian, and there was only a slight difference in purchase of service of employment services for consumers who identify as White or Hispanic. Although we're paying close attention to all purchase of service spending trends, a gap in spending we need to pay particular attention to is displayed on page 47 of the agenda.

This chart displays a trended purchase of service for three different service type independent living skills, supported living services, and personal assistance for individuals 18 and older. We see the gap in spending widening between individuals who identify as white as compared to other ethnicities, with individuals who identify as Hispanic showing the biggest gap. In summary, the needle is moving in the right direction in some areas, but there continues to be much work to be done in the equity space and it must remain a priority.

The third question was what key and specific strategies we need to be mindful of and act on as a state to understand the cause of inequitable access. First, the Department needs to continue strong community engagement with all diverse communities to include individuals who identify as Hispanic, African American, Black, Native American, and all other ethnicities, including individuals of our deaf community. We need to continue decision making through the lens of cultural differences and preferences.

Soon, DDS will be releasing the Lantern Act in Spanish. This is the first time the Lantern Act has been translated in another language. Lastly, as we've heard about the master plan for Developmental Services, this will be very important work to look at, and it'll be another avenue for increased community engagement, prioritization of the work, and building on the existing work that we're already doing. Thank you.

Next up.

Chris O'Neill, Department of Finance. Nothing further to add.

Legislative Analyst Karina Hendren, LAO, we understand that there may be equity issues and various issues across the Department. We wanted to note that our analysis this year focused on one specific area, and that is efforts to improve equity and purchase of service via the Coordinated Family Support Services Pilot Program. And we'll share our comments later. That'll be during agenda item number 12 on HCBs ARPA funding.

And we did want to note that although our comments later will focus on coordinated family supports, we note that this is not the only equity issue that warrants consideration.

Thank you. Next panelist.

Good afternoon. My name is Vivian Hahn, and in addition to being a Senior Attorney at Disability Rights California, I also have a brother who has autism and is served by a Regional Center. In order to address racial inequities in our system, one of the most important things we can do is to find more equitable ways to manage costs. The approaches that our system has relied on for years are effective at cost containment, but they impede people's ability to access services in racially disproportionate ways.

I'll point to three examples. First, when we ask why average spending amounts may differ from group to group, we may want to focus on how spending decisions are actually made and what principles or rules those decisions to approve or deny spending are based on. At Disability Rights California, where we get thousands of calls from people every year seeking assistance with this very issue, accessing services from their Regional Center, one of the top reasons we have heard for denying services is the failure to exhaust generic resources.

That's something that some other speakers have touched on before me, but I know that this is a barrier and an issue that Regional Centers and the Department have recognized and have tried to address in different ways. One of the main ways, one of the main investments that they've undertaken to address this problem is investment in more navigator positions or in the creation of new service types or service codes that include service navigation as a component of that service.

But these investments, investing more and more in individual navigators to help people wade their way through complexity without also focusing on reducing that complexity at the same time is a losing argument and a losing investment. I'll give you an example, and this is an example that I shared with you all the last time I spoke before this Subcommitee.

If you have a jungle, a thick, dense jungle that just keeps growing and growing and getting thicker and harder to navigate, you could approach it by finding more guides, bringing in more guides to help you navigate the jungle, printing up more maps, more maps, and better maps to the jungle, putting up better signage to help people find their way through the jungle.

Or you could take those dollars and invest in building a highway, a paved road through the middle of the jungle so people can just go through. That is the solution that we have not yet tried and not yet really focused on. If we do not do that and do not try that, and instead keep relying on individual family members or individual service coordinators to navigate this maze without doing these other things at the same time, it's never going to work.

And even worse, when we think about a budget perspective, it's an inefficient, non cost-effective approach. So that's one. Second, one of the things we should focus on in terms of cost containment are the limitations that are placed on how and when people can get services. Regional Centers. These are called purchase of service policies that Regional Centers determine and the way that our system works. Each Regional Center sets its own purchase of service policies. In essence, they get to set their own limitations on services.

These are rules on who can get services, for what purpose and how much. They may include things like caps on the number of hours a person can get or caps on dollar amounts that can be spent on a particular service. This has resulted in huge variation across Regional Centers in terms of access to the same type of service. I'll give you one example.

Currently, if you look at the website for Harbor Regional Center, their purchase of service policy for personal assistance describes the service, but then says that for children, for minors, personal assistance is generally not available. They typically don't provide personal assistance to children at all because they consider personal assistance to be a typical family responsibility. Why is personal assistance, which they define as support to help people be able to go out into and access the community?

Why is that considered a family's responsibility to take on in the South Bay Area, but that might actually be considered a Regional Center responsibility in a neighboring area, across the street, in a different Regional Center catchment area? It makes no sense. These purchase of service policies should be interrogated for their impact on racial equity. The Governor has put out an Executive Order. There is a Racial Equity Commission whose work is just getting launched and underway.

There are so many other racial equity framework efforts going on that I think our system has much to learn from, and one of the best things we can do is to look at that work and take from it and see what we can learn about applying an intentionally and explicitly antiracist lens to the rules that we have around who gets to access services, why, and how much. Third, one of the reasons why we rely so heavily on overly restrictive purchase of service policies to limit costs is because somehow we as a system, really don't have very good ways to really tell what people actually need.

This is because we don't really have consistent or comprehensive approaches to conducting service needs assessments. Unlike other long term services and support systems in this state and in others, we don't have a validated or reliable assessment tool that we use. We have no consistent rubric or criteria that is used across Regional Centers consistently. We have no comprehensive or commonly used assessment of functional need, assessment of activities of daily living.

We have no assessment of need for things like housing, risk of homelessness, or other social determinants of health. Sometimes these things may be asked about if a service coordinator happens to be thorough and to think of them for a particular client, other service coordinators, and other Regional Centers. It may not happen. There's just no consistency.

And this may be the most critical thing of all, because in the end, so much of what we talk about when we talk about racial disparities in our system, in other words, spending. Is really not the best measure of equity at all. People with intellectual and developmental disabilities deserve to get the supports and services they need to stay in the community and live the kinds of lives they want when they need them.

The degree to which this happens for people in our system, broken down by race, ethnicity, and other categories, would be a far more meaningful measure of equity than merely the amount of dollars spent. We all know, we've all made purchases that have been expensive and cost a lot, and have still not met the need that we actually had. We've all also made inexpensive, relatively inexpensive purchases. Don't cost a ton of money, but they make us happy and they meet the need that we bought them for.

It's not the amount of money that matters most. The thing, the spending data provides context, but it's not the thing. The thing is the degree to which people are achieving in their lives, the outcomes that matter the most to them as they define them.

So to me, that's the future of what we need to do to address racial disparities is to invest in and develop initiatives, projects, efforts that are being undertaken right now, including by the PAVE project, other efforts in our system to really have good, solid, meaningful measures of whether or not people are achieving the outcomes that matter most to them, and then disaggregate that by race.

When we disaggregate, if we compare and we see that there's a huge difference, if we see differences by race, that's the real measure of equity. And I don't think we will ever be able to achieve or really even pinpoint or target effective, including cost-effective approaches to addressing, to really reducing racial disparity until we have that kind of data capacity in our system. Thank you.

Okay, my colleague just said all these things that you don't want to look at data, and I'm about to give you data, so just ignore that part. Judy Mark from Disability Voices United. Yeah, I totally agree that outcomes are what matters, but we can't measure outcomes right now, and so all we have is data. So I want to talk to you, Assemblymember, about your Regional Center for a little while. The Regional Center that's in your catchment area.

So last year when I was here, I presented a chart which looked at both race and place. So we looked at these lines and I handed them out. Folks can't see it. Where you look at the difference, that there are horizontal lines from the lowest racer ethnic group to the highest race or ethnic group, and in the vast majority of cases, the highest is the White people and the lowest are the Latinos. But it does differ at some Regional Centers.

We updated the chart today by Regional Center, and you'll see that it's pretty identical, that the Regional Centers are in the exact same order, and that things really haven't changed since last year. Inland Regional Center in your district, Assemblymember Jackson, is the largest by far, but it's right there at the bottom, just like it has been for decades. Funding is based on historic spending, and so Inland is never going to be able to make it up this chart. It's just not going to happen.

And I'm going to break it down even more for you. If you were a Latino adult in the Golden Gate Regional Center, which is the one at the very top there, you're only receiving 46% of what Whites receive, so you're getting less than half of what Whites receive if you're a Latino, however, you're still getting twice the amount of services as Whites get at inland Regional Center. So you can't just look at racial differences. You have to look at geographic differences as well.

And if you're an Inland Regional Center, Latino adult, you are receiving the lowest amount of services in the State of any major ethnic group at any Regional Center. So you really don't want to be a Latino at Inland Regional Center because you are getting so few services. Your future is pretty poor. There have been many efforts over the years. I've been part of many of these efforts to reduce racial disparities. I'm going to just talk about a couple that were mentioned in the agenda.

The first one is to establish a standardized IPP template so that there are similar procedures, similar experiences, regardless of race or place through your IPP meetings, which is what determines your services. DDS provided an update to you for your agenda, saying that it was being finalized very soon with lots of stakeholder input. And I just want to share that the original proposal was presented to the public last summer at public meetings, and there was pretty universal concern over the document that was being shared.

And we have not seen any further drafts since last July. And so we're not exactly sure what's going to be presented in its final form. But we really have to get this right because this is an opportunity for us to ensure that we are providing a person-centered and equitable approach and experience through the IPP process.

The second item from your agenda is to talk about the differences, the driver of disparities that you heard already today, that Latinos, because this is a Latino issue. Latinos are the most underserved community in the state and that Latino families keep their adult children at home, and so therefore they're going to get fewer services.

Well, one of the things, but actually, I want to point out real quickly that if you compare apples to apples and you look at Latinos who live at home compared to Whites who live at home, there are still disparities among Latinos. So they're still getting fewer services.

But there is this new service that you just heard LAO talk about, which is called coordinated family support services, and it was touted as a way to bring more equity to the system because it provides supported living for adults living with, still living in their family home with their parents. But the problem is that when coordinated family supports was rolled out last year, it didn't look anything like supported living.

DDS defined the service as an agency, basically a total stranger coming into the family's home and starting to coordinate things, coordinate things like making doctors appointments, arranging for community outings, things that the parents kind of, we don't need help with that. As a parent of an adult who is living at home, we need staff to be up in the middle of the night when our kid wakes up, that's what we really need. And the problem is that the Latinos already don't trust the Regional Center.

They already don't trust strangers coming into their home. And so they haven't utilized this service at all. In fact, very few people of all races have used this service. And finally, we have to address the fact that there is a lack of trust of parents of color with their Regional Centers. And if we don't directly address that, then we're never going to solve this problem. Parents of color report to me that they are afraid to have the Regional Centers come into their home.

They're afraid that the Regional Center is going to make judgments on the way that they live. They're going to take away their child services and possibly even take away their child. And this is because there is an inherent conflict of interest with service coordination in the state. These service coordinators are there to advocate for people, to advocate for their families, but then they are directed by their superiors to deny services to these same families and sometimes even testify against them in a court before a judge.

Service coordinators are put in these untenable positions, and they lack any power to change things. And so there is consequently absolutely no trust in service coordinators. One major solution, which is not at all on the table right now, but it's from the 1980s, and since we're having this conversation about the master plan Committee, I want to bring it up. We need to separate out service coordination from service decision makers. They should not be the same people.

We should be able to choose who is our service coordinator based on community organizations that we trust and that come from our community. This is working really well in the self determination program, where underserved families can bring on facilitators. They choose to be their advocates. And we see racial disparities narrowing in the self determination program, and it gives us a model for us to work on. Thank you.

There are over 100 people watching this video live streaming on Zoom. And actually we're translating this meeting in real time as it goes on because there is that many people interested in the subject matter. We are a community and the panel before us, lively discussion, great subject matter, promise of a master plan, which sounds great. And we know that every single individual is important. However, Latinos make up over 42% of individuals served by the regional center system.

And as excited as we want to be about a master plan, what we're seeing is that only 17%--even though we're 42% served--only 17% are Latinos, are on the task force. So we already know that there's going to be underrepresentation. And furthermore, there's not one--best of my knowledge, because I know information is still coming out--there's not one Latino self advocate on that task force.

Yes, there will be meetings in the community and there will be conversations, and we're looking to use those as we slash our way through the jungle, as my colleague here uses a comparison. So, as a dad and from the onset of nearly two decades of advocacy, my family has relied on the Lanterman Act as our lifeline and beacon of hope. It embodies our aspiration for children to lead meaningful lives throughout these years.

I have advocated for our community, wrestled with the stark realities of the disparities that we just heard Judy share and the challenging barriers and roadblocks that hinder our journey. The question that weighs heavily on my mind, and I believe the minds of many, is how do we effectively advance equitable access for all, every single Californian under the Lanterman Act?

What seems to be working is that there is a tremendous amount of conversations about system navigations, disparities, inequities happening across the state, resonating at various levels of our community. But yet what we see is missing is the synchronization of efforts at the point of service coordination, the point where we call 'the rubber meeting the road.'

Too often, families encounter a culture of rejection, where they must portray their loved ones in a negative light just to qualify for services, only to be thrust into an overwhelming and complex process of obtaining those services that they direly need. The rules and the criteria for qualification of services remain disshrouded in mystery, leaving families frustrated and overwhelmed in the life changing services that are needed out of reach, a process that takes months at end in a tiring amount of time.

Unfortunately, the system of supports do not share the same urgency that we as family members have, where it seems to be okay if it takes six months, a year, even more so, to obtain a service that could have been used that very same day. We all hear and agree that service coordination should be person-centered, yet too often it feels very bureaucratic and isolating. Directives are convoluted and inconsistently interpreted, while compliance demands further alienate individuals and their families.

Trust and respect are essential pillars in bridging disparities. They are eroded when information shared in good faith with service coordinators is later weaponized against the families in places like hearings. We recognize the immense challenges faced by the service coordinators. They must navigate regional center policies, adhere to system directives, and maintain compliance while striving to be person centered. They are caught between a rock and a hard place.

While increasing coordinating numbers, more service coordinators, and reducing case load ratios, that may help, but the service delivery process still fails to align with the needs and the expectations of the communities that it serves. While programs like coordinated family support may appear beneficial in supporting families, in reality our community perceives them as intrusive, in many cases untrustworthy. However, programs like the self determination are perceived as a game changer, and one is lucky enough to transition into self determination because it is a pretty challenging and difficult process today.

While some regional centers are striving to change embedded cultures of bureaucracy, compliance demands often stifle that progress. Our community yearns to be heard, to be a genuine partner in shaping equitable services. We provide feedback, we share experiences. Yet at times, it feels though our voices are not being heard. So we know and have heard about the data that shows Latinos families are getting, for example, more respite than white, non-Latinos. However, that's, in many cases, the only service that they are receiving.

In reality, for many Latinos, we are looking to have that equity, have access to diverse services that are needed for our family members to survive. So true person-centered service coordination embraces our diversity. It holds the promise of transformative change. There are dedicated individuals who work tirelessly. We heard of many more. We have a director here who's going to be providing her testimony. We have another director who's coming in in the next panel, who's providing testimony.

There are many, many individuals with amazing hearts who are trying hard to fix this system. But what we're looking at is a service coordination that's really not in alignment with the community that it serves. So despite the challenges, we remain hopeful--hopeful that through collective effort, we can dismantle these barriers and create a system that truly serves all Californians. We must continue to advocate, to collaborate, and to believe in the possibility of a future where equity and inclusion are just not aspirations, but realities. And we do agree with you that surviving is not enough, that we should be thriving. Thank you.

Good afternoon. Thank you for the opportunity to speak today. My name is Michi Gates. I'm the executive director at Kern Regional Center. With the support of Senate Bill 138, regional centers have an opportunity to improve services to individuals, their families, providers and other stakeholders. Many things have changed since the Lanterman system began over 50 years ago. Our day to day lives and the demographics of our state are vastly different, and we have a lot of work to do to catch up with all of those changes.

In addition, the regional center system has become increasingly complex as the number of people we serve and the funding needs grow. Standardization of the IPP, the intake process, respite assessment tool, and vendorization procedures is in process, and regional centers look forward to the benefits this work will bring. Standardization will make our system easier for individuals and families to use and easier for our staff to administer.

It also addresses geographical differences in service provision between regional centers, a common source of confusion and frustration for our individuals and families. Making our system easier to understand and navigate will lead to greater empowerment for individuals and families, which is a core principle of the Lanterman Act. Through ARCA, the Association of Regional Center Agencies, regional centers have been working for some time to identify areas that can be standardized.

In addition to the areas identified in Senate Bill 138, ARCA is working on a standard daycare assessment tool to ensure consistent assessment of needs across the system. Standardization should streamline processes and free up time to do what regional centers are passionate about: building relationships with individuals and families, developing and implementing person-centered plans that contain a thorough assessment of needs and identify meaningful outcomes, creating new resources as well. All of these things are necessary to addressing equity. Senate Bill 138 also addresses generic services.

One of the requirements, as noted earlier in the Lanterman Act, is that generic services must be exhausted before regional centers can fund. For example, private insurance coverage and MediCal may have to be explored as funding sources first. However, for our individuals and families, knowing what generic services are and applying for those services can be another barrier to getting their needs met. Defining generic services and how regional centers will assist with coordinating them will be a huge support to individuals and families.

Identifying and tracking the use of generic services would be helpful in identifying how needs are or are not being met outside of regional center purchase of service. This understanding may further illuminate root causes of disparity. There are many complexities to the purchase of service data, but POS is only one measure of equity. We should be looking at other data as well to ensure we are getting a full picture of the challenges our individuals and families face.

The most basic question we need to ask: are your needs being met? Are you attaining your goals? Are the array of services regional centers offer sufficient to meet the needs of our diverse population? The addition of the self determination program, coordinated family supports, the expansion of participant directed services, the community navigator program and the restoration of social recreation and non-medical therapies are examples of the system's attempt to better meet the needs of the people we serve.

One of the most important things our system can do is to foster culturally sensitive relationship building between regional center service coordinators and individuals and families, keeping it top of mind that it is our individuals who are at the center of all plans, driving their plan with the support of family, friends, caregivers, and the regional center system.

Allowing service coordinators the training and time to develop thorough, person-centered, individual program plans and building efficiencies into the system for the paperwork side of the job is crucial in this effort. The standardization measures in Senate Bill 138 should support this. Improvements to the statewide database system, what we call SANDIS, can reduce time on paperwork and make data more expansive and reliable. As a state, building clear pathways for collaboration between agencies supporting our individuals would decrease the burden individuals and families now face to access whole person supports. Thank you.

Thank you all very much. Obviously, the issue of equity is so, so important. And one thing that I know that I've learned that in terms of equity: there's got to be--you can't nibble around the edges when it comes to dealing with equity. Because there's something about the systemic nature that has to be done with a sense of urgency, aggression, to be honest, to truly move the system in the right direction. So my question for the department is, what policies and practices have we've changed in order to hyper-focus on the huge disparity that we see in the Latino community?

Yeah, thank you, Dr. Jackson, for the question. I'll do my best to answer. There's a lot packed in there. So as a department, we have really prioritized looking at equity throughout our entire system and really looking at all the decisions that we make through the equity lens. For about seven years now, we've had funding for service, access and equity grants. Those grants are available both to regional centers and to community-based organizations.

Those grants have been really foundational to a lot of work that has gone on throughout the entire state and have really improved provision of information, engagement with families and individuals served, developing new models that we can then replicate throughout the state. For example, the navigator program--as I mentioned, we are translating the Lanterman Act into Spanish as a result of our community requesting that. So that work has been ongoing for quite some time.

Our department is also undergoing a transformation with regards to the regional center performance, their operations, as well as, you heard earlier, the quality incentive program. And there's equity built into both of those systems where there is both public recognition as well as funding incentives for good performance by service providers and by regional centers.

One example of that is looking at the language spoken by individuals who are served by regional centers, and then looking at the staff at regional centers and the languages that they speak, and trying to match those to some degree so that families and individuals served feel that they have someone who they can relate to. Oh, gosh. There are so many things that we're doing in the equity space.

Coordinated family supports, although there may be some who have not found it to be helpful--that was a service that was born out of hearing from our community, that families didn't want to be forced to place their adult children outside the family home. They wanted additional supports in the family home. And so we developed the coordinated family supports pilot program to provide that support inside the family home.

Yeah, I understand. I think all that is great. But I think specifically is, through my own studies, you know that in order to achieve some equity--and it's hard to achieve equity if your clients don't trust you. Right? All those things. So are you saying that each regional center has a Latino-centric program to specifically work on the issues facing Latino community?

I don't know if I would say that. I can't say that with all assurance.

So I would like to see Latino-focused programs that have been developed through that funding. Right? Because, again, you can't say this is an equity program, but it's not hyper-focused in order to move that forward. And so, if there are any, or even if there aren't, I would like to see a list of the regional centers and which ones have developed Latino-centric programs, to really move that needle. Right? Because, again, sometimes you got to say the stuff out loud, the hard stuff out loud.

But again, no matter how meaning a program is this, if it's not done, not in a culturally competent way, but a culturally specific way, then we are not doing everything that we can to move the needle. Right? So I just want to make sure that that request is there. I hear from constituents who are served by the regional center in my area, and there truly is a trust issue that is quite--it borders on traumatic in some ways. When I'm listening and I'm in the conversations, I hear, not just a sense of, well, "I don't know if they're going to really serve me the way I want them to." It's more of a, "There's a pain associated with this." And that's a different level than me going to the bank and waiting in line for a long time.

Right? Even though I might get violent that time, too. But anyway, but the idea is there's something more that I think we really, really have got to get to, because no matter how much money you pump into, again, all the well-meaning programs and initiatives and innovations you're trying to do, if the population doesn't trust you, you will not move the needle either. So my question is, what specifically is the department doing and what specifically are regional centers doing to build the necessary trust and real communication that will allow for that real movement to happen?

Can I speak to the regional center part?

Absolutely.

So I know at Kern Regional Center, but I also am aware that many regional centers have regular meetings with a representative group of their Hispanic communities. So, for example, at Kern, we have a group of families who actually have a nonprofit now called Padres Unidos, and we meet with them monthly to talk about these issues. Everything's on the table, whatever they want to talk about. A lot of times it's not pleasant, but we are there to solve problems, and that is what we all agree on, is that, yes, there's a lot of pain, there's a lot of frustration, but we're there to solve the problems and talk heart-to-heart about what we as a regional center can do to better meet their needs and to understand their frustration.

In addition to that, when we have programs like self determination, which we so desperately want our Hispanic community to understand so that they can make an informed choice about, "Hey, maybe this program would be really helpful to me," is that we regularly do in Spanish outreach, informational meetings to our Hispanic community. They prefer in person. I know during the pandemic, a lot of things were done by Zoom, et cetera.

Our Hispanic community has always preferred: "We want you to be there in person, talking to us in the same room." And so we do that. And as Brian mentioned, we have many staff who are Hispanic and Spanish speaking, and so we have no problem doing that. So we also have a very strong connection with what we call 'exceptional family center.' It's our family resource center. They're actually physically located across the street from us just by happenstance, but they are very focused on our Hispanic community.

And so through them, we work together regularly to educate, inform, offer trainings on anything, whether it's POS disparity, self determination, other things. They also have the community navigator program. So we meet with them very regularly, walk across the street and talk to each other whenever we need to. So we and other regional centers, I know, are doing our absolute best at Kern. Actually, the majority of individuals that we serve are Hispanic, so it is a huge focus for us.

So due to your focus, are you saying that that disparity does not exist, although there's a disparity statewide, that in terms of Kern, that that disparity with Latinos does not exist?

I am not saying that. I'm saying we are making every effort, but I absolutely agree with you that there is a trust issue, and it's not an issue that is always ameliorated by having a service coordinator who is of the same culture and language. It's a basic mistrust of the system, of the regional center itself. So we have a lot of work to do. That's what we're trying to do with our Padres Unidos group, and also by just opening an invitation to our entire community to please come to these meetings--doing everything that we can possibly think of to try to break down that lack of trust that exists between us.

But I think a big part of that lack of trust is just all of the bureaucracy that we deal with. And part of the issue of even rolling out new services that may be of assistance to our Hispanic community is just trying to get our service coordinators to absorb all of the new information that keeps coming at them. So it's a big picture. There's a lot of aspects to take a look at that can be improved. But no, we still have disparity issues. And we would love to see many more in our Hispanic community take advantage of the self determination program. The ones who have are very, very happy.

So can you just give me maybe two key actions you think can be taken, whether it's through the reallocation of dollars or a hyper-focus or tweaking on some of the other innovation programs. What are two key things you think can really move the needle?

I love your idea of really focusing on our Hispanic community, specifically with regard to services like self determination. We are attempting to do that at Kern. It is a strong goal of our self determination advisory committee. So we are doing everything we can to schedule in-person informational meetings, also contracting with agencies of independent facilitators who are Spanish speaking to hold these informational meetings to assist them--families with the actual transition process--to self determination, which, as Fernando said, can be complex. We have yet to see-

But, but I do have to say that at Kern, the self determination pilot program began in our eastern counties in Inyo and Mono. And so, many of the participants in our program currently came from that pilot program, from that very small population there that is largely white. So if we eliminate those, I would like to look at--the numbers are still small--so it'd be easy if we eliminate those individuals from the pilot program. How are we doing in terms of diversity within the new group of people in the program?

So what I'm hearing, and as I hear from the testimony here, there seems to be a lot of excitement around self determination program. And what I'm hearing is, is that that may actually, given the type of flexibility, honoring the helping profession's philosophy that the client is an expert in their own lives, that that may hold the biggest possibility to move the needle where we want to move. And it seems to me that this might be a program we should be looking at doubling down on. Am I headed in the right direction here?

You're exactly in the right direction.

Can I get an amen?

All three of our family members are in the self determination program, so we are big fans.

If I could have permission, to follow up on the point that I made earlier about assessment. I'll say this. Throughout my brother's life, whenever he had his annual IPPs, the way needs assessment was done for him was all in one meeting. In other words, a service coordinator who we may not have had much interaction, direct interaction with at all for the entire year, once a year, would sit down with us for maybe 90 minutes, collect some information, ask some questions, put it together, write down some goals and some services. Bam. It was enough to get services. But now, the first year that he was in self determination, he had a real, person-centered plan.

If I could show you these assessments side by side from the person-centered plan that he was able to get only once he entered self determination. It's a breathing, living document. You feel like you know who he is. It included not--it wasn't just taken from, like, one quick meeting per year. It involved almost qualitative-like methods where the person went out and talked to all these different people in his life, spent time with him on his own, without his family present, in places where he felt comfortable. She wanted to know what he was like, what he was interested in, and what he was like when he was just on his own.

That level of inquiry, it was just not something that is possible logistically right now in the traditional system, our service coordinators do not have the capacity, through no fault of their own.

And what I'm hearing is, if we use that type of philosophy, but direct it to our Latino brothers and sisters, that that might hold some promise. Would you agree, sir?

I definitely do agree. My son actually is in his fourth year. We were fortunate enough to be able to have navigated the migration process, from the traditional to the self determination. But what we do find is that there is tremendous amount of interest in the Latino community in self determination. But there are really a lot of, I would say, barriers that prohibit people from-

There's a lot of hoops, there's a lot of regulations, qualifications you have to meet in order to do that. So I'm hearing: making it easier, making it more of a straightforward process.

Straightforward process. And, if I may, Dr. Jackson, just wanted to expand on one key point. I know Michi talked about the parent group that meet and so forth, and that's really important. And Latinos, we know we do love to meet in person. But what we're finding out for true advocacy and be able to have an impact that we're looking at, that we're resorting to resources, especially digital platforms like Zoom, to be able to come together, because it's not just about training and information, it's about implementation. And that gives us a broader sense of community, engagement, interaction and the ability to support one another, peer to peer.

I believe that if we're able to capitalize on that type of technology, it'll also help facilitate programs like engaging into self determination.

Ms. Mark, you made a comment in regards to the regional center funding disparity, depending on which regional center, what part of the region. Are you arguing that if I am a client at one center, that I may be funded less for the same service?

If you get funded at all. So there are differences in the outreach that regional centers do. There's difference in the types of services that Vivian was talking about. They have these purchase of service guidelines and these rules. And in some regional centers, the rules are incredibly strict, so that nobody's going to get services. And in other regional centers, it's very flexible. I come from Westside--the two of us come from Westside Regional Center, and we are very grateful for that.

It has been a regional center that has--it's at the top of this list. They go above and beyond and they do what they need to do to get families, the services, the individual, the services they need. There are other regional centers that have historically just not done that. And unfortunately, Inland is one of those regional centers, where you are facing just systemic barriers. You have service coordinators who are very uneducated about what possibilities there are.

People are not informed that their rates of even intake are very low. I have to tell you, before this hearing yesterday, I was running some of these data on Inland Regional Center. And they are required by law to keep their data, their POS data by race on their website. And they were missing fiscal years 20-21. So I called to say, "Where is this? I need this data to give to this assemblymember." I literally tried five different numbers.

I could not get a hold of a human being at Inland Regional Center. And I wasn't in a desperate situation. I wasn't in a crisis as a family. I just need a little bit of data. Can you imagine if you are a family member in crisis and you cannot get a hold of a human being at your regional center? So the standards need to be much, much higher. But in addition--you could put lots more resources to get people to answer phones at regional centers.

Ultimately, it's not going to make much of a difference. If you are basing your spending on historic spending, Inland is never going to improve. Because inland has always funded people at very low levels and DDS provides funding to Inland based on what they spent last year. So they're never going to move up. So we have to look at the underperforming regional centers.

And I know this is not the year to ask for it, but we have to have a special pot of money to get these low performing regional centers just for POS to bring up their families, to bring up their individuals, to get the kinds of services that people like our children are able to get at Westside Regional Center. So it's got to be very targeted. And that just doesn't happen right now.

Mr. Winfield, when's the last time you have all updated the basic minimum requirements in terms of services and functions for regional centers?

I don't know if--minimum requirements? I mean, all regional centers provide the array of services that are in the Lanterman Act and they're funded based on individual program plan decisions. And that's how services get purchased throughout the system. So I don't know if there's necessarily a minimum standard.

It just seems to me that if this is the principal vehicle in which we're serving this population, we are using state funds to do it, and I don't think I've ever been in a meeting or a hearing yet that says that there's some level of consistency within regional centers, that the state has a responsibility to rectify that in a more meaningful and direct way. So I think my question would be, well, not would be, is--what is the plan to really rectify that?

Because again, I don't even think we can achieve equity if there's not a basic uniform process, goals, expectations that can be done universally so that we can actually have--so when we do have data, it's actually data we can rely on because there's a benchmark that we're all getting. You see what I'm saying here? And so, I think if there isn't, I'm highly alarmed. But it seems to me that--I'm not one to-

And the reason why I'm spending so much time on this, and I actually wasn't planning on it, but when you deal with issues of equity, you got to just go in and you got to sit with it and you got to just talk through it and try to figure out: what is those things we can do? Because it may not be five things, it could be two things. And those two things can go a lot further than those 10 things. You see what I'm saying?

I'm talking as a social worker here, so you're just going to have to deal with me now. But I think this is one of the greatest things we can do to be proud of. And it's my hope that we can begin to. To hone in to some things so that we're all talking the same talk. Sometimes we're not talking the same talk, right. And we're making the same steps together.

No matter what part of the state you're in or no matter how we're budgeting, that we're all marching together and we can understand why something is working and why not something is working and it shouldn't depend on who's being served by which Regional Center. Right? So I don't expect you to have all these answers. I probably gave you 10,000 different answers. I mean questions, some of which I no longer remember. I even asked you.

But I think the idea is that I want to start having more meaningful discussions about this. Right. So that we don't keep finding ourselves here having the same discussion. Now, I know the report just came out last year. I was in that hearing in terms of talking about the equity. And so I want to make sure that we're just not assuming that we're going to make progress, but I don't want to be here five or six years later saying what happened. Right. Right.

And so I appreciate you. Any thoughts?

Yeah, I think as I testified earlier, a lot of work has been done within the entire system with our system partners, but there is certainly much more work to be done. And we talked earlier about the respond assessment that we are developing. As Dr. Gates testified, there's a daycare assessment tool that ARCA is also working on. So there's some standardization that is going on in the system that will be helpful to sort of level the playing field.

The other item that I think isn't necessarily part of the discussion around the types and amounts of services a person gets, but it does play into the total purchase of service, and that is the implementation of the rate models, because the rate models bring about a degree of parity throughout the state and have some built in geographic differences in them. So that will also assist us in looking at apples to apples.

So lots has been done, but there is certainly much more to do, and we are more than happy to pull up our boots and work extra hard on this particular issue.

Madam Director, I know you can't--I'm sorry, I didn't see you from the--I thought you were security or something, you know. Come to take me away.

Not a chance, Mr. Chair, and I apologize for kind of sneaking in, but this is an extremely important conversation, and I just didn't want to be left out. So thank you. And I just want to just express equity and access. And absolutely, within each of the race, ethnicity we know, even within language, these are urgent issues. And I just want to share and just kind of reiterate what Chief Deputy Director Winfield is saying. We welcome those conversations.

And absolutely, the geographic differences have been a long standing issue as far as expenditures. And there's not one solution to fix such an important and systemic issue that is deep. And it's not just within Developmental Services, it's access to other systems. So we have to understand, like you said, we have to get into that conversation. The rates is certainly going to help because that was absolutely put forward because of those inequities between the geographic differences.

The SB 138 is an important piece of legislation that happened last year because it does start identifying those standardizations of saying, hey, we recognize there's 21 different ways, and sometimes there's actually even more than that. I don't know how that happens, but it does. So we need to standardize those experiences. We're doing the intake process, making sure we're standardizing intake.

We want to make sure that, because we do know that communities of color absolutely have entered in too, and timely access to services at intake has been slower than the white community. We know that we need to make sure that we're doing culturally responsive approaches to doing those things. These are just some examples, but I just want to kind of share in the conversation as saying we are fully committed as a Department, raising the urgency, continuing the urgency, and listening to the challenges that families face.

The trust issue? Absolutely. We have to talk about--these are really embedded sometimes in kind of those core relationships at a local, but we have to take a look at it from a state perspective. What are we doing to hold accountability? What are the things we can do to affect those changes? So just kind of my way to say this is an important conversation. Thank you for taking the extra time on it because it is so critically important and we're in it boots up.

We're ready to go because not getting access to a service that is so critical early on could have a lifelong impact on an individual and family, and we can't have that happen. I'm not punting to the master plan, but that is one element to make sure that we're doubling down. But I'm not giving up, even on our current initiatives to make sure we're affecting change, because it's absolutely the priority, and it is one that I have personally taken on.

You know, in order to be successful in this work, and I think it's important for everyone in this room to hear this, and that's when you're going about this work and especially sensitive subjects like this. This really has to be done in the spirit of love and respect. And although we're talking about heavy situations, we're talking about mistrust and all those things, it's not my hope that it bring forth anger, but it brings forth a moral imperative that we can all share together.

And to say, to tell you the truth, I mean, we're dealing with humans, it's messy. Whether you're a client or a provider, if you're a human, you're messy. Some of us clean up a little better than others, but we all have bad days, too. And so I think the question becomes, how can we help each other be successful, right? And as we're engaging even in these tough questions, yes, it may feel uncomfortable, but if it doesn't feel uncomfortable, then we're not doing what we're supposed to do either.

And we'll never get to the solution. Right? So just know I appreciate everyone in this room and to be able to have this discussion in a way that hopefully will continue to continue to bend that arc towards justice. Right? Anyway, church is over. Where's the collection plate? Go ahead. And then I actually have to get back to my script.

And I'll be extremely brief. And thank you for sharing about love. And from love comes respect and trust and all of the things that are important. Speaking on behalf of our community, we're looking to help the system help us. And I got to be honest, Director Bargmann, from day one embraced the idea of creating the Integrated Community Collaborative, an outreach model that empowers individuals. And behind me I know is Mr. Cruz and him and his team work with us day in and day out. There is love.

I mean, we've got our boots on as the community is. We just have to figure out how it comes together. And I like that analogy about that road, the pathway. I think it's there. We just have to figure out how to put it together. Thank you.

Thank you for that.

I would like to request that the information that was provided for this agenda, and we certainly thank for receiving this information, but we would also like it to be included as a regularly written update in the quarterly meetings that are conducted with legislative staff pursuant to the statute to assist in tracking, number one, the steps toward implementation of the equity changes that were instituted in SB 138, Chapter 192, and then, number two, the progress, or lack thereof, and complicating factors in narrowing and evaluating disparities in the development services system over time.

It's important to understand that it actually is written in statute that this Committee receives quarterly updates, and it's going to be very important that we make sure that we are following through with that. Is this amenable to the Administration?

Absolutely. We appreciate the opportunities to meet with legislative staff quarterly to provide updates and have a dialogue with them, and we'll be happy to have a conversation about what additional information would be helpful.

All right. I appreciate everyone. We'll move on to the next issue.

Thank you.

We're going to take a three minute recess. I told you, this is a marathon. Three minute recess. And we'll be back shortly.

Okay, we're going to ask people to begin to take their seats, please.

If. Everyone can take their seats so that we can keep going. Want to catch at least one Netflix episode before bed?

I'm sure there is one more.

I can't remember who it was, though. And it was you, Ernie. Me?

I think there were six.

Yeah, I thought so. I know. I'm like, I think there's more, right? Like, who's on this one?

Bring this.

Leave it on high note.

Hearing back to order. We are now on issue number 7, regarding social recreation and camp service implementation oversight. We're going to start picking things up now, and so I want to remind all of our panelists as well. You have five minutes. Five minutes. Five minutes.

And then we will continue on with the rest of our hearing. I want to thank everyone for hanging in there, but your presence is so important and so Department can begin when you're ready.

Hi, good evening. Ernie Cruz, Department of Developmental Services. So, first question, what have been the issues with the restored implementation of social recreation and camp services? The issues with restored implementation of social rec and camp services include one rebuilding the pool of service providers providing social recreation. Previously, services were provided in segregated social recreation and camp settings.

Regional Centers have needed to work within their local communities to secure inclusive providers who are willing to provide a vendor, who are willing to become a vendor and or use financial management services, who can handle the billing for the families. The Department identified and provided specific documents to Regional Centers that Regional Centers are to use when vendoring social recreation entities to facilitate and expedite the vendorization process. That's the process of becoming a service provider with the Regional Center.

There are social recreation entities, there are some social recreation entities that have not been interested in becoming vendored with the Regional Center due to possibly being paid in arrears. Regional Centers responded with proposals to use financial management service agencies to pay for services, which eventually led to social recreation being added as a participant directed service. Tracking purchase of service for social recreation and camp has been a challenge. The Department instructed Regional Centers to use a specific sub-code for purposes of tracking purchase of service expenditures.

Payment process and paying in arrears was also a challenge. The Department addressed this issue in correspondence to Regional Centers. The Department provided direction and clarification about the timing of payments for these services or subscriptions which can be paid ahead of the service starting. Lastly, there's been some ambiguity about what social recreation services can be purchased by the Regional Center.

Good evening. Brian Winville with DDS. The second question is, have these issues been resolved and what issues or areas of concern remain? DDS has been engaged with our community around the various issues that Regional Centers have encountered. That's why we have issued two directives to Regional Centers to clarify the statute and to provide direction to the Regional Centers about purchasing, social, recreation and camp. We also issued the information around the vendorization and are helping to streamline so families can get services through participant directed services.

Are there issues remaining? We are certainly open to hearing issues that come from individuals and families in our community, but at the current time, we're not aware of issues that are being faced. We are reviewing Regional Center's purchase of service policies for compliance with statute, and those are currently some have been approved, some are under review, and that process is ongoing. Lastly, would implementation be improved by clarifying underlying issues and legislative intent in Trailer Bill in the 2024 budget?

The Administration is not proposing Trailer Bill Language, and I would note that current statute does have a provision where the Director of DDS can issue a directive to Regional Centers if there's need for additional direction or clarification. Thank you.

Department of Finance

Chris O'Neill Department of Finance, nothing further to add.

Legislative Analyst?

Karina Hendren LAO, no comments to add at this time.

Okay.

Thank you, Dr. Jackson and Subcommitee Members. I'm Vivian Haun at Disability Rights California. Already? Really?

We told you we gonna start going quick. You thought we were playing.

Gotta be on it. Last weekend, I and some others in this room went to a memorial service to honor the life of a remarkable man who died last month at the age of 68. His name was Howard McBroom. Howard had autism. He'd been raised by a single mom and had no living family members left after she'd passed. Howard had been living on his own for the last two decades. But if you think Howard died alone, you'd be wrong.

His service was full of people who loved him, staff, co-workers, former service coordinators, and so many friends, some of whom had visited him in the hospital and held his hand at the end. When he was young, Howard struggled to be accepted, but that turned around when he got a job as the manager of his high school basketball team, where his teammates adored him, made sure no other kids gave him a hard time when they were around, and went on to become lifelong friends.

Later, Howard would say that getting to be part of that team saved his life. Some of you may know what that's like. I know I do. Which is why there was so much hope when the Legislature brought back social recreation and camping services three years ago, because social recreation isn't just about giving somebody an activity to fill their time or a momentary chance to socialize.

It's about helping people find a way to belong, to join with others around a shared goal or interest, and build relationships in the process. In short, it's about providing someone an opportunity to find their people. Our system talks a lot about the importance of having what's called a circle of support, a network of folks who care about a person and can help them out in everyday life.

Sometimes we call these people natural supports, and we lean on them heavily, not just to provide unpaid caregiving or to save on costs to the state, but to keep people with disabilities living in their community. Social recreation and camping services help people with intellectual and developmental disabilities cultivate those circles. But people, and especially children with disabilities, have had a hard time getting them, too hard. Some Regional Centers would only give it to you if you gave up hours of other services in return.

Some would only pay up to $100 per month and no more. And that includes your local Regional Center, Dr. Jackson, Inland Regional Center and some Regional Centers said in their policies that they generally wouldn't fund social recreation for children at all, since they considered that to be a family's responsibility. Here, I want to thank and give credit to the Department who recently worked with DRC and heard our feedback as they developed a new directive to Regional Centers to help clear up some of these issues.

We appreciate the collaboration, but written guidance alone won't be enough. We'll need more specific language in statute and in the DD waiver to define social recreation and be clearer about its scope and purpose, for sure. And we need to find less burdensome ways for nontraditional providers who aren't vendors like boys and girls clubs and local recreation and parks departments to get paid when they need to be.

But most importantly, we need to make sure that folks across the system, from service coordinators to the hearing officers who decide complaints, understand what's most important. At the end of the day, if our policies, practices and decisions aren't prioritizing helping people to be less alone in the end to connect with others who could love them and be there for them, then I don't know what we're here for. Which brings me back to Howard.

Howard often said that the life he got to live, full of love, purpose and self determination, would not be possible without the Regional Center System. In many ways, Howard's story exemplifies the very best of what a Regional Center can do for someone, which is why it's only appropriate that the Regional Center, Howard belonged to was the one named for Frank D. Lanterman, the man whose vision for a more inclusive world is what unites us today. Thank you all, and thank you, Howard, for showing us the way.

Daniel, would you like to go next?

Of course. Good afternoon, everyone. My name is Daniel Antunes, and I'm honored to have the chance to share with you today why access to social, recreation and camp services is so important to me and countless others like me. As a 17 year old senior in high school served by a Regional Center, I can't stress enough how much this program has impacted my life. They've provided me with a sense of belonging, growth, and invaluable experiences that have shaped who I am today.

Firstly, let me tell you why social, recreation and camp services matter to me and have changed my life. I have made friends, and I feel included that I can be with others in teams like the one in my school. I am a student who has tried very hard to be a part of the varsity team in my high school, and at first I was very depressed because I wasn't completely accepted. But now I am making friends who support me.

I feel included, connected, and have personal development. For someone like me, who faces challenges due to my disability, these services offer a safe and supportive environment where I can participate in activities, make friends, and simply be myself without judgment. Under recreation and camp, under social, recreation and camp, I've had the opportunity to do so many things that I wouldn't have been able to otherwise.

From outdoor adventures like hiking and camping to creative activities like arts and crafts, these programs have opened doors to experience I have never thought possible. They've shown me that my abilities far outweigh my disabilities and have given me the confidence to pursue my passions. I am actually on my high school's varsity wrestling team now. Moreover, participating in these programs have taught me valuable life lessons. I've learned about self discipline, teamwork, and the importance of perseverance.

Whether it's working together to solve a problem during a team building exercise or pushing myself to try something new, I've grown immensely as a person thanks to these experiences. One of the most important lessons I've learned is that it's not just about me. It's about being a part of a team and supporting each other to succeed.

Whether we're playing sports, working on a group project, or simply spending time together, I've come to realize that the power of collaboration and the joy that comes from helping others thrive, being able to contribute to the success of my team has been incredibly rewarding. And has taught me the true meaning of empathy and camaraderie. Lastly, I want to emphasize how much I love being myself. Social recreation and camp has provided me with opportunities to develop confidence, engage with my community, and embrace my uniqueness.

These programs have shown me that my disability does not define me and that I have so much to offer the world. And don't get me wrong, it wasn't easy to get the social recreation services, but thankfully, I have a strong circle of support who advocates for me. I'm happy for me, but I am a Member of the ICC Young Advocates for Change Self Advocate Group and I know there are many other of my friends who still do not have these services.

I hope soon they receive the help to do what I do. Please do everything possible so that others like me can have better access to social recreation and camp services so that their life can change for the better. Thank you for listening.

Mr. Antunes. I want to let you know how important it is for you to be here and how you're the most important person on this panel. Don't tell the others, though, but I really appreciate you. But I do have one problem. I was in wrestling, too, and I never got that kind of letterman jacket. What size is that? We're going to have to talk after this hearing. I'm going to get my letterman jacket tonight. I appreciate you.

Thank you. Great job.

Thank you.

Thank you. Thank you, Dr. Jackson and Subcommitee Members for giving me a moment to talk to you about social recreational services. My name is Patrick Rupee. I'm the Executive Director at Harbor Regional Center, and Regional Centers were thrilled when, after years of advocacy, funding for social recreational services was restored back in 2021, our community was very excited to hear the news and that Regional Centers will be able to fund again, and our staff were even more excited.

One aspect of the restoration of funding that was a significant change from prior years was that this restoration of funding was to support social recreational opportunities that promote inclusivity. In the past, vast majority of the social recreational opportunities that our community had access to were segregated sites or programs where people we serve only had the opportunity to engage with others with disabilities.

With the new mandate to fund, Regional Center staff were excited to assist individuals in exploring opportunities that may be available to them in the community. Even though we're excited to fund these services, it was a challenge to restore the program. It's like putting the wheels back on a car that's been broken down for 10 years. And I like to categorize these challenges in really three broad categories, resources, administrative, and education. Under resources.

We've heard a little bit of discussion about the fact that there were not available providers in the community, at least that were vendored through the Regional Center. Many of the providers were no longer business, they stopped 15 years ago. The ones that were still in business were segregated sites and they would not really meet the goal of funding for inclusive sites for our individual served.

We also heard the discussion about some of the providers that are in the community having an issue with our vendorization, and Department has taken steps to help overcome some of those barriers. But there still are challenges in the community where the providers are trying to access the funds directly from the family as quickly as possible. I know when I have my own experience with my children, I pay up front right there.

Some providers don't want to work with the Regional Center and so we're working through barriers with the FMS agencies and with the families to overcome those barriers. But it still presents a challenge when it's a third party coming and paying them. They don't want to work with us necessarily. Administratively, Harbor Regional Center did not have policies in place that outlined our philosophy or purchase and practices related to social recreational services. What can we fund? How much can we be funded? Will there be limits?

Moreover, when can an exception to the policy be made with regards to education? We have to remember a good portion of our community that we serve now, as well as our staff that are on our rosters at this time were not working at a Regional Center or served by a Regional Center the last time we funded social recreational services. This lack of knowledge initially limited everyone's perspectives on what is possible through our service system. How has Harbor addressed these challenges?

Number one, to increase the resource pool individuals and families could access, we've had to be very creative in our funding. As we've heard from the Department, they've given us some authority to be able to pay upfront when the family may not be able to pay. That's taken off a load, but then there's workload on the backside for our staff and I'm going to go in a little bit numbers in just a minute or two about the increase of social record over the last couple of years.

Another exciting development was the FMS services that we discussed earlier, financial management services coming in and be able to pay, get the receipts from the individuals and so that we can reimburse the provider in a more expedited manner rather than having the provider be vendored through the Regional Center. Using FMS in this manner will substantially increase the service possibilities available to our community.

And we're excited about that opportunity as we work through vendorization with FMS agencies at this time administratively, our board approved a policy back in 2022, and this was submitted to the Department. It was reviewed and approved by our board. We submitted it to the Department back in 2022. It was reviewed by the Department, it was approved by the Department. But recent directors have recently come out saying, hey, there's been a change in statute. We need some minor modifications made to your policy.

And at this point in time, we're in the process of revising that policy and we'll be taking to our board at our March board meeting. And I know our board will be fully supportive of the changes in the policy because they want to make sure that we're serving our community as effectively as possible. To address the educational barrier, we have been on a role hosting webinars, Zoom meetings every chance we get that we're interacting with the public.

We're discussing social recreational opportunities and the fact that we can fund those. I think it's still getting out there to the community of like what is possible and even to the staff. I think it's still getting out there what is possible. There's sections under statute that says there's parental responsibility. We are actively working with our staff to overcome that misunderstanding in relations to social recreational.

Not to say that there's not parental responsibility, but that Regional Center has a role to play in funding these services and supports for individuals that are served by the Regional Center system. And that actually goes a little bit over and above, I believe, what we would consider typical parental responsibility for a non-development of a disabled child. How have these efforts impacted our community? We have seen the number of individuals receiving funding from harbor increase from a little over 100 in the first fiscal year.

Social Rec was in place as we were trying to get everything in place. Then last year we had over 2000 individuals serve social Rec, and this year we're on track to nearly double that. And again, like I mentioned, there's some workload issues that come along with that volume of increase on the back end, on the accounting side, processing the payments and processing the vendorizations for families for one time reimbursements. It's a workload for everybody involved.

And so we've been working through that, though we also see individuals access an array of services such as horseback riding, kickboxing, karate, taekwondo, swimming, music lessons, art lessons, gymnastics, baseball, soccer, basketball, tennis, summer and science camps, acting classes. The list is almost limitless on what families have been accessing through Harbor Regional Center and I would like to say probably across the whole system as well. So as families are asking for services, we are responding in a positive manner. We are taking those agencies names.

We're reaching out to contact them to see if they'd like to be a service provider of the Regional Center. And like I mentioned before, some choose not to, but we work around that and work through the FMS agency or reimbursements through families if they have that means possible. One thing I would like to highlight that Harbor was very lucky to participate in last year was a grant that was allocated to address social recreational services statewide.

The grant allocated 4 million to Harbor to Fund activities across the state through two agencies that are embedded in our communities. Already everybody will know these agencies, the YMCAs and the Boys and Girls clubs. The California State Alliance of YMCAs received 2.5 million and the California Alliance of Boys and Girls clubs received 1.6 million in grants, the Alliance of both entities distributed their funds across their local affiliates, so every local affiliate had the same opportunity to apply for a grant up through their state alliance.

Not all of them were accepted. Some of them were not really hitting the target that we wanted the grant to address.

And the five priorities that we really wanted the grants to address were to create, reestablish and or enhance existing programs that are inclusive of children and adolescents with intellectual and developmental disabilities, support development of friendships between children and adolescents through integrated and inclusive programs and activities, hire and train staff to ensure the provision of adequate support for children and adolescents with complex needs, support communities with cultural awareness and sensitivity by enhancing language access and cultural competence within the social and recreational programs and activities themselves.

And then the fifth one was to develop and vendor inclusive social and recreational programs that apply person centered and family centered practices. While we wait for the final reporting from the alliances, we have been happy to see that we've heard reporting back informally at this time increase in local affiliates capabilities to provide assistance and materials in more languages, including American Sign Language and Spanish, and that concludes my statement. Thank you.

Thank you very much. I think particularly in terms of these issues, I think the more communication and check ins the better. And so I think on most of these items you're going to hear the constant request, let's do some check ins, let's meet quarterly, right? Just so that we are able to hopefully be as supportive together to make sure that we're making each other successful.

So I would like to request that the Administration and ARCA together report back on trends and barriers in the utilization of social, recreation and camp services. Starting April 1 2024 recognizing during the great recession, this is one of those programs that was basically obliterated. Right, and so now we have to build this baby back up, and so we recognize that this is going to have to be a team effort to do so.

And so if we can get a report back on these trends and the utilization of social recreation camp services starting April 1, that would be great. And of course, if there's issues with the deadline, just about communication, and then of course we would like to have regular reporting on a quarterly basis on this as well. It is our hope that this reporting would include the indication of issues and misunderstandings in the implementation that are maybe creating barriers to the services for family, for families.

The reporting should also include the input of the regional central liaisons as the on the ground state presence at Regional Centers who are intended to assist with communication and clarification of state policy for the provision of Developmental Services. The Committee also sees the need to clarify some of the statute as well.

And so we are asking that the Administration engage with the Committee and stakeholders to craft some clarifying Trailer Bill Language in terms of the social recreation and camp services policy, aligning to the extent appropriate with the clarification and the DDS directives, and that captures more explicitly legislative intent for the availability of these services. It's our hope that we can draft a consensus or as close as possible with Trailer Bill Language. And again, we want to accomplish this by April the first.

Is the Administration willing to engage in this process with us?

We're absolutely happy to have the conversation around what information is needed, yes.

Okay. What about the Trailer Bill Language?

Sorry. Chris O'Neill, Department of Finance. Mr. Chair, I think as Mr. Winfield articulated earlier, there is no Trailer Bill Language associated with the Governor's Budget. And I think it would be the administration's position that the directive authority maybe makes needed changes more nimble when they need to occur. So we would be glad to have more conversations on Trailer Bill Language itself, but that would be the position of the Administration right now.

Okay.

Thank you for that. We do want to make sure that we actually have more explicit conversation on this to see if maybe we can make this a win-win for everybody if possible. But thank you so very much. I want to thank this panel, especially Mr. Antunes. Thank you for you. You have made the panel worth doing. All right. Thank you so much, panel. Thank you,

It's got a lot to learn still.

We want to bring up issue eight, individual program plan and individual family services plan meetings. This is the governor's Trailer Bill proposal will. I just want to bring everyone up.

Administration. You may begin when you're ready.

Thank you. Good evening once again. Brian Winfield with the Department of Developmental Services. For issue eight, the first question is, what do panelists recommend for the continuation of IPP and IFSP remote meetings? We believe the triable language proposed by the administration strikes the right balance. Remote meetings serve an important role, but we all benefit from face-to-face interactions with each other, especially since service coordinators and individuals served by families develop lifelong relationships.

We do not want to limit choice for people, but meeting in person helps build relationships, and it helps build the trust that we all talked about earlier is so important in that relationship between the Regional Center and individuals who receive services. Meeting in person also facilitates a more accurate evaluation of needs and services that can benefit individuals served and families.

The proposed trailer bill language allows another individual or advocate to join an individual program plan meeting remotely, which makes it easier for them to join the meeting. This can help individuals receiving services and or their families to feel more supported in the conversation. For children in the Early Start program, the Office of Special Education Programs extended flexibility for individual family service plans to be conducted remotely when face-to-face meetings were not feasible during the pandemic.

Federal regulations emphasized the need for conducting initial and annual IFSP meetings being conducted face to face and at times and settings convenient to the family while providing flexibility for semiannual reviews of the individualized family service plan. What is the optimal policy scenario for remote meetings to maximize access for harder-to-serve, isolated, and disadvantaged families and individuals with intellectual and developmental disabilities?

Again, the proposed trailer bill language specifies the IPP meeting must be held at a time and location convenient for the individual served or family, which removes barriers. This could mean that meeting could occur during lunchtime, it could occur in the evening when the family is available, and it can also occur in the family's home, but it can also happen at another location that is convenient for the family's choosing. So, we believe the trailer bill language meets all of those requirements. Thank you.

Department of Finance.

Chris O'Neill, Department of Finance, nothing further to add.

Legislative Analyst

Karina Hendrin, LAO, nothing to add as well.

Good evening again. I so appreciate the opportunity to speak to this issue. Will Leiner, with Disability Rights California. Chair and Members, we find ourselves at a critical juncture with this issue because, without action, the statutory option for remote IPP and IFSP meetings is going to go away. It's going to expire on June 30. It needs to be preserved. The ability to conduct these meetings remotely, which started as a necessity during the pandemic, has proved invaluable, even beyond safety.

The remote option has enabled broader participation from loved ones, from supporters, from advocates, and it has helped countless people and their families overcome barriers such as disability, distance, transportation, childcare needs, difficulty taking time off work. It's also helped people who are afraid. In short, it has increased access to our system. And instead of preserving this option in statute, the administration's proposal threatens to narrow access, favoring in-person meetings using the rationale that this fosters trust.

And don't get me wrong, we agree that building trust is important and that in-person contact can help cultivate it. But let me also say this trust is earned through mutual respect. It's earned through offering and then following through with support. It's earned through people feeling seen, and it's earned by saying yes to services and breaking out of a culture of no. These are the things that build trust and a proposal that makes in-person meetings a priority without affirmatively safeguarding the remote option. That's going to have the opposite effect of building trust. People are going to feel like their choices are being taken away, their choices about how they want to have their IPP meetings. And we've already seen this happen with our clients, even with the statute, with how it is today, who are being told by Regional Centers that in person meetings are now mandatory, no exceptions.

In one case, this came through our intake line just last week; a client was told they had to fly from Northern California to Southern California for their IPP meeting at their own expense. This doesn't build trust. It breaches it, it breaks it, and it demonstrates why it's not enough for the administration's proposal to just be silent about remote meetings. Getting this balance right is too important to be left entirely to Regional Center local control.

The push for in-person meetings also risks marginalizing those for whom in-person requirements aren't just impractical but can feel impossible. I'm thinking about people with IDD who have very complex support needs and who are already forced to navigate intersecting challenges across multiple systems. I'm thinking about people served by the child welfare system, by the criminal legal system, by our behavioral health systems.

These are people who experience crisis with greater frequency than anybody else, and for whom gathering meeting participants in one room is challenging, even under the best of circumstances. And I heard Deputy Director Winfield talk about, well, advocates can just join by Zoom and people can be in person. I think we've all been in Zoom meetings where you're joining by Zoom, everyone else is in person. Maybe you can see the room. Maybe you can't see the room. People are having side conversations. When everyone's by Zoom, that's kind of a great equalizer in how people can participate in those the discourse around remote meetings versus in-person meetings. It's not just theoretical. Other Cal HHS programs have developed entire telehealth policies to get this balance right. We can look to CalAIM, for example, just one example where care managers, they're required to develop individualized plans that list out people's services. It's kind of similar to an IPP.

And while care managers, yes, they're expected to have some face-to-face contact, in-person contact, they also need to pivot to telehealth when it's necessary to respect choice, cultural preference, access to these meetings, and this type of intentional flexibility, which is absent in the current trailer bill proposal, it's not just a convenience, it's a cornerstone of equitable service delivery. It's how people access their meetings, access their services.

And it also begs the question, if remote access hasn't been embraced by other health and human services agencies, why should people served by Regional Centers deserve or entitled to be entitled to less? So, in closing, there are real lives that are being impacted by these decisions, people whose access to support hinges on the flexibility and inclusivity of the remote option.

So, we have to say we are pleased by the staff recommendation to keep working through this issue, to keep talking about this issue in ways that preserve this option, and we look forward to engaging in that conversation. And thank you for the time on this panel. Happy to answer questions.

Yes, good afternoon. My English is not very well, but I'm going to try my best. My name is Rubi Saldana. I'm a partner of three wonderful, special young adults served by Regional Center system. I'm also a co-founder of Integrated Community Collaborative. Over the past 18 years, I have tirelessly advocated for my children and hundreds of others families in navigating a complex and intimidating Regional Center system.

I'm here asking you, please hear me and know that I am speaking from the bottom of my heart, as well as on behalf of many other parents like me. Please, let's not let the option for remote ITP meetings expire in June of this year. It's crucial to upload the legal rights of clients and families to gather together in Zoom meetings, ensuring their safety at home and safeguarding their medically fragile children.

Removing this option will infringe upon their dignity, force them to miss work, incur travel expenses, and make them uncomfortable with visitors in our humble homes. In addition, in IPP, it's imperative that families have support from advocates and circle support. Ultimately, let's respect their fundamental right to choose what is best for them. Every person should have the right to choose. Navigating the Regional Center system is intimidating, and when you factor in language and cultural diversity, it becomes nearly impossible.

For families who opt for remote IPP meetings, it means having someone you trust and need with you. It also enables participation from family members, mostly dads, who now have been able to also attend the meetings. Family and sickle support who may be at work in a different locations are now in the same meeting. Hybrid meetings do not work, we know, because it has proven chaotic, and the clarity of the meeting is completely lost. Therefore, that is not a good option.

Remote IPP meetings are more productive, less expensive for staff and are better attended. We have heard the argument for the importance of having eyes on the child and building relationships through in-person IPP. In-person, meetings have been like this for years, and that hasn't earned the trust of the community, in the contrary. That's why I do not believe that to be true. Eyes on the child for my community means invasion or a fundamental rise to our culture and belief.

We typically feel uncomfortable and our privacy invited. Having people in our homes, we feel controlled, exposed to abuse of power. In my culture, trust is not something to be forced upon but earned. If system, who are very intimidating wish to build relationship, they need to make service coordinator more human and not be the same people who also deny the same services we came asking for. They should not be the person who also talks to the clinical team and tell our whole life to others.

They should not be the ones to upload denials and bridge the truth we have placed on them. Do not blame the families for not trusting. Retaliation usually comes to us from exactly the same relationship. You require to trust White, Black, Asian or Latino lack trust of the system. Our community faces numerous challenges, and it makes no sense to impose future burners on our families. This inflicts the system issues within our system, which prioritize compliance over person center approach.

In fact, I believe that by taking away this option, you are actually creating more barriers and distrust in the system. My voice here today echoes the sentiments of 10 of thousand of mothers and family members who plead for their voices to be heard. There needs to be acknowledged and to be generous partners in improving the system that serves us. Despite inviting us of initiatives or directives and well-intentioned efforts, we find ourselves at the crossroads facing the potential removal or something pur communities has deeamed and beneficial. It feels as though our voices are being disregarded and silenced, and changes are being imposed upon us as always. Unfortunately, this is an all too familiar feeling for many. I hope these comments that I present in true transparency and their eyesensary and real emphasize the importance of no soon setting remote IPP meetings. However, my question to you is, does our voice truly matter? My voice truly matter because I have been after you.

I know if you remember me, but I have been there with more than 30 of your constituents begging you for the same thing. I hope so. I hope that matters. I want to believe that matters for you and for us. In summary, I'm not English speaking, but what I want to beg you is please give our community the right to choose. Don't take away that right. They have the right to choose, not being forced like always. Thank you.

Thank you, Chair, Members, staff of the committee, for the opportunity to address this issue. My name is Lori Banales, and I'm the Executive Director at Alta California Regional Center. And while I've been the executive director for the past two and a half years, I am not new to the system. I have worked in a variety of capacities at Alta California Regional Center for nearly 30 years, starting off as a service coordinator, program manager, and director of client services.

Over the years, I've participated in many IPP meetings and have direct working knowledge on how best to gather information and assess for service needs. The IPP and the IFSP are foundational to the Lanternman act. It reflects the services and supports through the planning team process to identify the strengths, ambitions, and support needs of an individual and their family through a person-centered process. There are many advantages to meeting in person.

Face-to-face visits provide the client, family, and the service coordinator an opportunity to build rapport and to establish trust, and we've heard a lot of the need to do that in many testimonies across many panels. Today, relationships are at the center of the service system and, simply put, are easier to develop and maintain when meeting in person.

Being in person allows the ability to conduct a thorough environmental assessment through observation, observing the individual in their natural environment, observing the interactions between family members and friends who might be there, getting a sense of how the individual moves around in the space. For example, are there mobility issues or limitations that a durable medical equipment assessment could be helpful to address?

For example, there have been many opportunities where our staff have gone in without an individual knowing that the family was carrying an individual around the home, and so an overhead lift system was assessed and put into place for safe transfers. Bathing systems could also be put in place to allow for safe transfers and a better system all around.

Oftentimes, we go in, and we see somebody who is a wheelchair user, and we're able to see, "Oh my goodness, that wheelchair is no longer adequate to meet their needs." Are there behavior supports that could be available and a benefit to the family that perhaps we wouldn't be able to see in a Zoom meeting? All of these things really do speak to the need to be together, but I do want to underscore the importance of building that relationship and building that rapport and trust.

Ultimately, you're right; it is earned. But there are a lot of opportunities that face to face meetings help to facilitate that opportunity. In some cases, families report, when we're online, when we're in an inbox one-dimensional meeting, that everything's good, everything's fine, but through an in-person observation, the service coordinator, as I just mentioned, is able to do this environmental assessment and may identify potential areas of need that wouldn't otherwise be identified.

From the observations, the service coordinator will suggest service options that could benefit the individual family and that, like I said, may otherwise have been missed. In many instances, there are individuals and families that don't know what is available or what their services could be, and it helps to enhance their life if we're able to be able to be in that space with them and to offer those services. When limited to a remote assessment, these needs may go unidentified and essentially unmet.

And being in the home is ideal for conducting these assessments. But absent that opportunity, the Regional Center understands that individuals and families may not be open to hosting a meeting in their home. And in those instances, the Regional Center still leans into the value of a face-to-face meeting but will look to the individual to identify a place that is convenient for them, a place that they feel comfortable.

Oftentimes, our service coordinators will go to a child's school and pair the meeting with maybe the end of an IEP meeting, or if it's an adult that served in our system, going to their day program, going to their place of work if that is accommodated. Many people come to the Regional Center or a place in the community, like I said, that they've identified comfort in the location of the meeting can be anywhere that they choose.

Regional Centers are also very flexible in their ability to schedule the IPP or the IFSP meeting at times and locations that are best for the individual and or their family and in supporting access for advocacy. We certainly want to work with the entire planning team, and we know that the advocacy partners are essential to the family, to the clients served, and helping them to get their needs met. We invite those opportunities.

It is not unusual for our service coordinators to schedule meetings outside of their normal work hours. People get up very, very early to get to meetings that happen prior to an individual's workday, or they may work later in the evening. We also have projects that are currently going on and supported through ARP funding for Early Start in meeting on nontraditional work hours. So, meeting on holidays, weekend hours, and we're finding that there's a lot of great data supporting access and the ability to serve people, and this is through the service provider system. But it doesn't limit the opportunities for service coordinators also to meet in different times and spaces. Regional Centers are very supportive of recognizing and being sensitive to what families are wanting, but we're also recognizing our need to be able to fully assess what opportunities could exist.

And on a remote evaluation, there's just a lot of things that have been missed, and I thank you for your time.

Thank you. So I believe that this issue has been lingering for too long. So this is the year we're going to get this baby done. I think that overall, there is some clear points that I think that both sides have very clear points on, but I think both sides have some gaps in their arguments, too. This state is too big, too diverse to have a blanket policy. We're going to have to add a little bit more flavor in there.

Little too bland for me, but I think overall we can get there. But it's going to take us sitting down and actually talking in the same room at the same time and working this baby out and looking at language together. I am more than happy to facilitate that.

What I'm going to be asking for is that the department identify someone who will work with my office, who will work with me to look at the proposed trailer bill language and to be able to bring some of the stakeholders in the same room as well so that we can actually work through trailer bill language that we think and we can have a win-win here. You're right.

Sometimes, people don't know what they don't know either and what other possibilities are, and that there's some things and resources that might be brought to bear. But there's clearly been some bad actors through this process that clients have interacted with and too many of them have had a negative experience. So we also need to add some stuff in terms of confidentiality in there as well. So that when they're divulging stuff, that that's not being used against them after the fact.

We have to make sure that when they have opportunities where they need their family members or advocates who are not in the same area as them, they have the ability to ensure that some level of Zoom is possible. Right. Does a personal meeting have to happen every time? I don't think so, to be honest. Should it happen? Never. Absolutely not. What is the sweet spot? What is the point that honors people's dignity, honors their own confidentiality, but then also honors the need for the department to do their due diligence as well, to show that they're really doing what they need to do. There's sometimes there's been people on Zoom that I can't stand, but when I met them in person, I'm like, "Oh, ain't that bad," right? All I'm saying is, sorry, maybe it's getting too late, I'm cutting up. But what I'm saying is that we can get there, right?

And I want to make sure that we're using this process of the trailer bill language. I don't want to kick this off the road another year. I'm willing to put in the time. If you all are willing to put in the time, let's get this done. I think we can do this, and I think we must do this because going at this every year after year that's too much stress, right? Y'all stressing me out, right? So, let's work on this.

Is this something you're willing to work with me on?

Absolutely.

Okay. So we're going to work through this. Okay.

Dr. Jackson, I just want to let you know that, honestly, I feel like we are living in two different worlds. Because I have been in many IPPS in person, even remotely. I never have seen someone offering services. I have to fight for it. And honestly, I'm running out of time. I don't know if I'm going to be alive tomorrow. I have three children with special needs.

As a single mother, the Zoom gives me the ability to jump from here to there and there and there and there. And honestly, I never have seen someone to just offer something every time I'm tired. That's why I have been after you from there to here, because I never have seen that. That's why maybe we're living in two different worlds. I don't know.

Well, my goal is to bring us into one world, right? And before we finish this, we're going to meet again. You ain't done with me yet. We're going to spend some more time together. Okay. Be careful what you asked for.

What's for dinner?

I want to watch Netflix.

I'm a picky eater, too.

But that's my therapy.

All right. But we're going to get through this. I hear you. Okay. Mr. Lee?

Yes. I would like to align a lot of my comments with our Chair. Of course, you always more eloquently can put it than I can. But I would just say that in all aspects of public participation, I think that digital democracy and Zoom tools have been very helpful, whether it be in public comment, in city councils, or even in this meeting space.

Certainly, there's really nothing that can replace the in-person interaction and the observations you can make and those body language cues or even contextual cues that are not offered behind a webcam, unfortunately.