Assembly Budget Subcommittee No. 1 on Health and Human Services

Thank you. Good afternoon and welcome. This is the Assembly Budget Subcommitee Number One on Health and human services. Today we will be discussing the issues and programs related to the Department of Developmental Services. I have been asked to read some directions regarding public participation in today's hearing to help ensure the safety of everyone here today while allowing full public access to the discussion. Today we're having an in person hearing at the state capitol in room 126.

Panelists today are all in the room and presenting in person, with the exception of one who's on Webex right now. We are accepting public comment at the end of this hearing, both in the hearing room and on the phone. The phone number to connect is on the committee website and should be on the screen if you are watching over the Internet. The number is 1877-692-8957 and the public access code is 131544.

If you encounter any problems, please contact the Assembly Budget Committee at 916-319-2099 and a staff member will assist you. Those wishing to testify in person may do so when we start public comment, with the exception of us ensuring that our ASL interpreter will we will have those who want to give public comment do so at 04:00 p.m. The remaining public comment will come after the conclusion of our panels.

Once we've completed all the discussion issues, we will begin that public comment after the members have concluded their questions. There will be no votes in today's panel, and I want to note that we are accepting written feedback through the sub one email account and the address is budgetsubone@asm.ca.gov. Before we invite our first panel to begin, I'll make a few introductory comments and open it up to my colleagues to see if they would like to do the same.

I will begin by appreciating the speaker's office for working hard to make sure we are providing access through our ASL interpreters who are here, and also for ensuring that we're in this room to provide as much access to the public as we can. I'm grateful for that leadership and believe it's important for us in the people's house to continue availing ourselves to the public.

I also want to begin by appreciating all of the staff and hard work that goes into our agendas and will uplift Nicole Vasquez, who for years has been a champion in the human services space, as well as Andrea Morgolis, Christian Griffith, and Jason Sisney. Those who do the hard work of putting our budget need to be recognized right from the start. First, before I begin I also want to welcome some new members to the committee. I'll begin with Assemblymember Alanis and Dr. Jackson.

Thank you both for joining the committee. We are joined again by Assemblymembers Patterson, Rubio, and Dr. Wood. And thank you for your years of service to this subcommitee as well. Second, I want to take a moment to provide some context for the work that we will do in this year's budget cycle. As was with last year, our focus within sub one this year is two fold.

One is to elevate the priority issues in the governor's proposal, asking questions and gathering information that will aid us in making decisions as we head towards the June 15 date where we can take actions to pass a balanced budget. Two, given the many meaningful investments, restorations, and expansions in the recent budgets, it's critical that we exercise our oversight role.

This means that we seek transparency and understanding about how implementation is working, what outcomes we're seeing, and the difficulties that we may be able to address now to ensure that practice matches intent for appropriated public dollars. The challenge facing Californians in our safety net programs today are real and very tough. We are here to provide the state leadership to prioritize the most critical issues and to chart a path towards progress wherever we can.

I look forward to having the conversations that we've agendized for today regarding the Developmental Services. With that, I'll open it up and invite any of my colleagues who would like to speak. So, before we begin seeing none, let's begin with panel one. We will establish quorum by calling roll first.

[Roll Call]

You will notice that there are five chairs that are before us, and so I would ask the first five to come forward, and afterwards we will have you cycle through. Let's begin with panel one regarding Equity in the Developmental Services System and Strategies to Reduce Disparities. For those panelists who are presenters, please present in the order that your name appears in the agenda. I'd like to remind all of the panelists to please limit your remarks to five minutes maximum.

Given the density of our agenda of speakers today and our desire to turn towards public comment, I am asking all of the panelists for this issue to answer the following questions. What are the equity issues in the DDS system and what have been the trends? What are the root causes of the racial and ethnic disparities observed within the DDS system?

And what strategies should the state consider to address disparities in the purchase of services to create a more equitable and to better access for all families who are served within the Developmental Services System.

We will have nine presenters who are on panel one including Nancy Bargmann, director for the Department of Developmental Services. Leinani Walter, chief equity officer for the Department of Developmental Services. Grace Huerta, the mother and president and co founder of the Exceptional Family Center in Kern County and also the vice president of the Arc of California. Dora Contreras, grandparent of a person who has served at the Valley Mountain Regional Center and manager of the Integrated Community Collaboration Integradoras. Judy Mark, President of the Disability Voices United and parent of a person served by a Regional Center. Vivian Haun, senior attorney of the intellectual and developmental disabilities practice group for Disability Rights California. As well as Amy Westling, executive director for the Association of Regional Center Agencies. Christopher Odneal with the Department of Finance and Ryan Anderson with the LAO.

We will hold all members'questions on this panel until after all of the presenters have concluded. Let us begin with Director Bargmann when you are ready.

Thank you, Mr. Chair, and thank you to the committee members. Also want to acknowledge the staff's work on the agenda and the information that was provided as context and background. I'm Nancy Bargmann, the director of the Department of Developmental Services and pleased to be here with you today. This is a really important topic. This is a topic that is a priority for the Department and mine personally for many years, an area in which we have to continue conversations.

We have to make sure we're continuing to evaluate the progress that we're making and supporting all individuals to receive services from the Regional Centers. Today we support over 400,000 individuals. And like California, we have a very diverse population in which we serve.

So when we take a look at kind of the issues that we hear from the community and the issues that we've addressed over the years has really been centered on a number of things and appreciate LAO's report and highlighting the inequity or the disparity in spending that's noted, I believe it's on page 11 of your agenda. And while we do recognize the value and the importance of looking at the expenditures by individual is really important.

And what was noted in the report is that that was on an aggregate level. It's an important tool in our tool chest of evaluating disparities in equity. But I also want to make sure that we take a step back and look at a bigger picture when we look at the total spending in our system, that when we look at it taking different variables, the variables are also equally as important.

So individuals that are under the age of 22 tend not to be in out of home services when we take it, those who are accessing out of home services, it's a higher cost of service. When we look at kind of generally those supports. Very excited about some of the initiatives that we put forward as listening to our community, building on trust and making sure that there's an equal seat at the table for our community, no matter who you are.

In areas in which we've been able to do that, is doing a total reform of our appeals process. Happy to say that most of those changes are effective. March 1. Really important to make sure that people have an equal voice and feel that they are being heard. Really pleased with our disparity funds.

The $11 million that back in 15-16 it was targeted for regional centers, we were able to take a step back, heard the community, and make sure that our community based organizations have an equal service at a service code level. Significant changes have happened. So many of you have heard me say based on respite expenditures in respite back in 15-16, essentially it was equal to the expenditure.

No matter kind of looking at each of the race and ethnicities, I've still said that you have to take a look at the experience of the individual because just because there's an access to that service doesn't mean that the experience by the person is the same. So moving to a new system, making sure that we're evaluating the experience of individuals to make sure that not only are we looking at the expenditures, but making sure that the experience is a meaningful experience for the person.

So as we look today on the expenditures for respite over the last five years, there's been a significant increase of utilization of respite based on our communities of color versus whites. I still will say that we can't take a step back and say, okay, we finished. That we have to still evaluate is the experience, what the individual is needing, and having access to services beyond respite or beyond other services. So it's an important conversation that we remain engaged in.

I would like to have Leinani be able to share some of the work that we've been doing, that we've been able to do statewide as an experience of some of the community based organizations.

Thank you, Nancy. Thank you, Mr. Chair and committee. My name is Leinani Walter. I'm the chief equity officer at the Department of Developmental Services. And as Nancy said, some of our focus and our value from the grant program also comes from lifting up the voices. And what I mean by that is every month we have over 75 organizations that come together not only to share information, but to collaborate, to learn and to hear from the community what is happening. That's monthly.

We also have, and very proud in the last three years have established an African American focus group focused specifically on the needs in the African American community. This is a compilation of leaders and family members and service providers that come together and talk about these issues. These are difficult conversations, but they're meaningful and they're authentic. It's an important way for the department to learn. And as we participate in some of these listening sessions, I would say that the most value comes to the department.

While families and service providers and many of our CBOs are family members, they are parents. I am a sister of a person with a developmental disability. So when I do this work, I think of him, I think of as a native Hawaiian woman. I think of my family accessing services in the system and it means something. As Director Bargmann said, the quality of the service and the type of service matters.

And those are some of the hard conversations that we have, but they're good ones because they help us to learn more and to develop policy that's more responsive to the needs of the families. And just wanted to highlight a couple of the initiatives that have been implemented in the last year. The Community Navigator Program is one of the programs that I am excited to report. Over 1200 families have been served in less than six months. We have over 44 community navigators.

This was again one of the seedlings coming from the grant program. We have implicit bias training, which I am thankful to report, that we now have a contract, a statewide contract for regional centers to utilize and that finished just last week. So there are opportunities that we have to not only learn, but to recognize where some of our challenges are in the community. Early start tribal engagement.

That has been one of the most meaningful experiences not only for me and our department, but for each of the regional centers that are now leading our efforts and working with our tribal communities. Now we have listening sessions where we didn't even know that regional centers may exist. We now have opportunities that regional centers and tribal nations are coming together to have conversations. We also have our enhanced service coordination. That is an opportunity to take the time to develop a smaller caseload.

Those are again ideas that were born from the grant program. So while we look at the grant program on the surface and see maybe what has happened in terms of an individual project, I want us to look at the bigger picture and see what has come from. The grant program is now dialogue opportunities to communicate with leaders from diverse communities we now have some of those leaders now part of our everyday conversation rather than just once a year. It's every month.

So I think there are many examples of where a grant program has focused, and this year, just highlighting, we have the additional 11 million. I think our focus has been to prioritize, diversifying our workforce. You'll see that that's one of our priorities in the grants that were awarded and expanding our community navigation and awarding areas that we didn't have a focus before, we now have the first Native American navigation program on tribal land.

We have the first deaf and hard of hearing navigation program, and that's the first of its kind. So there are many other examples I can share. I think the importance that I wanted to share is just that our work does not happen in one day. It happens over time and service, access and equity is something that needs to be part of the narrative and part of the fabric of all the work that we do. Thank you.

Thank you. Next we will hear from Grace Huerta, who will be joining us via Webex.

I was referred to current regional standard but was denied services. I was lost, confused, frustrated, but also had a sense of urgency. I knew every day that my son didn't have services. He was falling behind, but I was fortunate that I married into a family with a strong roots in advocacy. I decided to go to the regional center office and refused to leave until someone came out to help me. It wasn't an easy process, but after much advocacy, he finally got qualified.

Sadly, families continue to experience this today. That experience is very common for a lot of parents we support. Partnership is important for parents because often families in rural areas of Bakersfield struggle to receive the information they need in their language. There are many obligations of work and family responsibilities that limit their ability to find resources. Part of the challenge is there is not one path to achieve equity. As advocates, we have highlighted this issue of disparity. This committee has lighted the issue.

The Little Hoover Commission has highlighted the issue and DDS has made it a priority in their funding and work groups. Yet the data continues to prove that needle has not moved much towards a more equitable system. Why? Something in the system is not designed for equity. Because of Arc of California, we realized we have an opportunity to organize the parents in my area. Professor Nidas of Kern County organized and requested the regional center executive team to include them as part of the disparity plan of action.

That plan includes ongoing education to service coordinators and families regarding the regional center service options. Additionally, parents are asking for the leadership of Kern Regional Center to go where the people are to have a presence in the underserved areas. We've learned several things at the monthly meetings at current regional center which include systemic issues exist. Turnover service coordinators at regional centers continues to be a problem. They are not adequately funded, do not have adequate service coordinators or even enough space for them.

Many of them are still working from home. The regional center and department should consider satellite offices in the underserved areas. The regional center remains closed to the public. The IPP process needs to be more streamlined. It should not be that difficult for families to obtain services. The policy at Kern Regional Center, as payer of last resort, causes delays in obtaining services. Families need guidance in learning what generic services are and how to access them. There continues to be a lack of awareness of available resources.

We must bridge families to available resources to help with the process, such as Office of Plan Rights, family resource centers, the Arc of California cultural parent centers such as Congreso Familiar De Fiesta Educativa. Many parents do not know they exist, especially the Spanish speaking community. And even if the eegional center is required to provide the information we know, it doesn't always happen. I recommend attaching a one page document in their language of choice with the IPP, with the names of the local advocacy centers.

It's important that families know where to go for support. White educated families with a stronger skill set and higher income levels get more services. People of color are treated differently. Biases exist, not knowing the lands footsteps at a disadvantage. Many do not know they can appeal if they do not agree on the eligibility results. In conclusion, the principles of a Lanterman Act must be protected. To not do so would be a violation of the civil rights of people with developmental disabilities.

As a leader, it is not only my job, but my responsibility to carry forward the voices of my community. We continue to hear a lot of frustration from families whose needs are not being met. Many feel that racism and discrimination exists and impedes families from accessing the services they need. It's important to remember that Kern County has the second highest poverty rate of 58 counties in California, and that parents view disparity as a discrimination to people of color.

We need a drastic change to the system because the reality of families not accessing services is a reflection of the system. We support the department, our regional centers, and the dedicated professionals. We have a common goal of achieving an equitable system that gives dignity, respect to all individuals with developmental disabilities and the families that support them. We want to work together to build trust and strengthen a system that works for everyone. Gracias. Thank you.

Thank you, Ms. Huerta. Next we will hear from Dora Contreras, who is the grandparent of a person served at the Valley Mountain Regional Center and manager of the Integrated Community Collaborative.

Thank you. My name is Dora Contreras and I'm from the Stockton area. My grandson Sergio is in the audience. He has been a client of the Valley Mountain Regional Center since he was two. As a single grandparent, I have raised my grandson for almost his entire life, since he was a toddler. Sergio is now 30 years old and needs continuous care around the clock. Sergio didn't have any regional center services up until he was nine, when they said they would pay for a daycare.

They would pay for daycare because I was a teacher, but no daycare would keep him, no babysitter would keep him. When Sergio was 10, a service coordinator told me one day I would have to give him up instead of giving us the support we needed to keep Sergio at home. When Sergio was 12, that became a harsh reality. When I became a principal, worked many hours. The regional center solution was to pay for him to go to an expensive four eye crisis group care home.

That started a horrible journey for four different care homes for him. At the first care home, somebody engraved with a razor, the initials of a wrapper on his arm. And at that same level, four I home, he got tuberculosis. At the second home, Sergio landed in the hospital and the care home wouldn't take him back. The third care home almost killed him because of over medication.

It seems like my grandson had access to very limited options at that time, and even what options he had were very challenging. Sergio has been placed in jail overnight while under out of home respite care for attacking law enforcement when they were called because of destruction of property. He has had three bad incidences with law enforcement, has been arrested, handcuffed, put in a straitjacket and thrown in a law enforcement car. In fear for his safety and quality of life,

I finally brought him home during the pandemic and I was retired by then, and he has stayed with me ever since. During COVID the state was offering more services to keep people out of congregate settings. And now the regional center is making an exception for me and I'm assuming for my age, by providing supported living services to Sergio while he lives with me currently. He's doing much better in our home with the right supports.

Here's a picture of him when he was over medicated and close to dying. And here he is now. Sergio, stand up please. Sergio, stand up so they can see you now. Sergio. Sergio. Sergio. Oh, he went to the bathroom. That's him saying hi to everybody outside. He's a happy go lucky person. Now he brightens up any room. He has endless hugs for everybody, as the young lady standing at the door found out. While my story may seem unique, it is not.

Many faces face similar battles to get supports and services they need for their child. I'm educated and I speak English and look what I went through. What are they doing to others? I found out a couple of years ago. I went to a board meeting at my regional center and saw many Latino women speaking up about the services they needed and advocating for changes. And I thought, I need to know them and I thought, I will join them.

It turns out that they were part of the Integrated Community Collaborative, a community based organization that helps families navigate the system and break down barriers on a peer to peer basis through the community Integradoras. Finally, I found a group whom I can relate to and they to me. I now work as a manager for ICC to unite and help other families. What I hear consistently from the community is that people don't trust the regional centers.

They don't want them coming in their homes, digging into their private affairs. Some people are afraid that the regional center will take their child away from them. In a way, isn't that what happened to me? Many Latino families thought that they get tricked into thinking that they are being helped, but the regional center takes their information and uses it against them. Also, it doesn't matter if the regional center staff speaks Spanish. The trust issue needs to be addressed and it needs to be resolved.

The legislature restored funding for social rec to reduce disparities, but still Latinos are not able to access their services. One regional center says you can't get the service unless you give up needed respite. Another is telling people their IHSS money should go to pay for social rec programs. Some regional centers are requiring families to pay for the program first, pay for the program first, and get reimbursed months later. Most families can't afford to do this and should not be paying out of their own pocket.

Some families don't have credit cards. We know and appreciate the fact that DDS is trying to make things better, as you heard these ladies say, and that the regional centers are trying hard to make the needed changes. But it doesn't seem to be working and it's not quick enough. For things to truly change. There must be a commitment to a change of the culture at every one of the 21 regional centers. My perspective is that today the system still lacks a sense of compassion.

Families must still go to unrealistic lengths to obtain much needed services. Many feel humiliated for having to beg for something that their child is entitled to. This problem is deep, and it requires oversight of every single interaction that regional centers have with families. It requires regional center staff, regardless of their college degrees and years of experience, to be humble and have empathy with families. It requires the individuals and families served by regional centers to feel embraced and empowered and not to feel intimidated or discounted.

Sadly, we are free from reaching these goals, but the community has woken. And we pledge to be part of the solution. We pledge to work with the legislature. We pledge to work with DDS. And we pledge to work with our own regional centers to keep trying in making the system fair and equitable for all. I speak for everyone here from our community and for those that couldn't come. And they're seated. Can you stand up, please? My community. Stand up. There's Sergio in the red. Sergio, hi.

I speak for my community and for those that couldn't come because I can't drive a bus and I can't park it. But next time we're coming by bus. Thank you. And thank you from all the Sergios sitting here today. As you see, most of our moms have brought their sons and they're standing right next to them. Thank you very much.

Thank you, Dora. Next we will hear from Judy Mark, President for Disability Voices United.

How do I follow? Feel. I feel bad that my back is to you as well, but I'll try to go like this. My name is Judy Mark. I'm president of Disability Voices United. I'm also the parent of a 26 year old son who served, who has autism, who served by a Regional Center. And I'm going to dive right in because I'm not going to sugarcoat it. California is failing people of color with developmental disabilities.

We're also failing people with disabilities who live in certain areas where regional centers have historically provided few services. And despite state spending of $88 million intended to eliminate these problems, recent reports, state audits and the Little Hoover Commission have highlighted how California's developmental disability system is still plagued with racial, ethnic and geographic disparities. Newspapers have also taken notice and written extensively about the issue, with disturbing headlines like in today's Sacramento Bee.

In case you haven't seen it, this is a story from today's Sacramento Bee, which is titled "California bill would overhaul failing systems serving adults and kids with disabilities." And another one from a few months ago in the Orange County Register titled "It helps to be white if you're disabled in California." The bottom line is that regional center clients receive vastly different levels of services depending on the color of their skin and where they live.

Disability Voices United is directed by people with disabilities and their families and has produced multiple reports on this issue. Our most recent report is titled a Matter of Race and Place, and I brought copies for those of you who are here. And it shows that the state has made little progress, even when the research accounts for the underlying cultural differences and different living situations.

Adults of color live at home, for example, adults of color who living at home, for example, receive the least amount of services at every single regional center, with Latinos fearing the worst, there is not one regional center in which white adults living at home receive the least amount of services. At 15 regional centers, Hispanic and Asian adults are far more likely to receive no services at all. And at every regional center, white adults are the least likely to receive no services.

But focusing solely on differences in spending by racial groups doesn't come close to telling the full story. Your place or geographic location matters as much as race. For example, if you are a Latino living at home and served by Westside Regional Center in Los Angeles, you may receive less services than whites, but you are still receiving more services than almost every other similar adult in the entire state.

The chart on page three, if you want to look at it, and I will try to hold it up for the camera. For those of you who don't have it, looks at the intersection of race and place for adults. The lines show the variation between spending by race from lowest to highest, and the wider lines are the racial disparities from the highest race to the lowest race receiving services.

You'll see the vast differences between an average spending between regional centers ranging from a high of over $60,000 at Golden Gate to a low of 26,400 at inland. The highest spending regional centers have much greater racial disparities. But at the lower spending regional centers, the racial disparities are smaller because, frankly, no one's getting very much there. We need to ask why.

With all of the focus by the legislature and media coverage and grants provided that these significant racial and ethnic and geographic disparities still exist, individuals and families of color report to us that they believe the cause is systemic racism, rooted in a bias toward white educated families with the resources to fight for services and the ability and time to navigate an intentionally complicated and bureaucratic system. Many people of color tell us that they face a culture of no and no means no in many different languages.

That includes intimidation, discrimination and fear of retaliation in their interactions with their regional center. And these experiences of racial discrimination lay on top of the geographic disparities in a statewide system that is anything but statewide. With that in mind, we have laid out a set of recommendations in our report, which you can read and are cosponsoring AB 1147, the Disability Equity and Accountability Act, that I hope you will consider supporting to bring about this change, this needed change in our system.

Very, very briefly, in 20 seconds, I will tell you a little bit about our recommendations. We believe that we should create a more person centered, equitable and consistent experience for every person served, regardless of who they are or where they live. We should develop a level of outcomes and performance, including individual and family satisfaction, that all regional centers must meet, and if they don't, they go on probation and get technical assistance from DDS.

We need to increase oversight of regional centers by improving governance of their boards of directors and empowering DDS to do more. And finally, we should enhance the transparency of regional centers by making them subject to the Public Records Act and ensuring that data is accessible to community members and researchers. We must stop approaching this issue with the same strategies and expecting different results.

While it is very difficult to legislate culture change, we must work together to change the culture of no to a culture of trust in regional centers, especially for communities of color. We believe our recommendations move us in that direction. Thank you.

Thank you. Next we will hear from Vivian, Vivian Haun, senior attorney with the Intellectual and Developmental Disabilities Practice Group with Disability Rights California.

Thank you so much, committee members. My name is Vivian Haun. I work at Disability Rights California. I am also the sibling of someone who is served by regional centers. My brother has autism and has been served by the regional sorry, my brother has autism and has been served by the regional center system nearly all his life.

We have so much more work left to be done to address racial disparities in this system, and the reason why I think the needle has not moved as much as we would like for it to have moved is not because the initiatives that the department has launched haven't been valuable. They've been very valuable, as Ms. Walter and others have described today. But unfortunately, they haven't been enough. They've only focused on certain parts of what we know to be a multi part problem.

If we think about the pipeline that people served by regional centers move through to get services from their regional center. Imagine three segments to a pipeline with the top segment being the community, where they first learn about the regional center. So community outreach, the bottom segment, closest to the services themselves, would represent the service providers. The middle segment would be the regional center, right, where they move through to get access to those service providers.

The many good initiatives that the department described today have tended in large part to focus on the top segment and the bottom segment. So if we think about the community segment, really good work around outreach service navigation cultural navigation there's been a lot of investment in building the service provider workforce, in raising rates and increasing the number of linguistically appropriate and culturally appropriate providers. But there hasn't been nearly as much focus or attention paid to the middle segment regional centers.

And they're central, not just to this image of this pipeline that I've sketched out for you. They're central to the problem itself. They're central because regional centers are the entities that determine the criteria of who gets services, what services, and when. Under what criteria. regional centers have long had broad discretion to set their own rules about when service requests are approved or denied. And that is what drives the intensive regional differences that you just heard Miss Mark describe.

And while many of these purchase of service policies appear to be racially neutral on their face, they don't mention race in practice. Many of their impacts are highly racialized. They just are. They tend to overly and disproportionately restrict services in a way that tends to correlate highly with race, with language, income and education levels. We think that it's time to take a closer look at the 21 different regional centers, 21 different ways of doing things. We've heard about that a lot.

But when we think about 21 different local purchase of service policies that people have been able to set with wide discretion that affect people so differently. We all know in systems what happens when there's a lot of discretion. It's where bias can seep in, and the layers of discretion don't just stop at their written policies. There's discretion then in how it gets applied by service coordinators, by other regional center staff. And so these are all things that I think should be taken a closer look at.

One of the other, I think major drivers of disparities in our system, as I mentioned, are those policies, in particular, purchase of service policies that we call gatekeeping policies, because they are designed to prioritize limited dollars by deciding, or by determining when a request for services is actually the regional center's obligation. Many of these guidelines will say to a disabled person, that thing you're asking for, that's not our obligation. That's someone else's obligation.

It's your school's obligation, it's Medi-Cal's obligation, or oftentimes it's your family's obligation. You live at home with your family, you rent instead of own your home, that's on you. That's not our obligation to pay for that. These policies, again, are set regionally by each regional center.

And while there is something to be said for some local control, I think we've reached a point where it's time to take a closer look at standardizing certain core principles that this system stands for and just need to be made part and parcel of every purchase of service policy at every regional center so that we can live up to the promise of the Lanternman Act. The last driver that I might point to again is generic resources.

When I mentioned earlier policies that point to other systems, schools, Medi-Cal, the Department of Rehabilitation, the regional center system is often described as the payer of last resort. That's what it says in the law. That's what it says in Medicaid law. It has been described as a gap filling system. When all the other systems fail, someone with a disability, the regional center system is supposed to step in to fill that gap.

However, we can't know if we're filling that gap adequately without knowing much more about the size and shape and location of that gap. If we learned anything from the pandemic, we have learned that the other systems have been failing people of color. They've been failing communities of color. So we know that those gaps that the regional center needs to fill must be larger. But we don't have very good data yet about exactly how big, what is their shape, in what direction.

But we know they must be really large. So the fact that after 10 years, they are still communities of color are still having less spent on them, we know that it's not enough to fill that gap. So thank you for your time today. I appreciate the opportunity.

Thank you. I'm going to ask if we can transition a few of the chairs just to make space for Amy Westling, who is next executive director of ARCA, as well as the LAO and Department of Finance, and I will bring you back up for questions.

When you're ready, please begin, Ms. Westling.

Good afternoon. My name is Amy Westling, and I'm the Executive Director of the Association of Regional Center Agencies, and I have the honor of working with all of the state's 21 Regional Centers. Thank you for the opportunity to be here today, and thank you to your staff for the comprehensive agenda that did a wonderful job setting the table for this important discussion.

I want to take a moment to take a step back, and I want to tell you the principles and the foundational ideas that have always guided my career and that of the Regional Centers. When I first started at a Regional Center, the Executive Director sat me down my first day and he said, this is social work, and this is about relationships, and nothing that you do in this system can get in the way of that relationship.

It is all about building a relationship with that family and that individual. And this relationship needs to endure because we, as a Regional Center, will be serving that individual oftentimes beyond the life of their family, and they need to trust us, and they need to believe that we're going to do what's best. We know that individuals with developmental disabilities and their families are leading undeniably complex lives. We all are.

But they deal also with the complexity of a number of systems being brought into their lives as a result of the developmental disability. They interface with the Regional Center in home supportive services, Medi-Cal, special education. And one of the primary goals of the Regional Center, as I used to tell my staff over and over, is to help make their lives better and easier. And part of the way we do that is through ironing out some of those challenges that arise in interfacing with various systems.

Over time, our system has become more bureaucratic. It is natural for that to happen as the system swells to serving 400,000 individuals. And with the size of budget we're dealing with today, there have to be systematic ways to deal with things. But in some instances, we are taking a step back and thinking about how can we best support communities, all communities and individuals, regardless of background. And that's some of the important work that is taking place. Some of the barriers that we've heard.

I believe Ms. Haun spoke of the idea that people really have to exhaust generic resources before Regional Centers can step in to assist them. And quite honestly, by the time they exhaust those generic resources, they're exhausted, they're tired. And so part of the role of the Regional Center is to step in and help them to navigate systems.

And what this requires, as well as the development of trust, all those things boil down to that relationship between the individual served and their service coordinator, and ensuring that there is sufficient time built in to develop that relationship so that it isn't just an interaction where the service coordinator is doing the required paperwork, checking the box, and moving on, but is instead spending quality time getting to know and build trust with individuals and their families.

That's the core of our system in terms of the work that's been done to support and develop our capacity to better serve communities from a variety of diverse backgrounds. We're very proud of a lot of the work that's been done. And the question now is, where do we go from here? We know that one of the things that we need is to be able to clearly articulate what does success look like.

Director Bartman noted that in many ways, we have looked at the system through the lens of POS spending. How much are we spending on each individual as a measure of equity. But it is much deeper than that. It is also our people represented in our system? Do they make it through the front door? Do they make it through intake? How quickly are their needs being met?

And those are all things that the Department is working hard on in terms of some of the system reform that's taking place. And the important thing for that is that we know that you get what you measure. And if we measure outcomes and we measure the quality of supports that people receive in their own words and asking them to be part of the conversation, then we know that we have something to build upon.

Additionally, it's important to drill into data because that tells us where to target our interventions, such as the Coordinated Family Supports Initiative, which is really targeting closing the gap for those individuals, particularly those who are Latino and living at home with families into adulthood. So there's a lot of work to be done and there's a lot of great work that has taken place.

And I'm personally encouraged by Ms. Huerta as well as Ms. Contreras and their dedication to working together to continue to advance this critical work. Thank you.

Thank you. Next we will hear from Christopher Odneal with the Department of Finance.

Thank you, Mr. Chair. Christopher Odneal with the Department of Finance. Nothing further to add at this time.

Next we will hear from Ryan Anderson with the LAO.

Good afternoon. Ryan Anderson with the Legislative Analyst's Office. I think I'll just summarize what I've heard this afternoon, which is that I don't believe that we are lacking for potential answers to the question of why these disparities exist. What appears to be lacking is some consensus about what those drivers actually are. And to at least some extent, this does seem like a quantifiable answer that just has not yet been quantified.

I've heard in previous testimony a variety of potential drivers for these disparities, which vary from what you might call coincidental, the differences between different ethnic and racial groups and their propensity to live at home and thus demand residential services, or to be young and thus consume special education services. Another category might be disparities that derive from specific policies or lack of specific policies, all the way to some of the cultural issues that were brought up by some of the testifiers.

Now, some of these are quantifiable and could potentially, with a close examination of the purchase of service data, we could get some answers as to how important are these specific drivers, which would leave us with the answer of how important do we think that the non quantifiable answers have been done, and that might be a useful first step in approaching this next phase of addressing these disparities. That's all I have to say for now. Thank you.

With that, I will thank very much the entire panel. Bring it up to the dais and see if any Members have questions. Dr. Jackson?

Thank you very much, Mr. Chair. I guess my first question is from LAO in terms of trying to find those quantifiable answers, or at least gain some consensus based upon the data that's available to us. Do we anticipate the study that is being done on the equity by Georgetown? Do we anticipate that that report will help us to get to the bottom of this, or we need to go on another journey to figure out how do we get to the bottom of this?

Thank you. Perhaps my colleagues from the Department can speak more to that specific study. I have no special insight into it except to say, of course, I am, as a researcher, looking forward to it. My understanding of the scope of that particular paper is that it is asking the question about the efficacy of, specifically the equity grants which have already been offered. That's an important piece of the puzzle.

As we note in our analysis, if you look at some important indicators, such as the share of purchase of service by specific racial and ethnic groups, you haven't seen a lot of the progress in those indicators that you would like to over that time. But that level of analysis doesn't tell you everything you'd want to know about the life of that program. So I'm hopeful that the research that we're awaiting from Georgetown will give us some deeper insight into that.

It likely, given the scope of the project, would not answer the even deeper question about what are the fundamental drivers behind these disparities to begin with.

Ms. Bargmann, can you add to that? I'm sure you're equally as concerned with these things. What are your thoughts on, or what are your intentions to try to start getting to the bottom of this?

Thank you. And you're correct. I'm deeply concerned, have been, but I'm also very optimistic for a number of reasons. I'm not optimistic that we're going to fix all the inequity or concerns and trust today. But just listening to the panel, I've known many of them for so many years. A couple of takeaways that I do want to highlight is that we are a system of partners.

We're a system of partners that are really focused on supporting individuals, self advocates, if you will, the family members, and really those within the community, whether it's service providers and certainly Regional Centers. The amount of interaction right now that the Department has with the community is unlike any other time in our system. And even before the pandemic, but certainly at the time of the pandemic, that understanding of who DDS is, I think is remarkable.

We ended up having statewide calls with our community to talk about the issues. And I don't want to say that that was the event that kind of opened up that door, because we certainly did a lot of that, but it really catapulted an opportunity and whether we like Zoom calls or not- and we have to still address and make sure that we don't have a technology and inequity and technology- but it broke down walls.

We have participants in really meaningful, there's a seat at the table, but we're still missing some things as far as trust. But the community based organizations that have really yielded through the $11 million- trust me, through the pandemic, if we didn't have those partnerships with our community based organizations, over 70, that were able to get out there and connect with the community and be able to be a messenger during a time when there was lack of trust in a lot of different areas, I really believe we saved lives.

That said, within our system of inequity, hearing from our community over the last five to 10 years, many of the policies and initiatives that we've opened up and are investing in and that the Legislature has been so gracious supporting has really stemmed from those conversations. I've been doing this work for over 40 years and I've never seen us really change that eligibility in a positive to Regional Center services. We've learned from our communities, whether it's our Latino community, but certainly our African American community.

And after digging into the research, we noticed that those from communities of color had a later diagnosis of autism than those that did not. And being able to peel back and look at the data and be able to say, wait, we actually started asking the questions. Who is it that's leaving early start services and then coming back to the Regional Center system at 7, 8, 9 years old and losing some really important time?

Through those conversations, we get to ask questions then, and I think that's what the purchase of service data does for us, but it doesn't give us the answers. Equal doesn't always mean equity, and we have to ask those important questions. And I could go on about all of the things that we've been able to do that's been stemmed from those conversations. I really believe we have to implement many of the initiatives that we have.

Ms. Westling has noted the coordinated family supports that clearly was stemmed around the community of saying, wait, we as a culture, multigenerational families, oftentimes that are the non Hispanic white community that has multiple generations in a family, saying, why is it that somebody has to move out to get supported living services?

So this is the first time we have a new initiative that's a coordinated family support, where there's going to be a really thoughtful process of supporting individuals who are choosing to live at home with families. But looking at it from a whole family perspective, it's new. So do I have data, is it going to work? It's going to take us honestly some time to really understand who's accessing it.

But I will tell you, in our public meetings of introducing this initiative, we have had thousands of individuals attend to be able to hear about this new initiative. We changed the provisional eligibility to make sure that we could open that door for those who are exiting early start and coming back at a later date. So we can really make sure that we give time for those who- it could be from systemic racism, it could be implicit bias.

There's a number of things why individuals are not being identified as having autism as compared to those who are white, but opening that door for giving more time to really assess it so we don't lose individuals in the meantime. So my recommendation right now is we still definitely need to implement the many initiatives, continue to report out in a very transparent way where we are on that, continue to evaluate what's working, what's not working, specifically to the Georgetown and our partner in LAO is correct.

It's focused primarily on the disparity funds. However, I will tell you that they are taking a step back in the initial discussions that we've had on their work. They are looking at what is the definition of equity nationally within IDD space. We're behind the health space in defining equity. And so those are the really important conversations that we're having, and I'm really excited that we get to be at the table with those who receive services and have those discussions.

And to include somebody like Georgetown in those conversations that get to take a look at it from a perspective of cultural and linguistic kind of sensitivities and competencies, because we have to make sure we have accessibility, that there's somebody making sure that individuals are looking at the accessibility, but also the availability and the accepting, because every culture is different, the quality and utilization, those are really key pillars to see how people are accessing services. And I'm looking forward to exploring that more.

And I look forward to having Georgetown's report to be able to give guidance and recommendations to improve our service access and equity grants. But I also really want to make sure that we lift up the important policies that the Administration and the Legislature have supported to address these really important and critical issues.

And obviously, we're expecting the draft of the report in April, I believe. Are we still on that timeline?

We are. And we're looking at the end of June right now for the final report. Correct.

Thank you.

Yeah. Thank you.

Dr. Wood.

Yeah. And my question is kind of around the grants that you've been talking about here. How are we ensuring that really underserved, remote, difficult to reach communities are getting an opportunity to access this? You mentioned, Ms. Walter, tribal navigators. So I have 32 independent recognized tribes in my district. You don't have 32 navigators there. So how is this working for our tribal communities? Because historically they have been some of the most underserved people in this entire state. So how is that working?

And how are we ensuring also that other rural areas and things that don't always have the technical expertise, the groups don't have the ability to apply for a lot of these grants. They're at least getting an opportunity at their fair share of the resources because that oftentimes, with all due respect to larger urban areas, that large sucking sound is all the resources going there while some of the most underserved people are left behind.

Yeah, I'd like to just share with you and then can certainly have Leinani provide some additional detail. I'm extremely proud of a particular parent within the tribal nation that as a parent she came to us, and I'm sharing this because she publicly has shared this information. She's a remarkable leader and she shared with us, I'm a parent trying to experience and navigate through early start other families don't understand. And she herself had just really braved coming to us and saying there's a problem.

And through that dialogue, we were able to again, take a look at some of the data. And it was absolutely true. When we started taking a look within the tribal nations and looking at access and comparing who's coming through that front door, we were really noting that we were behind the community and the percentage of population in California. So to that point of making sure that we have kind of the equal opportunity for those who are in very rural areas to be able to access it.

One of the things about the community based organizations, we've have a number of different kind of tribal nations that have applied for grants, and we'll be able to give a couple of examples. But the initiative that this young parent led was to be able to give us the opportunity to make a request, and it was supported, $500,000 per year, to be able to gain navigators and accessing through early start services. And many times the things that we're navigating, we're looking at pilot projects. Is it working?

Are we able to use that and then spread the word even broader? And that's what we're doing right now, is that we have been targeting that 500,000 and then looking at how we can kind of use that 500,000 each year to be able to expand, to be able to connect with the additional kind of tribes and tribal nations that we can within California.

But even without that, we need to make sure that the access to the 11 million and if there's times where we can then do education and opportunity, because the team has absolutely said, hey, we're going to have a public meeting on how to access these resources, so we'll send it to you so you can share with your community. If there's additional lessons or conversation, we'd be more than happy to have that with you.

I guess part of what my- and I didn't articulate it as well as I'd like- is one of the challenges that we have in some of these communities is they really need technical support. It's not just knowing about it, it's the technical support that's missing, because otherwise larger areas have the expertise and the resources often go by the wayside and not necessarily with this program, because this is a newer initiative.

Once you don't apply for something because you don't have the expertise, you often don't apply for the next one and the next one and the next one, and you fall further and further behind. And so my plea in general is when you're looking at these kinds of initiatives, to think about the technical support component for smaller underserved populations, rural areas, whatever. And some of our areas that we talk about rural, I talk about frontier. And there's a distinction. There's a huge distinction there.

We have people in my district who still don't have electricity. And that's what I mean when I'm talking about communities that are really underserved. Thank you.

Thank you. If I can add to just a comment to that, one of the things that we have focused on is providing technical assistance, providing not only a bidder's conference, but the opportunity to work with grassroots organizations long before the grant is due. So I'm proud to say this year, out of the 75 grants, 22 of the grants are brand new grantees. So I think that shows that we are looking for grassroots organizations.

We have larger organizations, it's true, but we also have very small parent run organizations that we are proud to say are part of the grant program now. Thank you.

Assemblymember Ramos.

Thank you, Mr. Chair. And following up on my colleague's questions within the tribal communities, the outreach, certainly. My colleague mentioned the many tribes in his district and the frontier area that's out there in some of those rural areas. But California is a large state, and so are we building a model to reach out to the Native American population with the support services and understanding that some of the technology is limited in certain areas.

So I guess getting away from a cookie cutter process, and are we making adaptions to the different areas in the outreach that we're doing to Native American tribes?

I will be the first to say we have more to learn and the opportunity that we've been able to use within the grant program, but also the $500,000 on an annual basis is really the benefit of the listening sessions.

That we've been able to be out in the community, have the listening sessions. But I think this is a really important point that I hear you saying that we can go back, take a look at who's attended the listening sessions and see if there's any additional outreach to make sure we're opening that door and making sure that there's the seat at the table for all and being purposeful in doing that outreach.

I guess another question is, with the 500,000 there annually, is that adequate to ensure that you're reaching out to California's first people and making sure that message is getting out with a technical support with the complexities within Indian country?

Yeah, we have the 500,000. This is a new program for us, and so we're using that, recognizing the opportunity to be able to expand beyond just one kind of Regional Center or tribal community, and being able to do that across the state. We're going to learn more as to kind of what that outreach can be. But I am also really pleased that we've been able to target and dedicate a number of the grants within the 11 million or this year, the 22 million.

Each year, we've really seen an increase of that participation, and we'll continue to evaluate it. It's an extremely important community to make sure that we're monitoring and evaluating and doing that outreach.

Through the chair, if it's possible to set up a meeting to find out exactly how the outreach is happening and if there's any way that I could assist or even colleagues could assist in getting that word out in the technical support. It's just concerning that for many years, the issue has been not even addressed within California's first people, in Indian country itself, that now we're discussing it.

But I want to continue to be an advocate to ensure that that $500,000- we know we're going to need more for the outreach going forward and the technical support in some of the areas that tribal communities live in. So through the Chair, we'd love to set up a meeting and learn more about that.

Yes, thank you.

Assemblymember Rubio.

Just a comment as a teacher, and I picked up on what you said. Equity is not equal. It's getting people what they need. That's equity. And I really appreciate the comments because I know that, as my colleague stated, the state has so many different issues and problems depending on where you are in that region. And so equity, again, is not everybody equal, it's getting people what they need.

And some folks, obviously in Mr. Wood's district, need different things that, for example, those of us in Southern California or even in the Inland Empire. So thank you for those comments.

Thank you.

Dr. Wood.

Yeah, thank you. And I'm not trying to belabor the point here, but I think the outreach is really important to underserved communities because there is often limited access to broadband. Like my district is the least served, or has the lowest percentage of served people for broadband in the state. And so how that outreach is happening at a district wide level is a challenge. And then we look at California's first people, and as I said, some of those communities don't have reliable electricity.

They definitely don't have broadband. And so how that outreach is happening is critical to being able to reach people that need help. That's one example. You can be in underserved communities in urban areas that face similar challenges, and they may not have access to Internet, their families may not have access to the Internet. And so the question becomes, how are we reaching to those people who are arguably some of the most vulnerable and with some of the highest needs?

So I think that's where we're going, or at least that's where I'm going. Thank you.

With that, I will bring it back up to the Chair. My first question will be for Director Bargmann and Ms. Walter, if I can. We've heard a lot about how these improvements can't be made within a day and that this will take time.

But I'm trying to understand if you can share some of the data that demonstrates the measurable improvements towards equity in the system that you've discussed, as well as what are some concrete system goals that will reduce disparities over the next five years that the Department is looking to operationalize.

Yes. Thank you. There's a couple of things that we're doing immediately. And while you'll hear me say that implementing some of these changes or initiatives, if you will, will take some time, it doesn't mean that we wait for all of that. We still have to take steps. There's a number of things that we're doing. We're working with ARCA and the Regional Centers, listening to the community about the importance of standardizing some of the areas where we can actually get some measurement.

So to be able to measure, we need to be able to have standardized data. We need to have the data to be able to inform that. I'll give you one example, is the intake. When we take a look at how long does it take for communities to navigate through the intake process at the Regional Center and to access initial services as a good example.

So we need to have a standardized approach and how we're doing intake and assessment while we have an information packet that is going to be informative for families that's soon to be released, that's going to be extremely helpful for early start, but we have to be able to say, what is that kind of intake standard? And each Regional Center that's following it. So those are things that we're immediately doing. And those are some of the measures that we're going to be able to do.

And through the performance incentive program, through the Legislature's action of funding service coordinators with the reduced caseload ratios for birth through five, and then also to achieve caseload ratios that's effective this year, that the initial investment was to say, what are those performance measures? That is an area in which we're going to be able to measure the timelines, for example, to get through kind of intake and access to services is a good example.

So those are some of the things that we're looking at immediately to be able to address it. And I had also shared some of the other transformational reform areas as far as changing the appeal process and a number of other initiatives that are currently in action.

So it sounds from there that you're going to be measuring intake and access to services as a goal. What other goals are we working on that will allow us to focus on the disparities we see currently in the system?

So we can provide you some of the performance measures that we're working on as one of the areas that is part of that investment. It's not just within the Regional Centers, but then also taking a look at what the measures we're doing within quality incentive program. So we'd be happy to provide that information to the Committee.

I may ask Ms. Contreras to make her way up, if I can. And first, I'm just going to applaud you for your advocacy on behalf of Sergio. He's lucky to have you as a grandmother, and it's unfortunate that it was required to have someone advocate as strongly as you did. But Sergio is very lucky to have you. And just want to make sure to say that both in public and in front of everyone else.

I just want to make sure that people saw the picture of when he was at the care home. And now when you see him stand up, you can see he's very active and quite healthy.

I'm going to have you sit down, if I can, so you can speak into the mic. You spoke powerfully about the service coordination and what occurred to you individually, but I'm hoping you can provide a perspective on service coordination overall and how the ratios coming into compliance could assist with greater equity. Currently, just so we're all aware, there isn't a Regional Center that has met and is compliant with those ratios.

What would it mean if a service coordinator would have had those ratios to you and your family?

I think what would happen and what we are asking for as a community is transparency. To have a menu of services. Sometimes you can go into these IPP meetings, and as you know, I work at the grassroots level for a community based organization. And we often go into these meetings and we help parents identify their needs. But somehow the services are not offered. We have to find out later that they're available.

So one of the things that I would hope that a social coordinator could do and would do, would look at the whole family, be able to identify their needs and be able to say, these are the services that are available for your loved one. And this is not happening. And that is what I think needs to happen, is that they see a menu and they hear the needs. I was at my IPP meetings. I said, I need care for my grandson.

I work full time, I'm single. Nothing was offered to me except daycare during that time. And daycare was hard to find. So I begged my family to- not my family, because my family is not active in his care- but I begged my friends, really close friends, to come and help me provide that babysitting. And when I was promoted to principal of a school, it got even harder. And that's when I couldn't do it anymore.

And I just had to put him somewhere somebody would care for him. But I do want the Committee to know that every weekend he was home with me. So I took him out, put him back in, took him out, so I knew exactly what was going on. And I'm speaking for all young people that are in those homes that needs to have a lot of oversight and transparency.

I think what I'm trying to ask, if I can, is if this service coordinator would have had less families that they were interacting with, do you feel that they would have focused and provided more attention and given you information about how to access resources, would that have benefited you?

That would been a hope. But what is currently happening is there's a culture of no. As Judy said, there's a culture of maybe because they are overwhelmed. I can't say what that is, but there's a culture of no. There's a culture where they're not describing the services I said before, and they're not actively involved with the family. There's families present here that we found with zero services. Zero services. Why? They had IPP meetings.

I think that the service coordinators really need to have a lot of training, and it's hard to be empathetic, sympathetic, compassionate. That's, I think a key here is that our families aren't being listened to. Even if we do try to help them when we sit in at these IPP meetings. Now, our Regional Center, I have to say, has come a long ways as far as respecting us as a community organization.

Coming in to train parents to be able to do their own IPPs and be able to advocate. Our community should be able to advocate for themselves, not have an organization that has to help them advocate because the social service coordinators are not available. And that's not all of them, because we have ran across some very, very good ones, even with the high ratios that are listening, are empathetic, compassionate, and will tell you, this is what's available.

I'll bring up Ms. Mark, if I can. I first want to applaud you for the information that you've provided. It's the first time we've seen it in such a concise and succinct way. And I'm hoping you can speak to the geographic disparities that you pointed out to within your presentation. Can you tell us what is the first step the state can do to address those geographic disparities?

Yeah, I mean, geographic disparities have been around as long as the racial and ethnic disparities. Back when my son first started getting served and I got to start meeting the statewide leaders, they would say, there are seven good Regional Centers, seven mediocre, and seven bad ones. And that was like an accepted thing. And how can we accept that? This is a statewide system, and I do believe there has to be more standardization in the state.

There has to be a minimum level of services that every Regional Center offers. You shouldn't live on one side of Rosecrans Boulevard, where I live in Los Angeles at Harbor Regional Center, and have no access to supported living services because they don't provide it there and live on the other side of the street and have access to it at West Side. This relates to what you just asked to Dora. It is about leadership. It is about the leaders of the Regional Centers.

I'm not here to sit and criticize the service coordinators because they're doing heroic work, just like the service providers. And many of them are absolutely disempowered. They have no authority to make any decisions at IPPs. I just had an IPP a few days ago with my son and our service coordinator's lovely.

But he said, I'm going to have to go ask my supervisor. That is against the law. The Lanterman Act actually says the IPP team is empowered to make decisions. And the fact that every single decision that I hear about from all of the families say they have to ask the supervisor. That needs to change. My feeling is, let's lower the caseloads, but at the same time, let's expect more. Let's put this to a higher standard.

I am tired of every day getting calls from Dora's friends, from people saying, I don't trust my service coordinator, I don't trust my Regional Center. That is the crux of this. It's about leadership. At every Regional Center at Valley Mountain, they have a new leader. Things are starting to change, and I think that that is what we need to see. And I want to say something to Nancy. People trust Nancy. People in the community trust Nancy because her door is always open.

And you cannot say the same thing to the executive directors of all the Regional Centers. And so we've got to change the culture.

No. And at our Regional Center, just want to add to what Judy said. We do have the program managers present at the service coordinator and IPP meetings, and they are instrumental. Some of them have really switched the switch where they respect us and are able to be there to also help the social service coordinator if they get stuck with a question from a family.

I may bring up Ms. Westling, if I can.

We just heard about the need to. Oh sorry, I'll wait till you sit down. We just heard about the need for standardization and for minimal levels of services. And I'm wondering how ARCA responds to the geographic disparities that we saw presented by DVU within their testimony and what responses you have.

Yeah, absolutely. So as an Association, we have heard the community and we have taken a close look at this issue, and we have decided that rather than waiting for someone else to tell us it's time to do something to increase levels of consistency and standardization, to tackle this issue ourselves. So in our testimony that we sent into the Little Hoover Commission back in November, we committed to doing four things to improve consistency within the system. And this has the buy-in from all 21 Regional Centers.

So first, we know that people want access to public information. They want information about where is the money going, how is it being spent, what are the policies related to purchase of service. And Regional Centers are required to post much of that information today. But that posting isn't consistent across Regional Center websites in terms of where the information is found or how it's labeled or titled, which we understand makes comparison between Regional Centers challenging.

So as an Association, we will be developing a consistent structure for those transparency portals to ensure that the information is indexed and titled the same way across Regional Center websites so that it can be more easily found. Second, in the area of intake, Director Bargmann made reference to people making it through the front door and through the process. And one of the performance measures that we're excited about that the Department has begun is that standardization of the intake process.

But as an Association, we wanted to take it a couple steps further. One of them is that we know that one of the things that challenges intake in the state is the shortage of clinical staff. It's difficult to determine Regional Center eligibility if you don't have psychologists who can do those assessments. Some Regional Centers have turned to telehealth in order to, when appropriate, do those assessments. So we've committed to finding a way to better share those resources across Regional Center areas because they're not geographically tied.

And second, when we think about the data, what the data tells us is that some of the kids that have the greatest challenge making it through the intake process are children and youth in the foster care system because they move from one place to another and start the intake process over.

So by the end of the calendar year, we'll have identified a way to make it so that when one Regional Center starts an intake, they will finish that intake for a foster child, so that then that child isn't left in limbo each time they move. Additionally, we've heard from our service provider partners that vendorization or contracting with a Regional Center can be confusing and challenging, particularly when you're dealing with more than one Regional Center.

So we're going to standardize and streamline the vendorization process to make that easier and more consistent across Regional Centers, beginning with an emphasis on social recreation providers, which I believe Ms. Contreras spoke about, because social recreation, what we know about that service is a couple of things. First, we know that prior to it being suspended, that those individuals from non-White communities accessed the service more and accessed more of it. And so we know that it's very important to non-White communities.

But when we restored social recreation, it was less of a restoration and more of a reimagining because the service that was taken away from people was segregated for the most part. And so now we're reaching out to various integrated community organizations, T-ball leagues, and those kinds of things with the support of, additionally, some grant funding for this service.

So we're going to start the vendorization streamlining with social recreation because we know that it's critical and we don't want families to be in the position of paying it in advance and us reimbursing them, which is the mechanism when vendorization is challenging. And the final thing is that we know that many families rely upon Regional Centers for family support services when they have individuals living in the family home, things like respite and personal assistance, and daycare.

And we hear advocates such as Ms. Mark, who have said that the volume of services you receive shouldn't be tied to your geography. So by the end of the calendar year, we will have developed a consistent assessment tool for the volume of those resources that all 21 Regional Centers will employ. We look forward to doing that in partnership with various stakeholders to make sure that we're considering those right factors.

But these are things that, as a system, we think will make us stronger, more consistent, and more predictable.

Thank you. Dr. Jackson.

A couple of things just kind of stand out to me here. And that is, number one, I remember, unfortunately, when we started to realize when my grandmother could no longer live by herself and she had some medical issues and she had to stay an extended time at a facility. And I remember her direct wishes after she came out. And that is, if I ever have to go back, just let me go. Just let me go. I will not go back. And that correlates to facilities for this population.

And that the state is obviously paying for these placements to facilities that, quite frankly, can be dangerous at times. And what are we doing to making sure that state dollars are not going to facilities that are creating opportunities for continued harm to be done? And I know it's not intentional, don't get me wrong.

But obviously, when you hear Dora's story about when her grandson was in a placement setting. And what are we doing to prevent these dollars being used in facilities such as that? I know there's a lot more complication. Don't get me wrong, I worked at a level 12 foster care placement facility, so I know how complicated these things can be. But any thoughts on how do we improve those type of circumstances? Any thoughts about that?

Yes, if I can. Thank you, Dr. Jackson. When we take a look at residential setting types, licensed settings primarily. First, I'll say that we've really had a significant change in the number of individuals who are accessing licensed setting types, and I'll speak to it here in a second.

But with supported living services, and I'm really looking forward to the coordinated family supports that's going in the family homes because there's the situations when families have shared with their adult child or a sibling who wants to live at home with a family.

But if there's kind of complicated family issues that you don't want to have to make a decision unless it's a decision you want to make, because there's times when you have a grandparent or you have somebody else in the family that may also be needing services and supports. So having the coordinated family supports allows for kind of the grace and space to be able to make the decision as a family as to what is best for the self-advocate and the family.

So we're happy to see that we're able to advance our system, to be able to have kind of person-centered decisions and approaches. The other things that we've recently done in the area of oversight for risk management and quality, there's two things that I think are really critical is the Quality Incentive Program. So the Legislature approved and actually expedited the implementation of a rate study that was done in 2019 that restructured all of the rates and full implementation of those rates. And it does several things.

One, it is responsive to some of the inequities between some of the Regional Centers and the rates that have been kind of been systemic for decades. But it also takes a look at establishing for those residential settings, what's the cost of business, what's the cost of services, and looking at kind of structuring that and that is a piece because then in the building of the rate models included.

Is that that 10%?

Well, it's. Well, yes, that's the quality incentive.

Okay.

Correct. That part of it is where we're going to be able to, and granted, we have phases that we're going to have to advance based on data, because we'll be able to start taking a look at individual, and you're going to hear some more about that, individual experiences. Is the individual who's living in that residential setting having a positive experience? So issue two is rates and quality incentives.

It's an important conversation because we want to get to an outcome-based system based on the experience of individuals and being able to understand. But I think not to complicate this more, we need to make sure it's going on with what Ms. Westling was saying is that we have to have choice. Families need to understand what options are available. And families have said, I'm happy with this, but do they know what their other options are?

So as we continue to have different service options, because we need to be able to measure what is that experience. And if you're living in a licensed residential setting, is that experience based on an informed choice? And then what is that experience? The other area that we have is that we are measuring based on risk management. I wish I could mitigate all risk, but at the very least we have to do is also measure what the risks are.

So we are tracking all incident reports in the state. We're working with our contractors to take a look at trends, seeing if there's anything within those license settings. We're working with our Sister Department, Department of Social Services, or Department of Public Health for our other license settings to see. Are there things that are risk for individuals and being able to collectively provide the appropriate response? Is it corrective action? Is it technical assistance?

So there's many facets of making sure that we're really evaluating the level of quality in all service types and then training. There's a lot of things that we're doing to really make sure that we're measuring it. I'm happy to say that those under age 22, very small percentage of individuals under the age of 22 actually live in a licensed setting. And so we continue to evaluate and continue to make sure that we're evaluating risk and also the appropriate response when we do see it.

And are we issuing directives in terms of when people are working or being served? If customers go to Regional Centers, is there a directive in terms of making sure that all options are presented to them in terms of if they qualify, they will be aware of, they will be presented with all the options.

Yeah, we're continuing to evaluate what that is. So when we look at how do we make sure that we're giving the kind of equal information? An example of an area in which we are doing this is that we have, I briefly mentioned the Early Start Information Packet that's going to be released because we want at every single contact for anybody who's just making initial contact at a Regional Center, that every person gets the same information in the state.

So the state took the responsibility to say, we're going to make sure that we have this information packet, but then also broadly get it out to, say, NICU's and other avenues. So there's information. We're actively working on the Lannerman one as well. So within that information packet, it's like, what are the services that are available? Kind of, generally speaking, supported living services. So we'll be able to have that list of information that's in there and then also contact for advocates.

Is there more that can be done as far as making sure there's availability and access to what types of services? Absolutely, and that's what our electronic record system is intended to do. We are working on revamping our entire electronic record system that would be outward-facing. So families or a self-advocate can go online to their Regional Center and say, I'm an adult, I'm graduating, what services are available to me?

And then we can start really taking a look and having information to families, I think is so critical. And again, we have to build our infrastructure on some of the technology side of this to get there. But I'm extremely excited about our future and how we're going to be able to have access to families that we don't have today.

My last question is for the Department of Finance, if you don't mind. Obviously, meeting our federal required caseload is very important and it seems like we still have a lot of work to be done, although we are seeing, I believe it's an 11% increase in this budget overall. What are we doing to making sure that we are giving our Regional Centers the funding that they need to make sure we're meeting the federal caseload requirements?

Thank you, Dr. Jackson. Christopher Odneal with the Department of Finance. As has been noted, the last couple of budgets have included significant investments to close some of those service coordinator-to-consumer ratio gaps that have been highlighted in the agenda and also been part of the conversation today. We would just highlight that as part of the Regional Center Performance Measures Incentive Program, the initial focus is on closing the service coordinator ratio gaps

And so funding is allocated for those purposes as part of that program and including about $59.5 million General Fund this year. And then also we have targeted reduced caseload ratios for children under the age of five to reduce those to one to 40. So as well as trying to meet those one to 62 ratios, the federally mandated ones, we also have targeted funding available for other caseload ratios as well.

When do we intend to get to those numbers where we're supposed to be? Is there a benchmark here? Is there a deadline by when we're trying to get to there? I mean, obviously I have flashback in terms of my social work days and in terms of how caseloads are so important to make sure we're getting them down. What is our deadline to say this is when we're supposed to get there?

I'll defer to my Department counterparts for more information on that timeline. I do know, I believe that next month we have updated caseload ratios that are going to be reported out. That's twice a year in October and March, but I'll defer the Director.

Yeah, that's correct. So Nancy Bargmann, on the funding. So Mr. Odneal had noted that we received funding for the birth through five reduced caseload ratio. So in current year, nine months of funding is available for that. Regional Centers are working to do the hiring. We're monitoring based on the caseload ratio reporting. Additionally, with the reducing to the waiver requirements of the ratios, that funding also came in for this year. So the Regional Centers have been reporting to us those ratios.

They're required to do it twice a year. We're continuing to work with ARCA and the Regional Centers to track it. We have heard that there's been some challenges in the workforce of being able to recruit and hire. So as far as.

What's the requirement for those caseload?

So in your agenda, I'd have to kind of get. The staff had included an agenda. I'd have to look to see what page number. Apologize. I don't have that readily available.

Is that a different panel? I'm sorry.

It's issue five.

Never mind. I'll wait until issue five.

Okay. Well, thank you for the question, and more to come.

Thank you.

I'm going to bring in Ms. Contreras, who had a comment to the previous questions.

Yes, I can now say that I'm very knowledgeable about care homes because as my grandson and very, very grateful to Dr. Jackson for bringing the care facilities in. These care facilities need more oversight, more oversight and transparency again. And the nepotism involved, which is part of our Bill that Judy Mark talked about, is outrageous. There are people within the Regional Center running care homes, number one. Number two, how does one individual own five care homes?

I'm running a care home now when you think about it, because I have my grandson with me and I have the SLL services, but I'm there. And most of the time I'm managing the employees that work with him to get better service from them so they know how to talk to him and know him. But then that's hard enough. But to allow one person to own five homes and become multimillionaires, to me, is a sin. And I wanted to say that, too.

And I wanted Dr. Jackson to hear that. And I don't know how that happens. And I love Nancy. She knows I love her. And I'm sure she's thinking about what I'm saying right now because I love her for that, because she listens to us all the time as Latino women. But I promised today when I brought Sergio that I would speak for those that were left behind, four young men that are still in the same facility.

And I've done my job today to them and to God. Thank you.

Thank you. Dr. Wood.

Yes. And please stay for a second, if you don't mind. So I was going to bring this up on the next panel, but since, Director Bargmann, you brought up the rate study, one of the concerns that I have is that that rate study, it was not perfect. And one of those areas that's not perfect is the rates for independent living services. And because they are misclassified. And I will quote a letter from the LAO.

Quote, since the ILS services focus more on functional skills training than personal care, the wage assumptions underlying the rate model for ILS may need to be adjusted upwards if the desire is to accurately reflect actual costs. That was an LAO letter in 2019. So fast forward to today.

We're losing these providers, and it's going to be really difficult to train a new workforce if we don't find a way to retain and adequately compensate those people who can then help some people in the community to actually live independently. So I want to ask the Department of Finance about this and also want to ask you, are there plans? What are the plans and what do we need to do to push that forward?

I may ask for us to address this in panel two.

Well, I only brought it up because she brought up the rate study and she's not on panel two.

Well, I'm happy to have her provide comments.

Unless you're going to stay for the second panel.

Chair?

I'm sorry, I didn't.

I leave it up to the Director. If she wants to provide some comments.

I'm more than happy to stay with the next panel. I'd be happy to do that.

With that, then I will thank very much the entire panel one. Given the pending report from Georgetown, I would like to ask the Department of Developmental Services to come back on April 26 for our Sub One hearing so we can discuss the best practices and the lessons learned from the disparities grants and other efforts, and to hear about a comprehensive plan to move forward towards greater equity within purchases of service. Is this something the Department would be amenable to?

I will also be asking the Little Hoover Commission to attend the hearing to present on their report, which is pending release now, but wanted to make sure you are amenable to being there on April 26.

Yeah, we would be happy to be there on the 26th. And I'll have to connect with our contractor regarding the report and the timing of it before I can commit to that. Thank you.

With that, all issues in this topic will be held open and we will now move on to issue two regarding provider adequacy rates, quality incentives, and the provision of services. The question for the panelists for this issue are what are the key issues with regards to the provision of services? What are the challenges in workforce and what impact are the rate increases having?

What is or should be the role of the quality incentives and what are the priority areas that the Administration and Legislature should consider to address continued quality improvement for services and supports within the system? We will have eight presenters on panel two, beginning with Deputy Director Jim Knight with DDS.

Ruby Keefe is a self-advocate and person served by the Alta Regional Center, followed by Judy Mark, President of DVU, Barry Jardini, Executive Director for the California Disability Services Association, representing the Lanternman Coalition, Mark Melanson, Executive Director for the California Community Living Network, Eric Zigman, Executive Director for the Golden Gate Regional Center, Christopher Odeneal with Finance and Ryan Anderson with the LAO. Let's begin with Deputy Director Knight when you are ready.

Thank you, Dr. Arambla, Committee Members, staff. I am Jim Knight. I'm Deputy Director at the Department of Developmental Services. You know, as the agenda notes, there's a significant investment in not just rates, but also rate reform, as the statute says. And it impacts so much it even spilled into the prior discussion. And I'm sure we'll talk about it more because not only is it a significant dollar amount. It's significant scope.

It really does help set some of the basis to really a couple of pillars and really needed things as part of a service delivery system. That means access to services and also the quality of those services. Because it's not just about getting them it's are those services really providing a benefit, and are they getting people what it is that they need, and what are those experiences that they're having with those services.

So as we talk about access, and Director Bargmann touched on it a little bit, and the agenda also discusses about the way that rates and services are set up now. There's a significant amount of inconsistency in the rates, even for similar services in the same area, as well as in some places, what the service is actually called. So there's not much transparency in there, and it's very confusing.

So one of the things we'll be able to do as well is set some consistency and in what those services are and the rates as we move forward. So when you talk about access to service, it's also not only dependent on the rates, but also a workforce that can provide those services. And our services are largely dependent on folks who are referred to as direct service professionals.

And I want to touch on some of the investments that we've done to help encourage more direct service professionals as well, three of which are very soon to roll out, hopefully in the next month or so. One of those is training stipends. There will be up to two of those available for folks, which would be about $500 each for completing a training curriculum online.

There's also additional funds which would be ongoing for direct service professionals who are able to communicate in languages other than English, and that would include American Sign Language as well. And the other thing that we're working on too, is that we've got a workforce that I think all of us recognize has changed significantly over the last three years, and in some ways that's shrunk. And so we need to look at and using the direct service professionals that we have more efficiently.

So looking at a pilot project that will be able to use remote and technology, remote services, and technology to provide support for individuals who maybe don't need someone right next to them all the time, but can use some reminders, some cues, like I said, with technology to spread out the limited resources that we have. There are other upcoming initiatives geared towards the direct service professionals as well.

A longer training curriculum be an option for folks that will increase their wages directly as more training that they complete, the higher their wages can go, as well as an internship program, which is something that we haven't started or talked about previously, but it's really trying to draw in more folks who maybe aren't interested in the system.

And by doing that, give an incentive not only to those folks who come in and try this service delivery system with training, but also then it's an incentive to the providers as well because for a time-limited period, then their wages and employer costs will be covered through this program. So really trying to look at a lot of different areas and ways to help increase and support that workforce in addition to the rates that we're talking about.

So getting back to rates, we've been working through this phased implementation and as was brought up just previously, there have been some concerns from stakeholders, in particular in some services that maybe there's some changes that need to be made in the assumptions used in the rate study. Independent living was brought up. Certainly, we're looking at early intervention, those providers that serve our youngest kids and families, as well as transportation, Family Home Agency, and some others.

As noted in the Governor's Budget, we are continuing to work with stakeholders and look at that and we'll be evaluating what possible changes may be needed through the budget process. So when we move on to incentives. So we talked about that access, now incentives, our services, really providing the desired results. We've worked with a number of stakeholders to identify what are some of those key focus areas that we should look at to incentivize.

And the message was pretty clear that we really wanted to narrow that focus down to what are the most important areas. And there are six areas, some of which we've touched on already today workforce, access, early start intake is one and there's some others. Employment is another key area as well. That's kind of in the interim, when I say in the interim prior to the full implementation in July of 2024, when those quality incentives will be part of the overall rates.

So while we have some now targeted incentives towards certain services, we do need to be mindful and we'll continue to work on what are some of those maybe core measures that will apply to all services, because the quality incentive does apply to all services. So as we move towards July of 2024, we'll need to be mindful and work through developing measures for all.

The other thing that I want to point out, and I know Mr. Melanson will be on the panel later as know some of the outcomes and the incentives that we talked about are more systemic level, but we're looking forward to the collaboration, and working together with the California Community Living Network on the PAVE project, which is looking at individual consumer level outcomes. Again, the services are here to give people what it is that they need and want.

So getting down to those outcomes is going to be very important. So thank you.

Next, we will hear from Ruby Keith.

My name is Ruby Keith. I have developed disability for entire life, but I didn't get any service from Regional Center until I was an adult. My parents were immigrants from Mexico City. They didn't know anything about Regional Center. No one gave information to Hispanic people who didn't speak English. My parents had to help me with everything. My dad would take me to the store. He would teach me how to pay for things. My mother had to do everything for me around the house.

But I wanted to be independent. I wanted to learn to cook, iron, pay rent and bills. I knew I could do those things. I just needed help. I had to advocate for myself to become independent. I know the Regional Center didn't think that I could be independent and have a job and a life. After many years of getting nothing, I finally got a Regional Center to help me by giving me the service I needed. Something the service provides are great. Sometimes they are not.

But the independent living service I get from STEP has changed my life. They help me with transportation and take me shopping because I don't drive. They come with me to medical appointments and help explain things to me. They remind me to take my medication and refill them. But most important, they teach me how to defend myself when people criticize me because of my disability. I go to support groups at STEP too.

When I first started going many years ago, I would not talk to anybody, but the support group helped me. Now I am one of the leaders and helping to bring other people into support group. I wanted to tell you a story about how important the service has been for my life. After I started getting service from STEP, I got pregnant with my daughter, Mackenzie. STEP was able to help me with parenting. They have the Parenting STEP Program.

I was able to meet with other parents with disability. We wouldn't get together with children and celebrate holidays, have picnics and other activities. When my daughter started having health issues, I didn't know what to do. STEP helped me take doctor's appointments. They helped me understand what doctor's office was saying. I now have another daughter, my husband, and two children and I live in Folsom together. My oldest.

My oldest daughter, who is now 21, also has disabilities. But just like me, at the age, she receives no services from the Regional Center. So now I have to start this fight all over again. I have to help my daughter because she needs all the same services that I get. If I didn't have STEP, I would not be where I am at.

The people who come to my house know what they are doing, but I keep getting new people all the time because it's hard for them to keep their staff. That's because they don't get paid enough. Rebecca is a Director of ILS at STEP. You can count on her anytime if you have any concern. She's there to defend us and advocate for us. She showed us. I'm here for you. You're not alone. You have somebody to back up. But I know there is a problem with funding.

This service didn't get any rate increase. I worry that I won't get this service anymore. Rebecca LaBoriel, please stand up. I didn't get any service for lot of my life. Now that I have a great service from STEP, I wanted to make sure that I keep them. For me, it's my matter of life and death, but it's a matter of being happy, and it's a matter of keeping my family together. Thank you.

Thank you, Ruby, for having the courage to share that. That was very powerful. Miss Mark.

Why do I always have to follow these people? Like, seriously? Hi again. Six years ago this week, a group of people with disabilities and family members gathered to create our organization, Disability Voices United. At the core of our mission is advocating for meaningful outcomes that matter to us. To us, not to DDS, not to the Regional Centers, and not to service providers, but to us. So what does that mean? So, for example, Regional Centers often think of outcomes as controlling or fixing behaviors.

But for us, we say we want to communicate. We want support to communicate, which, of course, addresses behaviors and produces better outcomes. Some providers think good outcomes are making friends. But you're sitting all day in a center that's completely segregated from the community. What we want is to be included. So meaningful outcomes, unfortunately, have been historically looked at as checking boxes. A provider just shows up. So you're getting a good outcome because your provider showed up?

Or parents who say to me, my kids, we're keeping him busy, so it's fine. That's not an outcome. Meaningful outcomes that matter to us are being part of the community, being contributors to the community. It's about having fulfilling lives with choice, and control, just like people without disabilities have. So looking through this lens, we have a very strong interest in ensuring that this absolutely unprecedented and historic rate increase leads to those meaningful outcomes that matter to us.

So to that end, we want to make sure that the people who directly support us actually are making livable wages and are receiving the majority of these rate increases. We advocated that last year's budget include a requirement. To that extent, it's still unclear to us how we're going to verify that and when we're going to know if that actually happened. Second, we believe that only service providers who offer choice, dignity and inclusion should be eligible for incentives. At a minimum, that means all providers who receive incentives must be compliant with the HCBS Settings Rule, which I know you have a panel on later. But I want to mention something.

Most individuals and families have no idea what the HCBS Settings Rule is, which goes into effect in 23 days and $105,000,000 and another $15 million you're going to discuss today has been spent, and there are no statewide efforts to ensure that self advocates and family members who are directly affected by this rule even know about it. Third, quality incentive measures for providers must be clear and ambitious.

DDS has been leading a stakeholder effort to establish these measures that I'm part of, but there has not been a lot of clarity or definition yet. Submeasures only affect a tiny fraction of people. Many measures are only about adults, and the measures around informed choice and satisfaction, which are the outcomes that matter to us, still haven't been determined. And I know that you are going to hear that it's very hard to measure these outcomes because of the new IT system has not been developed.

We agree with that, but we have to figure out something to do in the meantime. Fourth, we need to work with individuals so they actually recognize what quality services look like. That may be simple or seems simple, but many people served think that they're in completely fine programs because they have no other choices and they don't know what good looks like. But when you ask them, did you get to choose your staff? Do you get to choose what you do every day?

Do you get to have visitors and meals at the times that you choose? All of a sudden they realize, I'm not in a quality service at all. How are they supposed to recognize quality services and meaningful outcomes when they've never had it before? And finally, we must improve Regional Center accountability, service provider oversight, and increase transparency so that clients and families have the information they need to make informed choices. Many of us have had incredible and heroic staff like Ruby.

But many of us have also had some pretty bad service providers. Kind of like this nursing home that your mother or the rehab home that your grandmother was stuck in. My friend Howard had a support staff who belittled and made fun of him. He requested for the staff to be removed, but Howard has to regularly see that staff taking care of his neighbors. Natalie was raped by a staff member at a day program and contracted gonorrhea. No one was ever arrested.

The abuse is being covered up and the agency continues to provide services for others. When my autistic son was young, his staff person slapped him across the face right in front of me. She still works in the field 20 years later. All of these providers are getting the same rate increases as the heroic ones.

Rate increases should be prioritized for those providers who are supporting their clients to achieve the outcomes that matter to them, as opposed to agencies led by executives who make outrageous seven figure salaries while their clients sit in soiled diapers in the park. And they exist. Many people served and their families don't know what meaningful outcomes and quality services are because they have never seen or felt them. Let's make sure they all feel it soon. Thank you.

Thank you. Next we will hear from Barry Jardini with the Lanterman Coalition.

Good afternoon, Mr. Chair and Members of the Committee. As you indicated, I'm Barry Jardini. I'm the Executive Director at the California Disability Services Association. But today I'm here as a representative of the Lanterman Coalition, which is a coalition of statewide and regional organizations representing providers, Regional Centers, labor, families and clients to talk about our priorities and appreciate the opportunity today to be empaneled on this particular subject.

I was heartened to hear Mr. Knight start with direct support professionals because I want to provide just a little bit of context. The support that we received from the Legislature and the Administration in getting this rate implementation plan through is nothing short of extraordinary. I don't consider myself a pessimist, but I was not bullish on the opportunity for us to even be in this situation where we're looking at rate increases coming down the line in full implementation in just 15 months time.

So that is a tremendous win for our community. But right now we are really, really struggling, and I want to just provide some context. During the pandemic, one in five direct support professionals left the field. They're gone. We have wages in the rate study that are indexed to slightly more than minimum wage in most services, but certainly not adequate to compete with the new market forces that have taken place over the last three years.

We know that wage pressures, low unemployment rates, things of that nature, make it exceptionally difficult not only to retain your existing staff, not to mention hiring new folks to serve additional clients who you could otherwise serve at your organization, or to adapt to the growing census in our population, that growth continues to grow year on year, and new services will need to be developed.

So we have a real problem foundationally with kind of where the rates are indexed at this point, and it requires recognition of consistent oversight and review of whether those rates are going to be adequate for the long term. I'll jump back to that in a moment, but I also want to talk about just service provision generally, because so much of this came up in the first panel. And Dr. Arambula and Dr. Jackson, you both spoke to the concern around Regional Center service coordinators.

Regional Centers are the hubs, right? They take people in, they determine eligibility. They make determinations around programs. They take questions and complaints from their clients. And right now, we are asking those service coordinators to do an exceptionally impossible job. If you have 50% more than what the federally mandated ratio is to serve, how can you do your job well? This is a year where I know we're in a tough budget circumstance. We are not where we were last year.

We don't have record surpluses to play with, but we do have an obligation to serve this population. These individuals with intellectual and developmental disabilities have been promised supports and services to meet their needs in California, and we have an obligation to do so.

So I think that - well the Landerman Coalition is pushing this year for a revision to that core staffing formula to not only focus on that targeted population of zero to five, which, absolutely, we need to get those caseload ratios down to where they need to be, but we need to address the case manager or case service coordinator ratio and compliance challenges, not only for access, but mostly for that make sure people are getting the services they need, quality outcomes, quality providers that Judy, Ms. Mark spoke to, but also to the point that you were making around federal funding.

We are putting a significant risk, billions of potential dollars in federal funding that these are federal regulations that we are not complying with. At some point, if they came back to get us, we need to invest now so that we are making wise fiscal decisions in the long run.

From our perspective. I want to go back to the rate model implementation, if I may, and really talk about how heartened we were about the acceleration, but also need to recognize that we are only now, as of last month, 50% of closing the gap between where we were when this began and where we're going to ultimately be. We can't get there fast enough because we can't hire, we can't retain staff, and we have some recommendations around fixes in those rate models.

So if you're looking to the future and you see a rate increase, at least you can plan ahead. But as Dr. Wood mentioned, there are some services you're not seeing a very bright future for yourself because the rate model for you is not built correctly and there need to be some amendments. And I want to acknowledge and thank the Department for consistently being open and approachable when we have presented issues around particular services. They have proven themselves to be very good partners in this circumstance.

But we are calling as the Landerman Coalition, calling for an addendum to the rate study to just make sure, not that we have to go through exactly every rate model, but make sure where those identified areas of concerns exist, we are taking another look to make sure that we are going to be doing this right. In addition to that, there were some services for which there was no right rate model ever built.

Innovative, progressive programs such as Project Search, which is an employment thing that doesn't even have a rate model at this point. So the addendum would also call for the building of some rates that don't exist today. And the third thing on that rate model implementation is really at that final stage, what is that going to look like for providers? For those of you who haven't looked through the thousands of pages of the rate models, those are all built on an hourly basis.

We are at risk of if we strictly implement the rate models as they're built, going to a fully hourly system. In some services that works, in others, it doesn't work well at all because we have infrastructure problems, transportation, workforce, people who leave to go to a doctor's appointment, but you can't send the staff away in the day program because they're serving two other clients. So some of those core costs are already fixed.

So we don't want to go away from the billing units that have been agreed upon in the program designs. We want to maintain daily and potentially monthly billing options for some programs where it makes sense, where we can be more outcomes based and get away from being so compliance based on going to an hourly model. The next piece I want to touch on again, I want to thank the Department, Mr. Knight's comments around remote supports.

We know we have a workforce crisis that's really not going anywhere. If we're honest with ourselves, we need to spend more money. We need to get up to a living wage. We need more there. But it's going to require innovation and thinking outside the box and using remote supports, utilizing technology where it makes sense, where it's in the interest of the individual to promote Independence, individual choice, we need to be exploring that option.

We have the Silicon Valley in California, and there are other states that are further ahead of us on being a tech first kind of state. So we will always be a system where people are serving people. That is the heart of our system. It will always be the case, but we need to look for innovations and efficiencies where we can. So we're using state dollars as well as possible. We're promoting Independence and supporting individual choice.

And the final piece I know I'm probably running up against time is really regarding the outcomes discussion. I think Ms. Mark's comments were largely right on the mark. Quality should not be a checkbox. We have a 90/10 circumstance as we get to that final stage of implementation. Your core rate, 90% of it you get as a base rate, 10% you get if you meet quality metrics. The Department has been working with this quality incentive program.

We have the PAVE Program coming down the line, but these measures are hard to develop. If you look at other states, no one has national metrics on quality for the IDD space because they're kind of hard to develop. I think there are a lot of great people, a lot of folks who are going to look at this and really come up with some great things, but it's going to take time. We're not going to be there by July 1 of 2024.

I can promise you all that. Now. Right now, we have, I think four of 78 service codes would have distinct quality outcomes measures. So we are grateful for the conversations with stakeholders and the Department around looking at this 90/10 problem, but it's something that we would need to address in this budget year so that we can plan appropriately for that final stage of implementation, so that providers and the individuals that they serve are not left in limbo about whether they're going to qualify.

Because if you're only getting 90% of your rates, you could be back, as the agenda correctly notes, lower than you were before this rate model implementation started. So that is something that we need to see addressed this year and really go to a system, as Ms. Mark was saying, really promoting quality, not just hitting a base level. I think base level is obviously what you need to do as a base rate, but you need to really promote excellence. We want not just the bare minimums we want excellence in the system and so we promise to partner with other stakeholders in the Department to make that the case. And with that, I will pause my comments. Thank you.

Thank you very much. I will ask to create a little bit of space. Next, we will have Mark Melanson, Executive Director of the California Community Living Network, followed by Eric Zigman.

Thanks so much Chair and Committee Members. I feel like most of my testimony has already been already been talked about, but I'm going to walk through it anyways. My name is Mark Melanson, Executive Director of the California Community Living Network. CCLN is a statewide trade organizations with over 100 agency provider members, large and small. Our members provide specialized services that help California's diverse IDD community live more equitable, inclusive lives. Our members provide supported living services, independent living services, employment services, personal assistance and respite.

These are the in person services provided in homes, workplaces and neighborhoods on every corner in California. They all support our core mission, which is to provide person centered services with dignity and respect, with informed choice, control over their lives, living independently and inclusively in communities of their choosing. These guiding principles were not always the case. One of those services, independent living services, which began in 1978 when segregated, isolated and institutionalized settings were more the norm.

But since then, Intermittent Living Services, known as ILS, has continually been one of the most inclusive programs in California, supporting diversity, equity and personal individualized services rather than cookie cutter Institutional like programs. And the main reason we wanted to speak to you today was because ILS program, the most inclusive in California, is now in jeopardy with programs shutting down across California. Further reducing access to ILS for peoples served and creating lengthy waitlists for services.

This room is filled with people who could lose their services if we don't find a solution. From Ruby, who spoke at the beginning of this panel, to the people here today who will be participating in public comment. The potential meltdown of ILS program is all caused by a mistake in the newly implemented and accelerated ILS rate model structure, which miscalculated ILS worker wages.

While the overall rate model have been positively received and we are deeply grateful for the Legislature's commitment to increase rates, this fundamental flaw will ultimately reduce ILS rates. This mistake is actually harmful and destructive to the quality outcomes we are all trying to achieve. Simply put, ILS providers are instructors and skilled life coaches. They teach people with IDD how to live independently in safe, supported and person centered environment.

And as the person with IDD learns additional skills, they can lead more independent lives and reduce their reliance on other support services. But the rate study misclassified these ILS direct support professionals, essentially reducing their compensation rates to that of lower paid workers like personal care aides who assist with things like activities of daily living tasks such as getting out of bed, getting dressed, and getting fed breakfast.

To understand this another way, this rate mistake would be compensating credentialed public school teachers at the same level as a teacher's aide. It simply wouldn't work. The higher skilled, certified, credentialed teachers would leave and find different jobs with more appropriate salaries, which is what is happening now in our industry. We're asking the Legislature to correct this mistake with a simple fix by more accurately aligning the ILS wage assumptions with the high skilled job duties of the ILS worker. This is an issue that can't wait.

In fact, the longer we wait, the more it will cost California taxpayers because people pushed out of the ILS programs are ending up in more costly programs, including crises intervention services. A solution is in the works we're thrilled that Assemblymember Dr. Wood has introduced AB 1568 to correct the ILS rate. We are grateful to the Member and his staff, and we look forward to working with this Committee as AB 1568 moves through the legislative process.

A few quick additional other comments we echo previous testimony that highlighted workforce challenges. We're desperately struggling to attract and retain a sustainable workforce. We're nothing without our dedicated, passionate, and adequately trained employees. The previous budget, funding for bilingual pay training, training stipends, and DSP career pathways, once implemented, can all support our efforts to attract and retain a critical workforce. We also support some of the previous testimony regarding quality incentives. CCLN strongly supports the initiatives to identify quality indicators, quality measures, and quality incentives.

People receiving services in their family deserve and should expect the highest quality of services. There's been significant progress made towards this effort, and there still remains much work to be done to meet the timelines in full implementation of the rate study. Service providers need time to prepare to build the infrastructure and successfully implement the Quality Incentives Program by July 2024.

Concurrently, as Jim mentioned, we're excited that DDS and CCLN have launched the important work of the PAVE Service Outcomes Project, which will be developing data driven measurement systems, research and evaluation elements, and DSP training. The project will focus on two of the most important components of quality metrics that matter most to people served in their families, as Judy said, informed choice and satisfaction. We thank the Committee and Committee Members and Committee staff for the opportunity for CCLN to provide testimony on today's panel, and I'll be happy to answer any questions from Committee Members.

Thank you. We'll just provide a gentle reminder we don't talk about any specific Assembly Bills in a Budget Committee, no matter how great they may be. So, Mr. Zigman.

Thank you. And my name is Eric Zigman. I am the Executive Director of Golden Gate Regional Center and the chair of the Association of Regional Center Agencies Legislative Committee, as well as a Member of DDS's Quality Incentive Program work group. And I thank the Committee and Chairperson Arambula for this opportunity to address you. Also thank Committee staff, the LAO and ARCA for their analysis of the budget.

I think really, as Director Bargmann said earlier, we are a system of partners and it takes all of us rowing in the same direction to really have traction. So I started out 35 years ago in direct service to people with developmental disabilities, and all my 35 years has been in service and supportive of that community. Again, on the partnership, most simply, I conceive of it as we win together, we lose together.

The system has grown very complex over the last 60 years, but one thing that has remained as this need for the different layers of the system to work in harmony and work together collaboratively. And I think, like Director Bargmann, I'm very encouraged. We've seen the greatest investments in probably 30 years in our system, and it's up to us to get it right to take that theory to practice or the policy to practice that you mentioned, Chairperson. So outcomes definitely should be measured.

Obviously, we need a better way to describe the impact of these services to the Legislature, to decision makers, as well as to the general public about what an equal access system really does and the beauty of this unique entitlement system in the countries. The outcomes need to be. I think they are complicated and we do need to continue to take a step back to try to look at systemic outcomes. We all should. The entire system should be accountable for outcomes.

The Legislature, the Administration, DDS, Regional Centers, service providers. We should all share in seeing how we are better today than we were yesterday or where we need to improve. Examples of those systemic measures. We've talked about it before, employment, choice, health safety, social capital, engagement, and community life. Those are the overarching goals that all the detailed goals I believe should really inform and give us information about.

So the quality incentive workgroup under the leadership of DDS has done remarkable progress in addressing the quality incentive measures for providers. But there are still, because it is so complicated, some concerns. Providers, number one, providers must be able to reach that 10% and I don't think we've completely figured out for all the different, as Mr. Jardini was mentioning, all the different services, how they will be able to earn their full 10%.

And then we have to continue to check for attribution - that they're being measured, providers are being measured on things that they have control over that we found that in the Agnews closure and the quality management system in that era of closing an institution, that there are outcomes for individuals that have to do with quality of life that are extremely important. They're the holy grail of importance. But then there is measuring the service quality of providers.

That has to be things that they can control and get better at. I've said this in testimony before and it's come up a couple of times today. The one thing over 35 years that I've learned is that the actual reality of quality in our system hinges on the relationship of the person served and the person serving them. It's in that relationship and the expertise and the experience of direct support professionals that the quality of support is made manifest.

So really encourage the work done by the Department and the Legislature in last year's budget to have things like the Direct Support Professional University and bilingual stipends and other ways for staff to be more educated and be more compensated as professionals. And I think we should kind of lean hard into that because it's where the rubber meets the road. I meet with my provider community at Golden Gate Regional Center. We met every week for the two and a half years of the pandemic.

Now we meet twice a month. So I brought this some of the interests that the Committee had, including how it's going with the rate increases and hiring. Now, Golden Gate is not superlatively a crushingly high cost area. So my providers have the double burden of an underfunded system and a gap that's really significant. They are seeing progress on this. They're losing some of those increases to inflation as well as competition from everything from fast food to other service providers. And they really talked about transportation too, as being something I know the Department is working on to address people being able to get to their services as we move more and more back to in person services.

One of the things about the workforce that we talked a lot about was we're in a transition part in terms of workforce development, and we're moving from looking for direct care staff who are compassionate, as Ms. Mark says in the past, and good caretakers, to ones that have a whole lot of other skills necessary and other expectations, behavioral support, person centeredness social justice, community engagement. We need direct support professionals to be champions and uplift the people we serve in a way that in the 70s, 80s, and 90s.

It wasn't as much on the radar. So that's really important. And then in ARCA's budget letter, there was one line that continues to come back to me that's very simple, that says quality outcomes cannot be achieved without a foundation of fiscal sustainability. And that really applies to all three layers. The investments in providers are coming, and in my area, I just tell them if they can hold on to 2024, I think this rate methodology is going to be sound.

And the Department has increased staff levels in order for them to do oversight and technical assistant and accountability. But Regional Centers, as been discussed earliers, have not in any way, really, other than the new positions been made to be able to do this work. At Golden Gate, we have some of the highest caseloads in the state, and we are still funded at about 50% of what it costs to pay our staff because of the core staffing formula.

So modernizing the core staffing formula, as Mr. Jardini mentioned, is incredibly important. At my Regional Center, there's about 150 social workers funded at 50%, and the new social workers at maybe 95%. Finally, I think I want to end with just saying we have to listen better. And that's been a theme today as well. Listen to all the 400,000 people served.

I worry that our inability to listen deeply and sort of globally moves us to a situation where individual stories, which are incredibly important and we deal with every day at our Regional Center to try to make amends, where we've done poorly and increase and listen to the people we serve and their families. But we really need those ways of listening to the whole 400,000 people, or some large number of them.

What's changed in our system, as well as the expectations of the workforce, and I'll end on this, is that for hundreds of years, people with developmental disabilities had system experts, and for probably 100 years, they were doctors, medical doctors, telling them what they should want and what they should do.

And so I think there is an agreement in our system, which is incredibly empowering and optimistic, that it's well past time where we listen directly to the individuals and for adults that we serve, really getting their voice in every corner of what we do will help inform the outcomes, make them meaningful to the people we serve, and help inform public policy around how to continue this march towards having a system that is funded adequately.

Christopher O'Neill with Department of Finance.

Thank you, Mr. Chair. I'll address Dr. Wood's comments from the last panel. So the Administration has had active conversations with stakeholders and also including CCLN on the particular changes that are proposed for ILS. And we're really grateful to have had those opportunities to connect with Mr. Melanson and others on that proposal. As has been discussed in the agenda today and provided in testimony, rate implementation continues to be very much of an iterative process as we work toward that full implementation fiscal year 24/25. And so we continue to work with DDS and connect on issues that are arising in that process, but we continue to monitor and are glad to continue the conversation on these proposals. Thanks.

Next we will hear from Ryan Anderson with LAO.

Good afternoon. Ryan Anderson with the Legislative Analyst Office. Briefly, just want to highlight one part of our analysis which is present in the agenda, which is a reminder that on the Quality Incentive Program, as we've heard from the panelists today, the responsibilities that the state has put before the stakeholder group and the Department are rather significant. The number of service providers, provider categories for which outcome measures have to be developed and for which there isn't really a blueprint. It's substantial.

And the stakes are very high, both for the individuals served for whom these quality issues, of course, are paramount, and for providers for whom 10% of the rate is very substantial. So we just state that the Legislature should be open to the possibility that statutory changes on either the timeline or the structure of the Quality Incentive Program might be needed if some of those responsibilities are not able to be met within the existing framework.

Now, at this time, I'll say we haven't heard a consensus that that's the case. This is all very fast moving. I understand that there are some very promising proposals that are before the stakeholder group about how do we build brick by brick to where we need to be in July 2024. This is just a reminder that the stakes here are very high, the challenges are significant, and the Legislature may yet have a role to play. That's all.

Thank you. I will bring it up to the dais as that's the conclusion of this panel, and I will ask that our questions conclude for this panel by 4:30 so that we may allow our ASL interpreters to allow those who want to make public comment to do so between 4:30 and five. Dr. Wood.

Thank you. And I apologize to the Chair for my passion on jumping the gun on this and actually want to just commend the panel on the overview of the rates and the rate structure and things, I do appreciate that. Part of my concern about an issue like ILS is that I look at something like that as a preventive issue. I think when you hear the story of Ruby Keefe, where would Ruby Keefe be without ILS services?

She would be in a situation where there's going to be more cost to the system and she's not necessarily getting the services that she really needs. And so when I asked our Department of Finance to be here, part of my frustration, and it is an ongoing frustration for now, I'm in my 9th year in the Legislature. We don't do prevention well at all in the state. We don't prevent much of anything, quite frankly. It feels like we react to things, we do treatment for things.

But when it comes to prevention, it requires an investment, and you don't see the fruits of the investment until later down the line. But you do see the devastating effects of when a program is underfunded or whatever pretty quickly. And so when you start to lose workforce, you start to lose the people that provide services. There is a bigger cost to the system. When I see that people have been aware of this since 2019, this is 2023, we're seeing a decline in a certain workforce.

It's going to be really hard to get those people back. And so my plea, as I do this, it isn't just in this Committee, it's a variety of other things. How do we get to a point, and there's no answer for this because otherwise we maybe had bigger discussions, but how do we get to a point where we can actually make investments in prevention type programs and see the fruits of our labors rather than just focusing on one aspect of it?

We've got to do the budget says this and we've got to do it this way, and we can't go beyond that. And that's really important in the population of people we're talking about here, I think of diabetes prevention in this state, we do really good. We spend like three plus billion dollars a year on diabetes treatment. But you know how much we spend on prevention and education? A couple million dollars. Talk about pennywise and pound foolish.

And what I don't want to see is these kinds of programs continue in that respect. Other states invest in prevention things better than we do, and they see the results. But for whatever reason, we don't do that here in California. I don't know why, I don't know how to turn the glacier or the rock or the ship or whatever the heck it is, but it's really frustrating year after year to see. So thank you, Director, for staying and listening.

But these kinds of things really are really hard. They're really hard. How many Ruby Keefes aren't going to get services if we continue to lose this? And why is it three plus years when this was pointed out before we can get to a point where we're not even sure when we're going to act on something like this? So anyway, thank you, Mr. Chair. And I once again apologize for jumping the gun.

All good. I will bring it up to the Chair now. And I'm going to begin with Jim Knight, but hope I can ask Ruby Keefe to come up and find a seat as well. Deputy Director Knight, we heard with the rates earlier that there's the possibility that some providers may.

Just a moment. I'm sorry, sir. I can't interpret while they're.

Oh, understand.

Thank you. Hold on. Wait one more second.

Deputy Director, we heard there's the possibility that providers may receive a rate cut visa vis what they would have received prior to the implementation of the rate study if they don't qualify for the 10% quality incentive payment come July 1. Can you comment on that? And if so, which rates have the possibility to have that rate cut if they don't receive the 10% quality incentive payment?

Yeah. Mr. Chair, as far as specific rates, it really depends on the provider. So as I mentioned earlier, there's a real inconsistency in the way rates are set now with multiple services. So the situation that you described that was testified to would be a provider who, when we started this process, was already, say, 90% of the way to the rate model or more. And so it would be those providers that if they were not able to qualify or did not qualify for the quality incentive, that could potentially experience a reduction compared to when we started.

Does that help with the retention and recruitment problems we have to be talking about reductions in pay? Is that something normally we do within departments or why is there not a hold harmless, at a minimum for those of us who are trying to provide quality incentives going forward?

Yeah. And these are some of the, as far as in the implementation stage, certainly the initial focus has been on kind of these first phases of adjustments, and we are having some discussions about potential suggestions for how we should implement going forward. There is a hold harmless for providers that are already above the rate model, but there's been some other suggestions about maybe we need to look at some other changes as well for the situation that we just discussed.

Ms. Keefe, the next question is for you. I really would like to know what you would value most within this quality incentive.

So this is a question about how should we measure your service providers? Like what? Should they be held account?

I think that step should. I would love to stay with STEP because they're very good. I enjoy it. I do support groups on Tuesdays and Thursdays. I attend on Zoom, I try to get people involved. And if I lost STEP and had to go to another program, I don't think I would be happy.

Not as much as happy as I am with STEP, because STEP is like a family to me, because I lost my parents, I lost my dad in 88, I lost my mom in 2013. So step is the people that I have as a family and backup.

I'm also appreciative that you're providing peer support for others in your community by being an example of how being an advocate and standing up for your family and how that then is empowering people in our community. And just want you to know how vital that is for us to have. And I'm grateful that you're in this position, able to do just that.

But I'm trying to figure out if there are requirements for our providers that we may want to include that through the quality incentive payments will lead towards the outcomes that led to where you are. And may I ask Ruby Mark?

This was an interesting interaction with me because, first of all, how amazing that you asked her that question. You know, when you ask people who are served, if you asked my son, what is quality to you, it would be very hard for them to answer it. But you heard it. It's about feeling like you're belonging. It's like they're part of your family. Those are hard to measure, but it can be measured. There are ways to do that.

And that feeling of inclusion can be measured and verified, and it happens in other states. So the key thing, though, is that we have to listen to Ruby. We have to listen to my son and to others in the way that they communicate this. You're. I'm sorry I'm obsessing on your grandma, but she was able to clearly articulate, you better not send me back to that place. Not all of our folks can do that. Sergio maybe couldn't have said to Dora, it was a horrible place.

Don't send me back at the end of the weekend. My son, I don't think, could communicate that either. So we have to figure out a way to listen, to hear. And there are great people who can do that, particularly as part of the PAVE Project. I'm very encouraged by that.

Can you speak to some of the workforce or. Sorry, Director Bargmann, it seems like. Please go ahead.

Thank you, Mr. Chair. I just wanted to add, this is such a valuable conversation and lifting up really the importance of self advocates and asking the questions. I tried to stay quiet. This is such a passion of mine. As far as the quality incentive portion of what we're doing. We are doing something transformational in our system.

And I love the fact that our self-advocates and our family members and other advocates are pushing us to think differently as to how we're measuring meeting the needs of individuals and the question regard. I want to just highlight that the 90%, the 10%, whatever that factor is, we're having such important conversations about the measurement of how individuals have informed choice and the impact of their services.

While we are looking at, and we've heard from our stakeholders is the current quality incentive measures don't touch all the service providers. We've heard that loud and clear.

We are working with a particular group of involved advocates and family Members to say, okay, let's take a look at how do we look at those quality measures over the next year or two to be able to make sure that we are touching all service providers so there's not kind of that risk of somebody not being able to have that seat at the table of accessing the incentive pay. So we are doing that.

I will tell you, when we introduced the concept of quality incentive, I am so humbled by our community's response to welcoming, I mean that in itself is so transformational. I work with all my colleagues across the United States and I'm so proud of the fact that we're taking this on, I mean, we're taking five steps forward, three steps back.

We're identifying some of the challenges in our data systems that's making this very difficult, but I do think that we can say, okay, is there a satisfaction survey that we can do now? It may not look like what it's going to be when we have PAVE and all of those things, but I think there's things we can do in the interim. And I just want to just say that we're not waiting for those things, but we are exploring it.

We're challenging our data systems to be able to get there, but just want to just highlight that we really are having those really valuable conversations of what can we do and when can we do it.

Dr. Jackson.

You know, one thing is obviously, whether you're in the mentoring space or the social workspace or this space, everything starts with relationship and connectedness. And there are a number of assessment tools that are validated that talks about how well do you feel heard? How well do you connect with the people that are serving you? Right? And that in and of itself, if we can just begin to assess that part in a meaningful way, to determine, are you doing your job correctly?

Because it doesn't matter how many programs you connect them to, if they don't trust you. We got it backwards. Right? And so I would just encourage us to begin to think about that in terms of assessment. We don't have to recreate the will. There's many assessments that talk about the idea of how strong a relationship is, how well someone feels heard. Right? Those type of things that I think we can begin to start with.

Thank you, Dr. Jackson.

I may ask next for Mr. Giardini and Zigman to come forward.

Assemblymember, Ruby has a question, that she would like to ask, if that's okay.

Ruby, please ask.

My daughter is 21, and I've been trying to get the original center to help me with getting her into a program. And I'm having, really a hard time getting my daughter into a program when they tell me that when she turns 21, that she qualifies to get help for a STEP on my own or alliance.

So she's 22, and now she had her IEP in January, she turned 21, and still I am not getting no help from out to California and trying to get her the service that I need.

If you. Thank you, Mr. Chair. Ruby, I would like to have a conversation with you. If we don't have time today, I'm going to give you a call tomorrow. But I think what you're sharing, I do want to acknowledge that one of the things that we've heard from more than one parent or one self advocate is what is that transition between leaving high school and going to that next step.

So we do have some programs that we're implementing, but I think we have to have the conversation about what are those person centered discussions that the service coordinator is having with each individual to see what is that pathway from? And it's not to say, because one thing that I will flag, just because somebody's in education doesn't mean they're not eligible to receive Regional Center services. And so we just have to really take a look at what is that experience? How do we improve on that?

So I want to acknowledge that that's an area that we're looking at, and I would really value your participation in identifying that and to take a look at solutions.

Because they keep telling me that my daughter, even though my daughter didn't graduate, didn't get the certificate, but she got to continue.

She graduated with a GED. So she should be eligible.

She should be able to.

Will you be willing to talk to me today or tomorrow?

Yes.

Thank you. I appreciate that.

I also want to say to all the other Rubys who are out there in California who may be listening, that each and every one of us has a representative and an Assemblymember or a Senator that you can reach out to. And each one of our offices wants to figure out how to do constituency service. And so I would encourage you as well to reach out to your representative and happy that you were able to make that connection here today.

Yeah. And, Mr. Chair, if I will, we will also make available, again, broadly, we have a new ombudsperson office that is really valuable, it's new. We have the self-determination ombudsperson. Now we have the ombudsperson office, and we need to make sure that that information is available as a resource as well.

If we can make space for. Mr. Giardini. Earlier you provided some very powerful testimony that a fifth of the direct service professionals have left the field and that there are new market pressures. You also commented that your thought was that we weren't going to be able to get there by July of 24, that I'm trying to figure out how we address both those new market pressures and the need for us to get these rates up and running as quickly as we can.

But want to hear from you if I can. Has hiring improved since the rate increases have started to go into effect? What's occurring in real time?

So my data is going to be anecdotal, Mr. Chair, but I think the real answer to that is it's almost too soon to tell because, of course, in January, we got to the 50% mark in terms of filling the rate gap. It also has a component that requires wages and benefits of direct support professionals to get the majority of those rate increases. Of course, we have many providers who got ahead of this. Right?

They saw January's rate increases coming and were able to increase rates, multiple dollars in some cases, and they have seen a stabilizing effect. It would be interesting to see some of that data across the board. And I know that, of course, the Department started the staff stability survey this year, so we're going to start getting some of that longitudinal data. That's going to be helpful. But unfortunately, I just can't say that we have enough information at this point to say one way or the other. I do think that, of course, the final implementation will hopefully increase the opportunity to retain and hire staff.

Is there a normal turnover that can be expected within direct service professionals? What does a 20% turnover.

A 20% turnover would be a dream, Mr. Chair. I think nationally we're looking somewhere closer to 45%. I don't know the exact stats here in California, but this is a nationwide problem. California has tried to address it and we're certainly ahead of some of our counterparts that I hear from in other states. But we are facing increased pressures in different ways that other states don't face. So cost of living higher and things like that. So we are struggling. If we could get to 20%, we would be in a much better place.

Mr. Zigman, if I can. We're going to speak about it more in issue five regarding the service coordinator ratios, but I'm trying to understand what it would mean for you to come into compliance with those caseload ratios. And what type of scenario would you need to imagine that would help you to achieve compliance with those ratios?

Thank you, Chairperson Arambula. Well, you picked a good Regional Center. Golden Gate has the highest or the second highest, depending on the category, caseload ratios. Because of our cost of living area, it would mean, obviously better, more responsive services to families and individuals that we serve.

I'm thinking that we sit with our bilingual bicultural social workers, we call them social workers, service coordinators, and they talk about the pre 2008 years because this system has really been starved for 14 years and the new investments are seen as new investments, but they're partially making up for the billion dollars+ that was taken out in 2008-2009.

But the bilingual bicultural service coordinators talk about their ability to go to IEPs and be that advocate for families was strong when they had 60 or 65 individuals served at 95, at 98. They don't, they can't make those choices and be able to equitably serve all the people on their caseloads. They have to be kind of chasing the pink flags before they turn into red flags, if you will, the urgent issues.

So I think you would see that structurally what needs to happen is the core staffing formula, which is based in 1991, predominantly needs to be modernized. And I know the Department and the Association, Regional Centers Agencies have been talking about how to do that, but it's just so stark and not limited to service coordination. All the other work of the Regional Center supports our service coordinators in that critical relationship that Ms. Wesling was talking about between the service coordinator and the person served.

The fiscal department's critical for providers to get paid. The quality assurance Department is critical in a lot of the testimony you've heard today in the ways we respond to complaints and we monitor the quality of services, and we will need to monitor the quality even greater as these incentives come. So it really is a fix where so many things are interconnected that we deeply appreciate the additional social work and the service coordination dollars that are reasonably funded even for our area.

But again, it doesn't erase the predominant, the other 235 or 40 staff that I have that really get an allocation of about 50% of what we need. So just to be market driven and we do a lot of work trying to peg ourselves against the market. The other thing, I just make one other comment on Mr. Jardini's question. Assemblymember Wood talked about not the shame, the impact of losing staff.

And I think you heard from Ms. Keefe and we hear all the time from the people we serve, that the consistency of a direct support professional, not just the skill, which is really important, but the fact that they know an individual, much like service coordinators, they know the individuals they're supporting. The losses is more. It's not like you can just replace that direct service professional with a new one.

You can train them the same, but they're not going to know the individual in the way that somebody who stays for five or seven years does. So it really is a huge loss. And I think what I heard from my providers is the rate increases, even though only 50% of the gap between what we pay them and what the market says we should pay them has been filled, what they say is stabilization.

We are losing less people and we're having some pockets of success in attracting folks. So I think 2024 can't come quick enough for our high cost area.

Thank you. I'm going to thank this entire panel. I would like to ask for the Subcommitee to remain updated on how the quality incentives are materializing as they take shape and all issues in this topic will be held open. We will now move on to issue three regarding the transition plan to phase out sub minimum wage. I will hit pause on issue three. We will now take public comment from anyone who would like to provide it through use of our ASL interpreters.

Want to make sure to provide that opportunity. Now, if you would like to provide your public testimony, thank.

Public comment. If you would like to use the ASL interpreters, the remainder of the public.

Through the use of ASL for now, if there are not anyone who would like to give public comment at this time, we will continue with issue three. With that, we will now move on to issue three. Regarding the transition plan to phase out sub minimum wage. The question for the panelists on this issue will be, what is the state's plan to phase out sub minimum wage, and will we meet the current deadline of January 1 of 2025?

What is the employment goal for persons served in our system, and what are the chief milestones towards achieving this or these goals? We will have seven presenters on issue three, beginning with Aaron Carruthers, the Executive Director for the State Council on Developmental Disabilities, followed by Ernie Cruz, the Deputy Director for the Department of Developmental Services Maria Marquez SCDD council member and former sheltered workshop employee, Ken Barnes, former CEO of Options for All, based in San Diego, Melissa Gruhler, Executive Director for the Far Northern Regional Center, Kia Cha, principal program for Department of Finance, and Ryan Anderson, with the LAO. Executive Director Carruthers, please begin when you are ready.

Thank you, Mr. Chair, and thank you, members. Thank you for your leadership on this issue and making employment a priority for this hearing. Thank you to Members for your stamina. These are long meetings. We're only on panel three. We'll go fast and want to add to the chorus, thanking staff for their excellent work. I'm Aaron Carruthers. I am the child of a person with developmental and other a person with disabilities, myself, and a parent of a young man with disabilities.

I'm also the Executive Director of California's State Council on Developmental Disabilities. The State Council is a State Department. It's an independent one that is outside of any other department or even outside of agency. We're funded completely by Congress. There's a State Council like ours in every state and territory. So we're part of a sister network that exists to, well, we have state and federal mandates to change systems. We do our work by asking the community, what is it they want us to work on?

Every five years we ask. And so we get interesting trend lines over time. We noticed something probably for about 15-20 years, the answer was largely, I want my benefits, and I want to keep my benefits. That makes sense. Then in 10 years ago, in 2016, sorry, five years ago, we saw employment suddenly jumped up to the number one answer, followed by keep my benefits. Then when we did the survey again in 2021, the top three answers were employment and housing and education.

And we suddenly saw this generational shift in expectations about who people want, what people want from their lives, what they believe is possible for their family members. And we largely think this came from what we call the integration generation, just the effect of people with developmental and other disabilities being in classrooms with everybody else. That changed. And we're starting to see them come. They're in their early 20s, so they're getting on with their lives in their adulthood, or they're having children who have disabilities.

So there's a different expectation. So this sort of seismic shift in expectations is leading to what we're advancing and what we're prioritizing with employment being part of that. Really want to congratulate the state in 2013, 10 years ago, for leading out on its policy to declare California an employment first state. And that means we start with the assumption that everybody wants to and can work. That's the beginning. That's square one. Then we move from there. So it's 10 years later, and where are we?

Well, part of advancing employment for everyone is making sure that we're getting rid of programs that weren't, in fairness, the most progressive ideas of their time. But over time, views have changed, attitudes have changed, and there's one particular program that became regressive, and that is sheltered workshops. Paying sub minimum wage for work made great sense after World War II. Doesn't make great sense in 2023.

So thank you to the legislature, to Senator Durazo for the leadership in authoring legislation to phase out sub minimum wage sheltered workshops in California. That is now the law of the land. Sheltered workshops and sub minimum wage will not be allowable for people with development and other disabilities come January 2025. In the legislation, it asked the State Council to produce a plan and advising the state on how to transition out of sheltered workshops. And we produced that plan. It was published in last month.

We sent it to the legislature. We've sent it to the administration, and thank you for the opportunity to share a little bit of that plan today. The plan does tell how to get people out of shelter workshops, but it does a whole lot more because the community wants more. Community wants real work for real pay. So the plan itself really is a framework to how to achieve the ideals of how California can become that employment first state.

And, of course, if you're doing that, you're also finding a way for people to move out of sheltered workshops and out of sub minimum wage. The plan gives concrete, actionable items. It also leaves a lot of flexibility. We know departments know their programs and want to run their program. So it's not so prescriptive to say, here's exactly what you should do. But the roadmap is there, the framework is there. If the departments want to follow that Some of the recommendations in it are to.

Well, it's really common sense items make sure that people with disabilities and their family Members have the supports they need to make the transition. Those supports could be job coaches, job developers, individual transition supports. It's to make sure that the funding is lined up with our values. So we're making sure there's money for things that we believe in and disincentivize things that we don't believe in or don't work. There is making sure that the funding streams are working together.

So we're in developmental disabilities, we're thinking about DDS. But Department of Rehab also has a critical role, an important role in all the work that they're doing, making sure that programs from both departments are able to be intertwined and streamed together. There's telling the good success stories, there's engaging businesses, there's a whole lot of good that's in there that really will get the state to fulfill its employment first policy, while a whole lot of room for the department to come up with their specifics on how they want to implement it. The legislation also says, State Council report again on benchmarks.

So January 2024 will report again and say out of the 6000 people who were in sub minimum wage on January 2023, a year later, how many are still there? We recommend, it's not too scientific. We recommend if you got to get 6000 people out in two years, how about get half of them out, 3000 people out in the first year. If we started now and we're working on it, all regional centers working on it, it would be three people per week per regional center.

That's absorbable within current resources. I know that where people are grouped in sub minimum wage don't fall out that neatly. I also know that the work isn't that robotic. You're not just moving three people out per week because the work is individual based. You find out what people want and you move them towards that. But I make the point to say it's manageable, it's doable. And with meaningful commitment to the task, we want to make sure we get to January 2025 and zero people are left in sub minimum wage. With that, I want to brought a couple of people with me. They're on the panel, but one of them is going to talk about her own experience and what does it mean to go through that transition so you can hear it's possible it happens. Also want to hear from employment providers we brought along who can show how simple it is. So thank you, Mr. Chair.

Next we will hear from Ernie Cruz.

Thank you, Dr. Arambula. So the Department of Developmental Services continues to pursue initiatives that will move the needle on employment and create more competitive integrated employment opportunities. The department's plan includes initiatives that have been placed for a few years and new more recent initiatives, including increased amounts for competitive integrated employment incentives. Over the last two years, the incentive amount has increased for providers to find competitive integrated employment opportunities for individuals served. This increased amount is through June 2025.

There's also been a lot of discussion about the quality incentive program, and within the quality incentive program, there is an employment focus area and measures specifically related to employment. Among those are for providers who help individuals exit paid internship programs and achieve CIE, there's a new incentive. There's also an incentive for providers who help individuals who specifically exit sub minimum wage jobs and employment and achieve competitive integrated employment.

And another important aspect of the Quality Incentive Program is an incentive for providers to have their staff become certified in employment competencies such as ACRE certification, which is really going to increase the knowledge level of the staff supporting individuals in employment. There's also been the employment grants. The department received funding to increase pathways to employment.

Through these grant opportunities, entities can develop and can develop and implement innovative and replicable strategies and practices to increase paid work experience and employment opportunities for individuals who are served by the regional center. These grants, through the efforts of our stakeholders, these grants and the feedback from our stakeholders, these grants have priority areas and focus areas that include implementing evidence based new and emerging practices, providing pathways to employment for individuals with high support needs, developing business or industry focused collaborations, increasing family, adult and youth knowledge and use of community employment related resources and services, and changing service delivery models that promote competitive integrated employment. We also have the employment pilot.

In June 2022, funding was added requiring the Department of Developmental Services to establish a three year pilot program that focuses on competitive integrated employment, postsecondary education, and career readiness for individuals with developmental disabilities who are exiting work activity programs. As Aaron mentioned before, secondary education in order to explore inclusive options and explore other opportunities not just limited to paid internships.

And I would also comment that there's tailored day services, and tailored day services includes an individualized service design that allows for flexibility in the duration, location, and days and hours of services to prepare for competitive, integrated employment, amongst other activities. I would also with regards to what our goal is for persons served, our aim is to support individuals achievement of competitive integrated employment regardless of where they are on their career path. Individuals may be in different areas in that career path.

There may be individuals that have a job but would like to have a better job or move up. There are individuals that want a job but need help to find one. There are individuals who are unsure about the work about work and need help to learn more. Or there are individuals who do not think they want to work but may not know enough about it.

So the department continues through our efforts with our employment work group and meeting with our stakeholders to get feedback and work towards more competitive, integrated employment opportunities for the individual served. Thank you.

Thank you. Next we will hear from Maria Marquez.

Hi. Good. Well, good evening. It's almost five. My name is Maria Marquez and what I want to talk about, but I can't say everything because we'd be here all night about my whole life story. But I do want to say that I am a consumer from the Regional Center. And when I started with the regional center, let me see, I would say I was in high school and no, before high school.

Well, going into high school and they would go see me at school because I went to a regular school, because I really fought my way to go to regular school because they wanted to send me to another school that would deal with people that were orthopedically handicapped. And I liked it because I could do exercise. They taught me how to cook, but they weren't really into schooling. They were more like basic training for life. Make your bed, go up and downstairs, what have you.

But it was okay. And then I got older and I wanted to go to school in my community because I go, mom, I don't want to go to one of those schools anymore. I want to go to a regular school. My mom goes, well, I don't know because my mom only spoke Spanish and my sister was older than me and she was already going to graduate from high school. So my sister talked to the counselor.

So lo and behold, the counselor was so interested in me that she went to the school and they literally got my chart and looked at everything. And the counselor goes to my teacher, goes, zero my goodness. She knows all her state, she knows all her capitals. There's kids in eigth grade that don't know that. And she knows that. She goes, we could do something about this. And I said, zero, we can. I was so excited.

And I signed up at the high school and the only thing that I really asked for was remodial pe, which was not to do heavy stuff. And five to 10 minutes leave class so I could walk to my next classroom. And they did that too. But then when I got older, I got a phone call from the regional center and they said, we're going to send the bus for you. And then I go, what? Yeah, we're going to send a bus for you.

We're going to put you in a shouted workshop. And they didn't say what it was. They just said, sheltered workshop. I remember my service coordinator's words and I go, okay. So I hanged up the phone and I thought about it. I go, I don't like how that sounds. I really don't. And I was telling my mom and she goes, well, it's up to you.

So I called them back and I said, you know, I know you said you were going to send the bus, but please don't send the bus. I will look for something in my community to do to keep me occupied because I was already out of school. So what I did is I took a cake decorating class just to get myself motivated to be out and about.

And then what I did is I enrolled in a medical school, which was medical assistant, front and back office because I always loved the medical field. So I did that, graduated, and one of the doctors actually took me in and said, you know what? You can come work in my office. So I worked for him for a while. He didn't care about my disability. He just liked me because I was just a nice person, I guess, but I could be mean too.

But anyways, what I'm trying to say, that along my lifetime and now I'm married, I have children. And in my mind, when my kids were little and I was a single parent at that time, I literally worked. And one of my biggest jobs that really got me into working was being the first self advocate at the Eastern LA Regional Center.

And that just made my day because I would drop off my kids at work, then I would go pick them up because in my mind I said, I need to work. I need to show my girls that they need to work when they're older. And today they are working because they followed my instincts. I was team mom for my daughter's baseball team. I was team mom for my daughter that was in dance. And we went to Hawaii and they won the state championships.

So I'm saying that there's really a lot to life for people with disabilities. And then I even started a program at the regional center. It was called Kids First, Parents with Disabilities. And I wanted to start a group because I thought that I was the only person in the world that had kids that were disabled. And I'd go to the Mexican ladies, and I'm Mexican would say, zero my God, you're disabled and you're pregnant. I go, yes, I'm pregnant.

I go, and so are you. I went through a lot of hard times, but I went through good times too, because today, now I work for disability rights as well. But I could say that because of me, I got on the council. I just like volunteering and getting involved. So then four years ago, Aaron calls me and I was already on the council.

And he goes, well, he goes, I just got a phone call from a person, you know, and I recommended you for a job, maybe you may want to go for it. And I went for it. So today I am working at children's Hospital for USC as the self advocate faculty. So I have four years working there.

And I mean, there is always light at the end of the tunnel because there's been times where I've been down and out, but I've always learned to bring myself up and I want to help other people with disabilities as well because till this day, I run into some of the parents that I had a support group with because the regional center really stepped in and said, we'll help you do this.

We would get the ones that would bring the mothers to help the children, the small children, and then I would give them training classes on parenting. And one mother got her child taken away, but because she was going to the kids first classes, she got her child back. And that was just so rewarding for me. And so what I want to say about the shelter workshop, they never came from me. But years later I did presentations for them on self advocacy. And that's my story.

What an inspiring story, and thank you for sharing it. Next we will hear from Ken Barnes.

Thank you, Dr. Arambla. I just love hearing from Maria. So my name is Ken Barnes and I have notes because I'm an academic nerd. So I always make sure. Over the previous three years and a couple of months ago, I was CEO of a large service provider in San Diego, provides services for about 1500 adults living with intellectual and developmental disabilities across the state.

And I also continue to serve on the DS task force, which I have for the last three years at several of the work groups. The quality and incentive program that Ernie talked about, as well as the regional center's measures, and the one that's really special to my heart, the Lenani Walter talked about earlier, the African American equity group, where I was one of the founding members of that. And so thank you for starting with equity. That's literally what I live for.

I actively supported the passage of this Bill, SB 639, because I know it's possible to transition neurodiverse persons from these shelter workshops and these sub minimum wage roles into fully integrated, regular wage employment. One of the things that I saw when I first came into this industry, I'm a tech private sector guy who took a couple of years to lead a nonprofit, and I was shocked by it.

And so I banned it about six weeks in because what I saw was a way of taking advantage of persons with disabilities, frankly, as a business model. And it was obvious to me, and growing up with a twin brother who lived with cerebral palsy, I had a very negative reaction, to put it mildly. And I don't believe we can have a legitimate discussion about equity if we don't even get to baseline legal equality.

And that's what we're talking about here, just equality of the minimum bare wage. Finding competitive, integrated employment. It's not easy, but we were able to leverage, really some generous support from DDS and the Regional Center Network. And I hired, with an HCBS grant, a job developer whose sole purpose was to go meet employers across the State of California and fill jobs. One job here, five jobs there, 80 jobs at a casino, 30 jobs at SeaWorld, and another group at the San Diego Zoo.

In other words, they're out there. And every employer that we spoke to was excited about the prospect of hiring someone from our population. And not one person asked a single question about the wage. In fact, we went to them and said that our minimum wage internally as a company is $17. We'd like you to respect that. And everyone said yes, including a small little wine shop who hired one person, and they hired them at $17 an hour to work in the kitchen as a sous chef.

So when I look at the historic investment that the legislature and the Administration has made into this system, those resources are there, and I think it's important to separate out. Earlier, when we were talking about the challenges that families have in accessing it, those are completely different circumstances than a large service provider.

If you're a 20-30-40, $50 million a year company, I have a hard time believing that you don't have the capacity to understand the inner workings of how to fill out a document and make a request. There's a significant amount of support there on that side, so there's really good partnerships. I also would say that one of the things I know that we did is we changed our stance. We no longer begged people to hire someone with a disability.

We told them that this would be the best decision they would make. We sold it. We actually went out and became salespeople for our population, and there was all this support that came behind it. Initially, we did lose the largest historic donor at the organization. It was a heated conflict. We replaced that person with numerous other donors. In other words, there is a body of people out there that want to be part of making this change in society.

And I also think it's understandable that some family members have some fear of this transition. I'd be the same way about my own family member, but I think that the impediments to this transition are covered in this very comprehensive transition plan from State Council, particularly transportation, which we found was the number one issue hands down. There was a number of jobs that we were able to identify, but we couldn't come up with a way to get persons to and from work.

And that's going to take a minute to solve that. A lot of that is just California's transportation infrastructure is poor, but that's for another committee at another time. But the thing that really, I want to emphasize is that we can't allow a handful of service providers who are addicted to the status quo to try to delay or block this implementation. We saw this throughout COVID. Every time we came up with a new idea and we run it up the chain through Regional Center DDS.

There were some funny phone calls of like, okay, I know it's going to sound crazy, but I have this idea and they were open to it. But then you would have one service provider in this big group of 50. Well, that'll never work. And it did work. I think we're at that phase where it's the same people who said if you raise the minimum wage in California to $10, there will be no businesses left in the State of California.

We're at 15, and the economy is, what, the fourth largest on the planet. So you can't convince me that you can't change someone from $2 an hour to just the baseline minimum wage. And I would say that public policy is murky often, but some things are crystal clear, and paying somebody three or $4 an hour is a human rights violation. I'm glad that the legislature and the governor agreed with that and I think we move forward from here and I welcome any questions that you all have.

Thank you. Next we will hear from Melissa Gruhler, the Executive Director for the Far Northern Regional Center.

Thank you. I appreciate the opportunity. So good afternoon. Melissa Gruhler, Executive Director at Far Northern Regional Center Far Northern Regional Center is serving approximately 9500 individuals and that does include our intake units. At this moment in time, we serve all the northern counties from Sacramento to the Oregon border. I actually started in 1995 as a service coordinator at far northern and have been an executive director over the last four years.

Again, thank you for the opportunity to share with you the work that Far Northern has accomplished in the area of employment and the Regional Center's perspective on this importance of employment to those supported. Far Northern supports an individual's right to live an independent, productive and valued life, which includes being valued within our community's workforce. Individuals have the right to have opportunities for meaningful employment, which includes receiving at least minimum wage.

Far Northern has been a long term supporter of community employment for those it serves, regardless of the severity of disability, in part because earning a paycheck gives people more freedom to make economic decisions in their own lives, but also because having a job is great for people's self esteem and allows others to see them as contributing members of their community. Thank you, Maria.

This is the goal for Far Northern and all of California's regional centers to support those we serve to work in jobs that work for them. So, Far Northern's plan to phase out sub minimum wage involved educating the local school system, partnering with habilitation programs to amend their services to support individuals, and moving existing work activity programs to community integrated training. Far Northern provided local schools with the education regarding employment services for students transitioning out of high school.

Information was provided about employment options such as facilitation providers utilizing the employment incentives and paid internships. Benefit counseling was provided to individuals regarding wages and how their Social Security may be affected as they start to bring home those first paychecks. In addition to providing education, we celebrated the success of individuals being valued members of their community working at businesses such as holiday market, tractor and trailer supply, Mod Pizza, King's View Wellness, Chico golf course, and that's just to name a few.

So the partnership with the service providers to support people in integrated employment settings helped create those jobs that fill a community's need, pay at least minimum wage, and build upon individual strengths identified through the person centered planning process. This strategy has allowed those with significant support needs to begin their employment journeys through participation in various industries, including the service industry, art, tourism, floral ranging, screen painting and many more.

Over the years, available tools such as the paid internship program and the CIE incentives has supported this work through providing critical financial support to willing employers and offsetting the financial losses our service providers face when they spend time developing those relationships with employers to benefit those we serve. The relationship, as you have indicated with those employers, is key to the success of these services. We've had many of those individual placement employers seek out regional center clients. The people that are served.

Those employers want them to work for them. However, there's continued challenges in this area, which is not enough. Job developers and job coaches, due in part to the rate reimbursement our incentive payments don't support the work service providers need to do to match individuals with those most intense support services with the best employer options. The benefits counseling is a continued need to support individuals and their families in making those informed decisions about employment options.

As some they still have that fear that engaging in any work will result in loss of their medical benefits or their financial safety net. And lastly, service coordinators, with their high caseloads and their demands of continued case management, doesn't give them the adequate time to effectively do that person centered planning process so that you can identify what those wants and needs are for those individuals. So we're moving in the right direction, but we still have areas to grow in.

Thank you. We're going to ask the Department of Finance to first present. It will be Kia Cha. We've set up a mic there in the corner, followed by Ryan Anderson.

Kia Cha, Department of Finance. No additional comments at this time.

Thank you. Ryan Anderson with the LAO.

Evening, Ryan Anderson, Legislative Analyst Office. I think I just want to highlight in two pieces of context. There's been a lot of helpful discussion here. As we point out in our analysis, it's important to recognize that the broader context for employment opportunities for individuals in California with intellectual and developmental disabilities. We still have a lot of work to do. The employment rate is quite low, not only relative to the population without disabilities, but also perhaps relative to these populations in other states.

The second is that there's still a lot we don't know about the specific population that will be directly impacted by the phase out of the sub minimum wage. It's about 6000 individuals. And as the State Council's report notes, there's a lot of basic information just about their demographic makeup, the extent of their disabilities, the wages that they were earning that we still don't know. And that would seem to be an important part of the transition piece. So I think there's still work to be done there. That's all we have for right now.

Thank you. Bring it up to the dais to see if any members have questions. I will keep.

Here at the chair. I'm going to begin, if I can, first with Executive Director Carruthers. You have stated that you're funded by Congress and that there's a similar SECD in other states. When we look nationally, we see 34% employment compared to 20% for California. Are there actions those other states are doing, or how are they able to achieve those employment rates when we have not been able to?

Great question, Mr. Chair. And I want to point out that the 20% is actually an improvement. So California rates have had this interesting floor and interesting ceiling because of programs like sheltered workshops and other job supports. Even during the worst of times in California, the employment rate for people with developmental disabilities, so adults with developmental disabilities, never really went below 13%. And then at best of times, even after 10 years of economic recovery from 2009 on, never really went above 17%.

In the last year or so, we've seen it increase to 20%. And I think that's actually the key question, is, what is happening within California? Because that's where we have the control over that we're seeing the increases. We've seen some pieces. One piece we can look at is what's the impact of California's Competitive Integrative Employment Blueprint. That's a statewide initiative among three key entities with local connections. The phase-out plan for 639 is almost like a blueprint 2.0.

So what do they accomplish and where do we take it even further. So I think it's looking and figuring out what are we doing right to move it from 17 to 20. Not big improvements, not any numbers that anybody would really be comfortable with. But recognize there's movement being made, find out what's being successful and pushing it even further.

I'm going to follow up.

Mr. Chair, I'm sorry, I didn't answer your question directly, because every time I ask my colleagues about California, they say, well, you're the first one to tell us California is different. So why are you asking us? And oftentimes, I mean, some of the other states, they're functional service populations of the size of one Regional Center, one size of one Miss Grewler. So listening to her testimony is kind of the advice we get back, which is hard to playback and overlay into California.

Earlier, I felt like you were very strong in saying there are concrete and actionable items for us to be working on and that the framework is there. But I really want to focus on what some of the hardest challenges are left that are before us. And we heard that it may be transportation. And so I'm hoping you can provide some remarks on what are the biggest challenges we still have before us.

The report does recommend funding a study to figure out how to make transportation work. Love that you raised it, Mr. Barnes. Thank you so much. Because it does highlight one of the biggest barriers. The other barrier I think Ms. Grueler highlighted, which is how do service coordinators adjust with their current workload and population. In our view, it's a matter of, well, this is a change that's happening and something that's pressing, so something that must be addressed.

And we leave it to the good direction and wisdom of each Regional Center to realize this change is happening and prioritize it and make it happen. And we believe it's absorbable. Part of my testimony was to focus on how much resources currently exist in California to make this happen. Mr. Barnes pointed out the $15 million annually in HCBS compliance grants. That's basically a gimme for people who are providers, who are trying to move out of this.

Anybody can step forward for that 15 million and say, please fund me to change my business model. That's fantastic. It exists. It's on the table. Maria testified, Ms. Marquez testified to what the individual experiences and Miss Grueler. So collectively, we've. I think my takeaway from the collective story is there's resources to make this happen.

There are challenges, but those challenges should never, not a year from now, not two years from now, ever be an excuse for this policy to be not put into action as it currently is law.

I'm going to use this as a chance to soapbox just a half a second, because we're seeking basic equality. But I want to make sure that equality is not inclusiveness and it's not focusing on how we make sure that all Californians are able to be employed and do want to look towards the funding that we have to promote competitive, integrated employment.

And we'll be asking Deputy Director Cruz, as well as the Department of Finance, if you can comment on the graph on the top of page 20, why many of those funds are currently not being used or going unused. Can you comment on why these funds are going unspent?

Dr. Arambula, I don't have it in front of me, but I think it's the graph on the CIE. I think obviously the pandemic had an effect on the use of that. But even before that, that was an area where it wasn't being fully utilized. And through the employment grant and the recommendations and the projects that come out of that grant, our hope is that we'll see more utilization of that.

I think also with the new incentive amounts that have been added, I think those are further incentives for service providers to look for opportunities for competitive, integrated employment for individuals served. So I think the tools in the toolkit have increased over the last year, and we're hoping to see increased utilization of those funds.

Wouldn't it seem that those funds going underutilized are contributing to California not having the same employment as other states are doing? Wouldn't those funds help us to continue to encourage integrated employment? So I'm just, again, trying to drive at, we're using a quarter of the funds in two of the last five years and under 50% in two more of the last five years. And what more can we do to encourage these funds being spent?

I think going back to some of the new incentives, particularly having staff who provide those employment supports get better trained, get certified, and have a better lay of the land on employment, do that business outreach. I hearken back to the grants and the pilot because I think Mr. Carruthers said earlier, there's a fear, of sometimes from families wanting their loved one to get a job. So I think the things that we have in place right now will hopefully show some improvement in those numbers.

I will elevate again, if I can. The money we appropriate, we hope, gets spent for the intent that it was appropriated for. And thus, again, we'll say, when we're seeing the levels we do within that graph, that's something I think we can continue to work on. Assemblymember Rubio.

Thank you. We are using a lot of words like hope. Hope is not a strategy. I use it a lot. I was a teacher for 16 years, and it is frustrating to fight so hard for some of these dollars and then come back and have them sitting there. And the way the school system was working, for me, is if you didn't use it, you lost it, which I don't think is appropriate.

However, if we have a hard time trying to allocate some of these funds and then they go unused, then we have egg on our face because it was so dire. We talked about how important this is, and we sold it. I heard your comment about selling it, so we sold it as well to get these allocations, and yet here we are, and they're not being used.

And so how do we reconcile not just with the constituency and the folks that need these services, but for us, when we fight so hard for these dollars and then we're sitting here going, well, they haven't been used. So I think what Dr. Arambula is getting at is, you know, we can't keep fighting and fighting and fighting. And then now we come back and then they haven't been used. Again, hope is not a strategy.

So I think the purpose of this meeting is to try and figure out what strategies are going to be used, not hope, because again, it's not a strategy. And so how can we assure that we're not going to be sitting here next year and the year after that? To your point, if we don't, simple math, 6,000 people, 3,000 should be employed. And I'll get to you in a second, but also I have a really dear friend of mine that her daughter has Down syndrome.

Her greatest joy every morning is to get up and go to work and then she can't wait for her two week paycheck. She gets her nails done. She has this whole routine. And I understand that during the pandemic, everything was turned upside down. But now that we don't have that excuse anymore because for a while, quite frankly, I think a lot of the monies that were given to different departments, the excuse was the pandemic. Well, it's been three years.

And so, looking forward, how do we not hope? How do we implement strategies to make sure that we're implementing them? I'll continue after. No, go ahead.

Thank you, Assembly Member Rubio. And with your history in schools, I raised my hand, I don't know if you saw.

And I acknowledged. Thank you.

Thank you. And then I waited until it was called on again. Thank you. And thank you, Mr. Chair, for the questions about. I think there's an opportunity and the opportunity is within the state and the opportunity is about coordination. Employment for people with developmental and other disabilities is not just on DDS, it's not even just on DOR, but there is a priority from the state.

So one of the recommendations, and actually the number one recommendation in the report is to establish an employment first office with an agency. Take it out of the implementing departments. They'll keep doing their work, but somebody who has an oversight coordinating role to make sure everything's being spent, everything's moving the right direction, the different programs are working together, but also has the ability to reach outside of HHS over to labor.

They're doing great work with their interagency council and apprenticeships and have specifically a disability focus. Reach over to education regarding transition. So number one recommendation to make sure California becomes that employment first state is just do a little bit of investment, less than $1.0 million, I think is a recommendation to actually have an entity that's overseeing and coordinating to make sure everything working together.

It's going to sound a little bit ignorant, I guess, on my part, but we had all these folks employed prior to the pandemic, so is there any data or information about how many of those folks have we gotten back into employment? Because I know a whole bunch of folks just like everybody else were unemployed for a while.

And so it doesn't feel like, and again, just my own kind of observation is, how about start getting those people back to work and that you don't need a coordinator, you just go back to those. Again, simplistic for me right? But we don't need coordination and all of that to get those same folks that lost their jobs back into the workplace with those funds. I appreciate that. I agree with you that we do need somebody to coordinate.

However, how about we start with the basics and the folks that were employed in the first place get them back to work? And I don't have data, and maybe you can help me with some of that data of how many people lost their job and are they all back at work? If they're not, then low-hanging fruit, in my opinion, they're right there. So we don't need a coordinator.

We don't need hopes and dreams to be able to do this, because those folks that were unemployed are already there. And so let's start with the low-hanging fruit, for lack of a better term, and get those folks back to work and then do what you're suggesting. Try to get a coordinator so that we can do outreach and all of the amazing things that you're talking about.

Again, it sounds simplistic in my opinion, because I don't have the job that you do, but it just doesn't seem like it's rocket science either. It doesn't seem like it's out of this realm to be able to ask get those folks back to work. Yes.

On that particular one, actually, a great question, anecdotally from our... so representing Inland Empire, San Diego, and San Jose. So that's kind of our spread.

I worked in Fontana, as a matter of fact.

So for the most part, we got just about everybody back. The population that didn't go back was one, some were transportation challenged because of the changes post-COVID and the way busing and transportation were. There was a couple of people who just, there was a discomfort from a safety perspective, going back. And candidly, the primary challenge was in filling direct support, professional roles to support them. So the main loss was the loss of labor in the labor force to support the persons.

And so you ended up with this odd situation of persons queued up, if you will, for a job, employers queued up to offer jobs, and there's not enough internal staffing to then support those persons effectively on the job. And so you have the unemployment rate move up. And so it's a weird... that was at least what I experienced, and I know a number of other service providers did as well.

Is it possible to get some of that data again, just for us, that we're looking at it from the outside and are frustrated, quite frankly, and some of my colleagues are frustrated with the money that's being left on the table at the moment. And so that data would help us really understand what you all are doing and how we can help with that. To your point, somebody that coordinates kind of the work, but it doesn't seem that it's just coordination.

If folks haven't, the transportation folks haven't gotten back to work, then we're going to have the same issue regardless of who's coordinating, right? And so how do we help? And I know it's an issue across the country, and I know specifically in California, that we don't have enough workers to fill all of the necessary roles, but a coordinator would not be able to help with that. So there's different, I guess, partnerships that need to happen for us to be able to do that.

So if there's some data that we can have, because again, it's frustrating for us to have fought so hard for some money, and then all of a sudden we're sitting here going, well, it hasn't been used. And I know that the Governor's Office understands well, or don't. But when it comes to now that we're facing a budget deficit, how do we look at them and say, we still need this money? I know if it's specifically designated for this, they can't touch it.

But if we go back to the way 2011 happened, nothing was off the table. And so I would hate for us to lose that funding because now we're in a budget deficit and hopefully we won't get into a budget crisis. But in the event that it does happen, all of that money is on the table. And trust me, and you all know, and you were all around during that time period, everything was, you know, what was it? Rob Peter to pay Paul?

They were taking the money from anywhere there was extra money. And so we're caught in this potential, I feel like we're caught in a potential crisis where money is going to be taken away, and then now we're going to be left with no money if we don't do what we said we were going to do with that funding.

Assembly Member, sorry.

Sorry. I want to bring in Director Bargmamn, who's been very patient, and to provide some comments.

Thank you. Oh, thank you. Thank you. Nancy Bargmann, Director of DDS. Thank you for a moment to be able to provide some additional information and certainly acknowledgment to the importance of competitive, integrated employment. And thank you, Assembly Member Rubio, for really lifting up kind of the value of saying how do we get to recovery from the pandemic? I so wish that was easy.

Mr. Barnes had noted that one of the things that has certainly been shared with us, it's anecdotal, it's not data, is really some of the challenges of folks feeling comfortable going back to work. That said, there is a real desire for many self-advocates to have a competitive, integrated opportunity, and looking at ways that we can really advance this. One of the areas was certainly the tailored day services.

How can we kind of help some flexibilities to see if there's ways to have pathways to introduce the paid internship program. I think the paid internship program is one of the best things that we actually had as far as kind of policy and investments and certainly appreciate that it's not being spent based on the estimate of what we thought that we would be able to achieve.

That said, when we take a look at the quality incentive program, we're really looking to double competitive the quality incentive, the incremental incentives. So through that we're doubling that. So we're really trying to find whatever pathway we can to kind of get to that recovery for both the paid internship and then also for the Competitive Integrated Employment. So regarding the data for Competitive Integrated Employment, it's challenging.

We're working very hard to identify what is the data that we can validate and we're working to identify those pathways to do it. So we use EDD data. We don't always know what is included in the EDD data as far as like the number of hours worked. So we have more work to do. The employment work group that we have, we're bringing all the great minds together to answer and really wrestle through those questions, those important questions that are being presented.

So I just wanted to be able to say that we are really looking at the low-hanging fruit. We're looking at what are the other initiatives that can really advance this.

And while I do want to acknowledge the stakeholders' input, because with the quality incentive program, when we took a look at what are those opportunities to be able to get people and pay providers to increase the number of individuals in Competitive Integrated Employment. Our community voiced very clearly they wanted to make sure that we're cautious about really going to those individuals. That's the easiest pathway for employment that we have to support. Individuals have complex needs for the success of employment as well.

So we are definitely taking a look at how do we recover. We want to make sure we're looking at those individuals who may need extra supports. Part of the incentive program is making sure that we're looking at building the staff and investing in building the capacity of the staff that are working. So again, just wanted to highlight a couple of extra things.

And really such a rich conversation on such an important topic of some basic kind of desires and needs and wanting to be able to lift up the importance of employment for the individuals that we serve. So thank you, Mr. Chair, for the opportunity to.

Thank you, and I appreciate again the conversation and I look forward to us having it. I know this is going to be ongoing, but in any way that we can assist. I know our expertise is limited, but again, I would hate for us to leave that money on the table and not be able to provide those services for that community.

Thank you so much. Thank you.

I'm going to bring it up for one final question, if I can. I'm going to recenter us again on sub-minimum wage, and this is for Deputy Director Cruz. Are we working in tandem with the State Council in this transition? It seems like there are some disjointed efforts, and I'm wondering how we can help to coordinate an approach that can be facilitated. And so I'm hoping you can comment on how that transition is working today.

Dr. Arambula, I would say we are working together. State Council's on our work group, we're on their work group, and I know there's still a lot of work ahead and we're open to those discussions and working that out. So I know there's more work to do there.

I will remind us we have a timeline pursuant to state law, and thus I would like the Administration to consider providing a common and unified statement of the goals, the timelines, and approaches for us to eliminate and go through this transition for sub-minimum wage.

I'd like to ask for a report to come back to this Subcommittee by the April 26 hearing on how those transitions and conversations are going so that we can have that unified approach between the groups that are having the work group today. With that, all issues under this topic will be held open, and I will thank very much panel three.

Thank you.

We are now moving on to issue four regarding home and community-based services, the HCBS rule compliance. The questions for the panelists for this issue are where is the state in regards to compliance? And will we meet the deadline for full compliance by March 17, 2023? And what happens if we are not in compliance by the deadline? And what are the subsequent steps for us as a state?

We will have three presenters on panel four, beginning with Jim Knight, the Deputy Director for CDDS, followed by Christopher Odneal with Department of Finance, and Ryan Anderson with the LAO. Let us begin with Deputy Director Knight. When you are ready.

Thank you, Dr. Arambula. You know, as we get started on this, when we talk about these rules for home and community-based services, I think it's important to note one of the main drivers for the Federal Government establishing these rules, and it really was to make sure that folks who receive services are supported, to have the same choices and access as everyone else, meaning that those who just because they happen to have a developmental disability, that should not then prevent them, and, in fact, they should still be supported.

People should be supported in making choices, having the same rights that everyone does. And it really is refocusing on that individual. So I think I've testified before and we certainly here and then in other work groups. So it all gets down to if we do the person-centeredness of this right, we'll be able to make sure that we're, quote, in compliance, which is a scary term, but we really kind of need to boil down into really, what is the nuts of what this is asking about.

And so we're going to talk a lot about some provider numbers, but I don't want us to forget really, the focus is on the individual's experiences. So tying into what we talked about earlier with quality incentives and the like, that's really going to be a big measure when we talk about meeting these requirements. And so you mentioned the March 17, 2023, date.

And so that is the requirement that the Federal Government, specifically the Centers for Medicare and Medicaid services, requires the state to say that, hey, you have a plan to meet all of these rules. So that is the plan. There's a reference in the agenda to a, quote, statewide transition plan, which really is the roadmap of how we're going to get there. But things don't stop then. Then we turn into monitoring ongoing, how are we doing?

Because it can't be a one-time event, because this is so important to the people who receive services that we need to make sure that not only do people have policies in place. When I talk about people, providers, but also are they implementing those?

Also important to note as well that when we talk about the March 2023 and also in recognition of the workforce issues that we've talked about a number of times here, the Federal Government did allow for states to request what's called a Corrective Action Plan, noting that there may be some struggles with implementing some of the requirements, in particular about supporting people to have activities kind of away from where they're receiving services because there's some workforce shortages.

So it does give some time for the states to fully implement beyond March of 2023 some of the requirements of the rules. So as part of our Corrective Action Plan, we were able to note a number of the initiatives and investments that we've talked about here today, the rate study, the workforce investments with training, and the like, that we are looking at to support hopefully that increased workforce and so that we can continue to move forward and meet the requirements of these rules.

And even though they're federal rules, again, they really do align with the intent of the Lanterman Act. So getting to numbers, and I know in the agenda has a couple of different set of numbers, just I can tell you that as of today, this morning, we have 86% of all the providers receiving services. We've actually verified that they have all policies in place. There is a number, almost 14, almost all of the remaining. We are still in process of reviewing all that documentation.

There's still a very small number, about 30 providers that Regional Centers are still working with and going out and meeting individually to get their information so they can help them review. So doing a lot of individualized work. So there's been a significant improvement over the last couple of months. And so we are getting very much closer to where we need to be.

We did say with those 30 providers, we did issue, or Regional Centers did issue what we call a moratorium, so a hold on new referrals for service until we can work with them to get their documentation in place. And we're hopeful then that we will not have to go to the next step, which we did suggest could be include a partial temporary withhold of payment until those procedures and policies are in place.

Like I said, we're hopeful with the movement that we've seen so far, and I know hope is not a strategy, but we've seen some actual data to show that we are actually moving very rapidly towards where we need to be. So when we talk about the corrective action plan, which does allow a temporary extension or a little more time to do that, it does not allow for all elements of the rule to be delayed or implementation.

So the parts of the rule that really are about people's just basic human rights, right to privacy, right to be treated with dignity, and those types of things, those have to be in place, and they should be in place now, quite frankly, but those have to be in place implementation wise and going forward. The other big part of, and I know Ms. Mark mentioned it on an earlier panel, is the involvement of people who receive services in their families.

And while a fair number of, or a fair amount of the $15 million annually that's been referenced has been used towards providing information to people who receive services in their families, we need to do more in a coordinated way. And so that's going to be a big part of what we need to do moving forward because certainly, the state and Regional Centers are going to have some monitoring and oversight of this. But we also need to get input from people who are receiving services.

And whether we call it the rules or are we setting the expectation for folks about what they should expect from their services, how they should be treated, what choices they have, that's going to be a key piece of this going forward. And so we really do, again, talking about kind of refocusing things on what the tenants of the Lanterman Act are, and that's for all of us. And most importantly, starting with those that receive services.

So I'll stop there.

Next we will hear from Christopher Odneal with the Department of Finance.

Thank you, Mr. Chair. Christopher Odneal, Department of Finance. Nothing further to add.

Next we will hear from Mark Newton with the Legislative Analyst Office.

Good evening, Mr. Chair and Members and Mark Newton LAO covering for my colleague Ryan Anderson. Just a quick comment further to Mr. Knight's comment on maybe various sort of data shown in the Committee agenda. Our analysis was based on data at the end of December, and what's very encouraging is between the end of December and today, significant improvement in the level of compliance with HCBS policies. It was about a 50% level at the end of December and 86% today.

So that's still a ways to go, but that progress is a reflection, really, of very good outreach efforts by the Department to try to encourage compliance.

As that's the conclusion of testimony on this panel, I will bring it up to the dais. I'm going to ask one question for the Department of Finance, if I can. Do you have any concerns about our ability to meet this deadline? And if you do have concerns, can you tell us about that as we are going forward?

I think, as indicated by Mr. Newton with the LAO, we've seen significant progress in providers coming into compliance, especially within recent months. So I would say the Administration is confident in that deadline.

With that, we will thank very much this panel and move on to issue five. Issue five will be on the implementation, review and oversight for three areas. First, on the service coordinator caseload ratios, second, on the self determination program implementation and finally, the social, recreation, and camp services restoration.

The question for the panelists for this issue are what can be done to make progress on meeting statutory requirements for service coordinator ratios, and how do ratios and the proper provision of services tied to the other issues within our agenda? Also, how is the self determination program implementing and what are the key concerns and challenges moving forward? Are social, recreation and camp services being utilized as envisioned in the efforts to restore these services?

And what is the data telling us about how this looks per Regional Center? We will have four presenters on the panel for issue five, beginning with Jim Knight, Deputy Director for CDDS, followed by Ernie Cruz, Deputy Director for CDDS, Christopher O'Neill with Department of Finance, and Mark Newton with the LAO. Let us begin with Deputy Director Knight when you are ready.

Thank you. So I'll start with your question about the self determination program as of January 31. So just a couple of weeks ago, there are almost 2400 individuals that are participating in the self determination program. And as the agenda notes, that beginning in 2018, there was a limit for the first three years of 2500, so we're still not even there yet.

But I do think it's important to note that of that almost 2,400, about a third of those have been added just over the last six months. So the pace of growth has been picking up recently. And I think that, at least in some part, probably has some relation to some of the investments that are referenced in the agenda to help support self determination.

So some of those things, such as a service that's specifically to help, designed to help people before they move into self determination, there's a lot of details working through about how to work with employees, how to set wages, what kind of expectations you should have, and all those kind of details, taxes and the like, that really need to be worked out before someone starts.

And so that's just one example of one of the supports that can be provided to individuals before they actually make that decision to move into self determination. Another big support was removing the cost of what's called financial management services from someone's individual budget. That financial management service, it's provided to really handle the money, to pay payroll, to pay taxes, to manage the budget and the like. And it is a required service up until recently that needed to be paid for out of that individual's overall budget.

Now it comes out of that. So it really does allow for more access and more freedom to utilize the budget on other services.

Additionally, we started with working with the State Council for statewide orientation, so expanding the number of orientations and from whom so that we can hopefully get more people to have access to those orientations which are necessary because there's a lot to learn and be aware of for folks as they move into self determination, and also additional staffing at the Regional Centers to support people who are not only participants, but also Regional Center staff in what is self determination.

How to assist folks as well as people who may want to maybe not access the full self determination, but may want to direct some of their services, such as respite and the like, that without what we call participant directed services. And then further we have established, was also referenced earlier, an ombudsperson's office specifically for self determination that was established in October of 2021.

And some of the investments that we've talked about were brought up not only with regular means from stakeholders, but some of those suggestions have come through the ombuds person's office as well. When we talk about some work that still needs to be done, probably one of the major areas has to do with access to those financial management service providers that I talked about, it is a required service.

We are having some of those providers having a hesitancy with bringing on some new folks, supporting new individuals in the program, in particular those that have a large amount of money in their budget. There's a couple of main reasons for that hesitancy. One is the amount of support that's needed. So the time that's needed, so that has to do with the rate for that service itself. And then also cash flow. There's obviously more cash going through and getting reimbursements promptly.

So we've done a couple of things to address some of those. One, we issued a directive for Regional Centers to, instead of mostly for typical services, reimbursement and checks are issued once, maybe twice a month. We've instructed the Regional Centers to do that every week for those financial management providers to keep that cash flow going.

And then also we are working with on the rate side, a group of actually almost all the financial management providers that we have now to really get a better understanding of the work that's involved in providing that service so that we can have some recommendations, much like we talked about with the rate study, about what would be needed to support individuals going forward.

We established those rates in the beginning based on, with input from some of those same providers, based on what rates are paid in other states. But we're learning that much like everything else, things are a little bit different. In California in particular, the scope of self determination, it's very broad here and so there is more work that is involved and so that needs to be done. So still working through what those recommendations will be with those providers and look forward to having some continuing that discussion.

It's also in the agenda, pointed out some differences in access amongst people of different ethnicities and that it does not line up and it shows some inequities as compared to the overall Regional Center population. And I will say that that was certainly as part of that initial 2500, it was required that those first individuals, we selected them, those who had an opportunity to start in self determination. And we did that.

When I say we, it was with the Department, but with input from stakeholders to make sure that those 1st 2500 that were selected were representative demographically of the state as a whole. Obviously, ultimately all those that were selected did not ultimately get into self determination. We have some information as to why, but we still need to dig deeper into that one. Why are they maybe showing an initial interest and then not following through? Is it because they just didn't understand it?

Is it because it is too hard, is it because they're not getting enough support? And kind of what are the differences in those different demographics to that? So there is still more work to do, just like what we talked about on the first panel to really determine what next steps are to help address what we're seeing in that data. And then I'll move on to social, recreation, and camp, much like some of the others.

We touched on some of this earlier, and I think it was Miss Wesley that talked about, and I'll paraphrase and hopefully accurately that when this service, the statute was first passed in 2009 to suspend this service. And then you flash forward to now, what people want is very different than now than what they were getting before. Before, mostly that was services that were kind of what we refer to as somewhat segregated or mostly with other people who receive Regional Center services.

And now we are getting requests for people who want services from parks and rec, from different things. So just like we talked about with the federal rules, same access as everyone else wants. So that's great, but it has created some challenges for some Regional Centers trying to enter into those agreements or vendorizations with entities that they typically don't do.

And it's because those other city and county parks or the YMCA or what have you, it's a little complicated, just quite frankly, for them to go through that and kind of really kind of do things very different for a couple of people than they do for everyone else. So we are working with Regional Centers to one not go through what was talked about with have parents pay and then reimburse. That is not the idea.

We really want to work through that, creating that streamlined package that Ms. Westlane talked and looking at some other options as well, because these are different types of entities where we want to be able to make sure that folks have access to. The other thing that's been there was social recreation, community integration grants, and we had, I think it was over 120 or right around that applicants for those grants.

And most of those applicants were for people that we don't want to say we, the TDS and the Regional Centers do business with now. So they were the more public and or private entities that don't primarily serve individuals who receive Regional Center services. There were a number of webinars that we put on to describe what this would be and the expectations we'll look to award those grants here soon.

Part of the grants will also help and support some of those same entities to become vendored or contracted with the Regional Centers to help expand that access. So we have seen some increases. I will tell you that there is a bit of a challenge in the data because what was purchased before is not the same thing now. And there really wasn't a quote code or a service that stopped in 2009 and then just restarted.

So we do need to dig through some of that data to help answer some of your questions there.

Thank you. Next we will hear from Deputy Director Cruz.

Thank you, Dr. Arambula. I'll speak to compliance with service coordinator caseload ratios. So with regards to the question, recent investments in reducing caseloads will play a significant role in getting those ratios reduced in the agenda. The agenda has data on caseload ratios and concerns. This data is early on in those investments. We expect to see improvement when we survey the Regional Centers again in the spring. Coming up in March. The reduced zero to five age one to 40 caseload.

The funding, as was previously mentioned, was for nine months in the fiscal year 22-23 and there's an expected phase in the October caseload ratio was obviously still early in the process of recruiting for those positions. A portion of the incentive money was for infrastructure, including but not limited to additional staffing, and that can help with reducing the caseload ratios as well. At the Department, we continue to monitor compliance with these requirements.

Regional Centers are reporting different efforts at recruitment, and certain geographic areas face more hiring challenges than others. I think with regards to casehold ratio, there also needs to be a consideration that efforts in workforce stabilization will also play a role in recruitment and retention. There's statute now which requires a Department to establish and Regional Centers to administer a tuition reimbursement program for Regional Center employees who seek degree or certification in health or human services related fields.

So we feel that will also play a vital role in recruitment and retention.

We will now move on to Christopher Odneal with the Department of Finance.

Thank you, Mr. Chair. Christopher O'Neill, Department of Finance, nothing further.

To add at this time. We will hear from Mark Newton with the LAO.

Thank you, Mr. Chair. Yes, just in terms of the self determination program rollout, as mentioned by Mr. Knight, our review of the recent data did show some racial and ethnic disparities in the rollout. As Mr. Knight noted, it would be good to sort of go behind the data just to understand what was driving those disparities and that will help the state just in coming up with a good plan in order to ensure that there is greater takeup of the program across all consumers.

In terms of the service coordinator caseload ratio sort of issue. As our analysis noted, there have been several funding augmentations over the last number of years, and in spite of several of those, average caseloads actually continue to increase. And a number of reasons for that, I mean, the growing population of the DDS caseload along with sort of rising costs of the coordinators. But there have been some recent investments which the data do not reflect, and so hopefully there will be some improvements in that regard.

But our analysis did point to something that the Legislature may wish to consider, and that is the core staffing funding formula, which is how Regional Center staffing is funded, perhaps an outdated funding formula that may need to be updated to just reflect these caseload issues. Thank you.

Thank you. I will now bring it up to the dais to see if there are any Member questions. I will keep it here at the chair. My first question is for Deputy Director Cruz. I'm really wanting to look at the caseload ratios and ask a few questions, and I'm going to follow up with finance, but want to start with you, Deputy Director Cruz. How do we justify where we are?

It seems that we are so far out of compliance and that the situation is getting worse when you look at the graph at the top of page 29. And so how do we justify where we are right now?

Yeah, if I can jump in. So I don't know that we want to justify it there. Certainly as the budget investments that Mr. Odneal had talked about do recognize that we need to do more. And so the data that you're looking at is from October of 2022, when a number of those investments had just started. So we are looking forward to some more updated data, and we'll do an assessment then to see where we're at coming next month.

Can you speak how this issue looks through the lens of equity for the Administration?

Well, as we've talked about in a number of panels, the service coordination and access to service coordination to provide information, to help link people to services, educate folks on what services are available. That certainly is a critical role for service coordinators, and that's why, as I've mentioned before, we have put in some investments over the years, including some recently, in recognition of the need and the important role that service coordination plays.

It would seem that if we were able to decrease the ratios, we would empower those caseworkers to be able to listen and hear and advocate on behalf of those being served by the program. And since we've heard such disparities, which is why I'm asking the question through the lens of equity, I think we have to look at what some of those drivers are.

I'm going to transition slightly, if I can, as I believe there's the potential for federal adverse action through loss of federal funding that we've had before as a state when we have not been in compliance with these caseload ratios. And I'm hoping the Department of Finance can comment on that.

I may lean on Mr. Knight here. Mr. Chair has been discussed here. There have been a number of investments that have made, particularly recently this current year, that have come online, and we're anticipating that we're going to see more service coordinators hired at Regional Centers. In those cases, ratios come down as to interactions with the Federal Government. I think I would need to lean

on Mr. Knight for sure. The reference to the prior, I believe it was in the late 90s when the Federal Government had sanctions. So at that time, just in General, there were systemic concerns that were identified with not just service coordination, but a whole host of other things that led the Federal Government to take the actions that they did, which was, one, put a moratorium on new individuals gaining access to the waiver and some other.

So a number of things have happened since then, and it wasn't just because of California, but other states. Was that from the Federal Government? They were aware that they really didn't have a good kind of picture of what was happening out in the states. And by the way, they didn't have requirements for the states to have a picture of what was happening either.

So since then, there has been continued movement towards one, the Federal Government saying, okay, state, tell us what mechanisms you have in place to oversee the General operation of the waiver and then report that to us. So it's not necessarily a ratio, but really what is the outcome of that? So are service plans being developed like they should? Are they addressing all needs?

Are financial issues identified, so broad assurances that we can do so that the Federal Government doesn't come out and then see all at once there's a real systemic issues. And so what that does then is that gives an early look for the state and for the Federal Government to see when there may be systemic issues, to try and cut those off much earlier.

So not to say that there's still not more work to do, but I would say that just in General, and even going back to the new federal settings rules, is that with these increased oversight and data sources, then both the state and the Federal Government can see when some of those issues may be emerging and try and head those off.

Wouldn't you say there's a systems issue if every Regional Center has been out of compliance and that the caseload ratios are getting worse. Wouldn't that be a time when the Federal Government would want to insert itself and begin to advocate?

Certainly it could, and that's why, at the risk of repeating myself, why we have made some of those investments over the years and recognizing that we have those in statute for a reason, and we're looking to make investments to try and bring those ratios back to where they should be.

I think you'll hear from my office more about the need for us to manage the risk that's before us. While we cannot mitigate it all, looking at how we can address the core staffing formula and Fund those changes may allow us to more adequately address these caseload ratios and get into compliance, rather than having the potential that the Federal Government may withhold funding from us.

And so I look forward to how we can have those honest conversations, because last thing any of us would want is the Federal Government to not be putting money into or creating a moratorium for us going forward. And so I'm asking for some help as we haven't updated these core staffing formulas since the early 90 s, and it would seem that it's time for us to address some of that.

With that, I will thank very much this panel, and I will make a request from the chair if I can. I'd like to make three requests related to the items we have. First is an updated estimate on how much it would cost to modernize the core staffing formula for our Regional Center operations by a date certain which may support the progress towards service coordinator ratio compliance.

I know we've made changes into the younger age group, zero to five, but can we get an updated for that core staffing? Second, I would like a Regional Center specific reporting on the enrollment of individuals within our self determination program. And third, if we can have more detailed information on the implementation of the social Rec and camp services for Regional Center specific reporting as well.

For the first request on the core staffing formula, a more clear and detailed request for technical assistance will be necessary for our stakeholders, and I'm just hoping to have those communications as soon as possible. I'd like to ask for all of the information from the Administration to come back to the staff, including the LAO, by the end of March. Is the Administration amenable to this?

I think we need to look, as you mentioned, some of the specifics about what the requirements are for the core staffing ratio to see what will be possible, but certainly look forward to having those discussions on those specifics.

All issues will be held open that are before us. And again, just want to thank this panel for this conversation. We will now move on to issue six regarding the DDS safety net plan and the Governor's Budget proposals for this area. The questions for the panelists for this issue are what are the highest priority issues in the recently released safety net plan? What do the trends tell us about the future needs of the caseload might look like compared to now?

And how is the state assuring that individuals in institutionalized settings like Canyon Springs are being adequately and timely assessed for transition to the community? We will have three presenters for issue six, beginning with Carla Castaneda, Chief Deputy Director for the Department of Developmental Services, Christopher O'Neill with the Department of Finance, and Mark Newton with the LAO. Let's begin with Chief Deputy Castaneda, when you are ready, please.

Thank you, Mr. Chair. Carla Castaneda, Department of Developmental Services and I brought with me Director Bargeman for additional questions. The stakeholder process began for developing the safety net plan with looking at the focus for the plan. So some of that was a shift from prior plans that looked at development of crisis services to a focus of prevention and deescalation.

So priorities that are included in the budget include, and there's a nice description in your agenda, but those include additional staff at the Regional Centers to work with counties for trauma informed care for the children in foster youth in foster care, funding to develop additional residential models in the community. This would address individuals the needs with more complex needs, but also to reevaluate the existing stabilization homes that we have to convert them to intermediate care models, which would allow for additional tools and treatment.

Part of this proposal also looked at the staffing of those programs and the component for the crisis stabilization teams. So some adjustment of there was all netted in the proposal. And then finally, the last request is your next issue for a new autism services branch?