Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services
- Caroline Menjivar
Legislator
Budget Subcommittee number three on Health and Human Services will commence. Thank you so much for this full house. While maybe perhaps we'll look at this as a positive thing that you came up here to advocate, it could also be a negative thing because you had to travel so far to come here to advocate for a system that perhaps we don't all agree with.
- Caroline Menjivar
Legislator
But either way, thank you for coming, for each and every one of you to come up here and voice your concerns, your thoughts as we proceed. It's one of the most difficult systems I've come to learn about and find a way that we can really mend this system that serves the entire IGD population. My colleagues are on their way, but we're going to go ahead and start. We're doing two departments today. We're going to be doing the Department of Rehabilitation and Department of Developmental Services.
- Caroline Menjivar
Legislator
We're going to be doing public comment after each department, except when we go to DDS. We're going to do issues one through five, then do public comment to ensure that our ASL interpreter may be able to interpret for those items. And then we'll continue through six through 10 issues six through 10, then, once again, do public comment.
- Caroline Menjivar
Legislator
I do ask for the public comment at the end that if we could please, for my providers and my lobbyists here, if we could please give room for the individuals that have come here so far or from Sacramento to provide public comment first, then for providers and then for lobbyists. So again, families, individuals first, and then the rest of the party there. So I will ask for the departments under DOR to please step into the whale.
- Caroline Menjivar
Legislator
We're going to start with issue one, an overview of the department, and then LAO and Department of Finance.
- Joe Xavier
Person
Would you like me to start?
- Caroline Menjivar
Legislator
Please sir, go ahead.
- Joe Xavier
Person
Well, first of all, good morning. Thank you for the opportunity to be here. Always appreciate the opportunity to share the work that we're doing at the Department of Rehabilitation with the Committee and with everyone in the room. I'm Joe Xavier. I'm the Director for the Department of Rehabilitation, a former consumer, business owner, and now Director at the Department for a number of years. So the agenda does a really good job of describing the programs and services.
- Joe Xavier
Person
I'm just going to emphasize a couple of key points and then speak to the items that you've asked us to address. Who we serve is individuals with all disabilities, which include sensory, include intellectual developmental disabilities, behavioral health, physical disabilities across the entire spectrum. It's also important that when we think about the work that we do, it's not just the individuals that are here today. It's the individuals that will acquire disabilities in the coming years.
- Joe Xavier
Person
The child who can be born today with a significant disability, the individual who is going home tonight and tomorrow morning is a quadriplegic or a traumatic brain injury survivor. Individual who is injured acquires a disability in service to country, to state into our community. And the individual that because of illness, might lose their eyesight, have a limb amputated, acquire any other sort of disability.
- Joe Xavier
Person
And it's also very important that we continue to remember that when we talk about disability, there's the invisible disability, the individual behavioral health, suffering from depression, learning disabilities and the like. And while each of these individuals may have a different path and different circumstances, they're all seeking to pursue that family sustaining wage, to belong and feel like they can contribute to our community, to our society. And one of the things that we'll always call out is this means we leave no one behind. Exception. None.
- Joe Xavier
Person
When we talk about employment, it is prevention, it is intervention, and it is recovery for so many individuals. It creates that sense of belonging, of value, of purpose. It created for me the opportunity to provide for my family and to enjoy the very things I've just outlined. It is also an essential pillar and determinants of health. We have independent living programs within our Department. They advance the Olmstead decision, which is essentially to receive services and to live in the least restrictive environment.
- Joe Xavier
Person
It supports diversions from institutions and it facilitates transitions out of institutions. So item number one on the agenda asked us to address a couple of different things that I will get into the proposed budget solution to conform to the Department of Developmental Services rates. It's $1.6 million, which is proposed to be delayed until next year, and it conforms with the Governor's Budget proposal and the delay that is also being taken place in the Department of Developmental Services rate.
- Joe Xavier
Person
We at the Department of Rehabilitation share both consumers and providers with the Department of Developmental Services. And historically, we have aligned our job coaching services rates with the Department of Rehabilitation. That ensures that there's no disparity in the rates from one system to the other. And we are not currently expecting that there will be any impact into the volume of consumers that we are able to serve at the Department of Rehabilitation.
- Joe Xavier
Person
The second part of this item asks that we speak to the Traumatic Brain Injury program, the HCBS spending plan. And the agenda does a really good job of describing the expansion of services with the Traumatic Brain Injury program. So the question is, are we on track to expand off all of our funds? And yes, we are on track to fully expend the dollars by the end of this December.
- Joe Xavier
Person
The number of additional clients that were served through the expansion is essentially doubling the number of individuals we were serving. So collectively we're serving just over 1560 individuals. We were also asked to speak to what happens to the clients that are receiving services from this expansion. One of the things that I would call out here is that all sites, including those funded by HCBS Dollars, have continued to expand and to evolve their capacity to serve this population.
- Joe Xavier
Person
And the other thing that I would lift up here is that the traumatic brain injury grants are periodically recompeted and we are in the midst of competing those in the coming months. That means that all eligible CBOs, community based organizations, including the existing HCBS expanded sites, are eligible to compete for those grants. We also asked to speak to what happens to the individuals when there is a transition.
- Joe Xavier
Person
So when there is a transition of providers, of course, where there's a provider continues, there's very little support that we need to provide to the consumer on that front because they're already connected. Where it's a new provider, we work to link the consumer with the new grant recipient. Where there is no provider, we look to link that individual with other services that might be available within and in the community. And where there's a virtual option, we obviously look to leverage that virtual option for those individuals.
- Joe Xavier
Person
So I will stop there unless you'd like me to continue to number two.
- Caroline Menjivar
Legislator
Just a quick question you spoke about the sites are going to be eligible to compete for TBI grants. Are we confident that that ability will maintain the site's capacity to continue?
- Joe Xavier
Person
Well, obviously we'll continue, as we've said in the past, to look for resources to do that. But this recompeding of the grants is something that we do every number of years. So at this point we don't know that because we have not yet let out that RFA and we don't know who's going to be applying.
- Caroline Menjivar
Legislator
Thank you. Members, any other questions? Senator Grove?
- Shannon Grove
Legislator
Thank you. I have a couple of questions on programs for individuals on the sub minimum wage issue. It's my understanding, based on the information that we have through our consultants, that 15,000 people roughly have lost their jobs in the IDD community because of the sub-minimum wage. You have alternative programs that you guys are employing. And I guess my question is that what is the result of those programs?
- Shannon Grove
Legislator
And I want to know about regular full time employment like they had when they had sub minimum wage. I'm not interested in somebody working one to 3 hours a week when you have a job and all of the security, just everything that you have with self esteem and integration.
- Shannon Grove
Legislator
I want to know what we're doing to make sure that those individuals continue to be employed, because my understanding again is that 15,000 individuals in the IDD community have lost their job because of the sub-minimum wage bill that was passed out of this building.
- Joe Xavier
Person
Yes, we'll be glad to speak a little bit to the work that we're doing at the Department. I also would point the members and interested parties to the report that the State Council Developmental Disabilities just issued on the phase-out of that sub-minimum wage, which reflects the works of both the departments, ourselves and Department Developmental Disabilities.
- Joe Xavier
Person
When we talk about the reduction of 15,000 individuals, I would say that more appropriately to represent those individuals, yes, they may no longer be in sub-minimum wage, that they're not employed. I don't know that I would agree with that. Individuals have moved on into competitive, integrated jobs. Some of them we would know about because we help them, others may have done so through other avenues.
- Joe Xavier
Person
We know that as of right now, there are certainly many fewer people in sub-minimum wage than there was before, as we know that phase-out is coming up. So one of the things that we have done for quite some time is work with individuals to get them into employment. We obviously do the work with the state as an employer. We do the work with small businesses.
- Joe Xavier
Person
I was just down in Southern California earlier this week to celebrate two small businesses that hired individuals with disabilities into their workforce. And so there's a number of different initiatives. We even at our own Department, have stood up pathways to employment, which is the ability for someone to come in, get a paid work experience so they have the opportunity to be exposed to the workplace.
- Joe Xavier
Person
And then many of them are being hired not only within our Department, where vacant positions are available, but in other departments and other systems as well.
- Caroline Menjivar
Legislator
Director, currently, is it accurate that we have approximately 2000-4000 people only in sub-minimum wages?
- Joe Xavier
Person
Yes, I believe that is the number that is reported, yes.
- Caroline Menjivar
Legislator
Okay.
- Shannon Grove
Legislator
And Director, just to follow up on your comment that you made before, and then if you need to finish afterwards, that's completely fine with me, as long as it's fine with the Chair. I guess my concern is because we have data to say that it's not the number of people that are in the sub-minimum wage category, which we know we still have, but we have approximately 15,000 people, from my understanding. And you said in your statement just now that that number is not entirely true.
- Shannon Grove
Legislator
Because people have gone on to integrated employment and other avenues. Does the Department track that? And can we get a number that says these people went on to gainfully be employed, integrated employment, or are they in day programs, stills paid for by the state?
- Joe Xavier
Person
In terms of the folks that come to us, we know the individuals that we serve, and they all end up in competitive, integrated employment. We've had a number of individuals, hundreds of cases that we have opened thousands of cases, because we provide career counseling information and referral as part of our federal mandate. What we do not have the ability to report on, I defer to the Department of Developmental Disabilities on who's in day programs. That is not a program that we track any data for.
- Joe Xavier
Person
And we may know some of the individuals that come to us that were in sheltered workshop, but certainly not all of them, unless that is made known to us. So data on people that come to us and they go to work? Yes. Specific details about how many were here and ended up there. That is not data points that we track.
- Shannon Grove
Legislator
Okay, so the reason I'm asking these questions is because my former colleague Wes Chesborough introduced Employment First, obviously, in 2013, and then again the SB 639 a couple of years ago. That has, what I think created an unfair disadvantage to those individuals who will now end up in a day program versus actually being gainful. I realize that sub-minimum wage is not gainfully employed. I get that.
- Shannon Grove
Legislator
But the idea of self-esteem and going to work, even when they did the work out at the Tejone Ranch facility, the rest stop, when they hired our Bakersfield arc to go up there, and then that was taken away because they weren't part of SEIU, and there was this whole big issue. But they had pride. They greeted people when they show up. They kept that place spotless. I mean, having a job creates self-esteem and personal achievement, and it has a big benefit.
- Shannon Grove
Legislator
And I'm very concerned with the data that we received that 15,000 people have lost their jobs because of the sub-minimum wage job or the bill that came out. And in your statement just now, your exact quote was, they all, meaning this population, end up in competitive workplace employment? They all do. You have data to show me that all 15,000 people are currently in competitive workplace employment?
- Joe Xavier
Person
I don't believe I said they all. I said those that come to us that end up in employment are all in competitive, integrated employment, because our Department does not place anybody other than in a competitive, integrated employment. If I could just lift up the point you're making about the value of work that I spoke to at the outset.
- Joe Xavier
Person
I'll use a real-life case, a young lady that is now working for us, who is this individual that was in this sub-minimum wage setting, came in with what you described, very little confidence, very afraid of the workplace. And today, as a state employee, full of confidence, ability to perform alongside individuals who don't have intellectual developmental disabilities, ability to engage with me just like anybody else. And yes, Senator, employment did that for her.
- Joe Xavier
Person
She now has the income to be on par with the rest of society, to provide for herself, to care for herself, to go enjoy what everybody else gets to enjoy. That's what we do, and that's the focus that we take on everybody that comes to us for services.
- Shannon Grove
Legislator
Thank you, and I appreciate that. That's the goal that we want, and that's what I mean about self-esteem. I have a severely disabled individual with down syndrome, and he was so excited to have his job, and he felt valued. And the self-esteem and the confidence that that gave him, that's a personal story that I could share with you. I guess my thing is that in the May revise or before May revise, I guess I'd like to know the numbers that you have.
- Shannon Grove
Legislator
And I really want to drill down on this 15,000 people. I realize it's the only ones that come to you, but if they don't come to you, how are we tracking those individuals? And if they don't go to work anymore, where are they going? And if they go to the day program instead, there's cost implications for the state for that. And I'm just saying that to go to.
- Shannon Grove
Legislator
And I don't know about the significant knowledge about the day programs and if they're creating that same self esteem and that same self awareness and that same self achievement. But I would like to make sure that the individuals who have options to either have employment or if they go to a day program, let them go to a day program, but I want them to have the best available opportunities out there for them.
- Shannon Grove
Legislator
And I'm really worried about 15,000 people that lost their job because of these two pieces of legislation.
- Caroline Menjivar
Legislator
Director, any final comments on this? And then we're going to go back to the agenda.
- Joe Xavier
Person
I think I said what I could say on the topic.
- Shannon Grove
Legislator
I'm sorry, Madam Chair. Was I not on the agenda? Item number two says it's item number two, employment. My apologies if I stepped and waited.
- Caroline Menjivar
Legislator
You're okay, Senator.
- Shannon Grove
Legislator
Thank you.
- Caroline Menjivar
Legislator
Senator Roth,
- Richard Roth
Person
I realize this is not part of our program today, but I feel compelled to say something. You know I had my concerns and questions, as my colleague to my left did when we first did this action with respect to the sub-minimum wage. But I'll tell you that I have completely changed my view and don't have concerns. I had the privilege of visiting Phoenix Technologies, which is a company. They manufacture fire helmets.
- Richard Roth
Person
They're one of the few in the, I guess, certainly the country in the world that do this, and they have made a concerted effort to reach out to the disabled community to job coach and employ. And I visited the manufacturing floor, and I tell you, it took my breath away. And it was pretty clear to me after watching the employees. First of all, I couldn't tell who had a disability and who didn't have a disability.
- Richard Roth
Person
It was pretty clear to me that the key to helping those with disabilities is helping them secure a job at a regular wage, not a sub-minimum wage. And when I spoke to people on the floor and actually the workers with disabilities, some of them were given an opportunity to come talk to me, and I spoke to them. They didn't want to go back to jobs at a sub-minimum wage.
- Richard Roth
Person
In fact, there was one employee who was the employee of the quarter, and he told me that because of his job at Phoenix Technologies, and I hope they don't mind me mentioning their company, he was able to buy his first car. He bought a new Mustang, and he was so proud of that car that he had a car and he was able to drive. And the managers at the facility told me that individuals with disabilities were the ones who got to work on time.
- Richard Roth
Person
They came back from breaks on time. They didn't stop their work. They were the most productive on the shop floor. And so employers can do this. And I think as a state, instead of looking back at the sub-minimum wage program that existed for seemed like forever, what we should do is we should look forward. Employers are going to need to be informed, and employers are going to need assistance, and they're going to need to understand that this is not so difficult. This is about screening.
- Richard Roth
Person
It's about job coaching, it's about tolerance. It's about building a culture in a workplace that allows everybody an equal opportunity to thrive. And so I want to commend you for what you're doing. I know you will continue to look forward, you will continue to explore opportunities to secure additional funding. And that's what we're here for, to provide programs to educate and inform employers, perhaps to assist with job coaching and screening, to place people in jobs where they have an equal opportunity to succeed.
- Richard Roth
Person
And if the businesses in my district are any indication, they will succeed, the businesses will thrive, and everybody will be better for it. Thank you. So thank you, Madam Chair, for allowing me to deliver a speech.
- Caroline Menjivar
Legislator
Final thought?
- Shannon Grove
Legislator
I agree 100% with what my colleague said. I do. I guess my concern lies with those individuals who I think have an opportunity, because what my colleague describes, I see every day in the workplace, I see here in the building, I see at my company, I see that every day. But there are individuals that are not as high functioning with IDD, and we want them to have the same opportunities for competitiveness. And if there's not something out there for them, that's where my concern lies.
- Shannon Grove
Legislator
And I agree 100% with what my colleague said. My question to you is no antidotes, no things. We could all go back and forth on stories, and I know the Chair is ready to move on. I want numbers of those individuals who have not had the opportunity to be integrated into employment. The higher-functioning IDD community is not. I don't want to say that's not where my concern is. I believe they are thriving 150,000,000% better with what we have in buying Mustangs and paying for apartments.
- Shannon Grove
Legislator
I'm worried about the IDD community that is not as high functioning, and do they still have the opportunity to go and be integrated into a workplace? And that's my concern. And I would like those numbers if you could provide them for me. Thank you.
- Caroline Menjivar
Legislator
Thank you, Director. We look forward to seeing those numbers. I think all the members here on the dais would be eager to see those numbers as well. We're going to hold the item open, issue number one, and we're going to move on to issue number two, Voice Options Program.
- Joe Xavier
Person
Okay, thank you. So the purpose of this program is to provide speech-generating devices to individuals so they have access to the telecommunications network and communications more broadly. So in February of 23, the CPUC made the Voice Options Program permanent, and we administer that agreement. That program, through an interagency agreement with the CPUC. $3.6 million is transferred to the Department of Rehabilitation for the annual administration of this program. And it's 3.75 positions that we use to administer the program.
- Joe Xavier
Person
We expect to serve about 1260 individuals annually through the program. And the number that I shared here, this 1200, is determined by the experience that we have with the program thus far. Let me share what this means in real time for folks. So I'm going to talk about a very young girl, Riley, who had never spoke and who was never able to articulate what her wants and needs were or even engaged around her peers.
- Joe Xavier
Person
She was provided with an iPad with the speech-generating applications, and began to understand how she can use that to communicate what she was wanting and what she was seeking with those around her. And as she recognized the capability of this and start to see the possibilities, imagine the smile that she had on her face when she realized, I finally can be heard. I finally have the opportunity to say whether this is okay or not okay.
- Joe Xavier
Person
She is now routinely communicating with family and friends because of this device. Let me talk about Mina. So she'd been able to communicate, but when she had a trach, it eliminated her ability to communicate. So while in treatment, she was provided with a speech-generating device, the iPad with the apps on it. It enabled her to again start to communicate with those around her that are providing her with care.
- Joe Xavier
Person
And it also enabled her to communicate over the telephone, real-time translation, with her family, who is in another country. When you think of speech devices, you got to think of two things. For some, it unlocks speech for the first time. For others, it restores the ability to communicate that they may have lost. So I will stop my comments there, and glad to take any questions on this as well.
- Caroline Menjivar
Legislator
Director, how can one individual apply to obtain one of these equipments?
- Joe Xavier
Person
Well, so we have providers that are throughout the State of California. We try to make this program known as broadly as we can through all of our various networks, independent living centers, older individuals who are blind, programs. Information is available on our web page. So it's, again, how do we keep making it known? And then we link the individual to the providers at the local level to get the devices and the appropriate applications and needed training into the hands of the individual.
- Caroline Menjivar
Legislator
Would they have to go to the Regional Center to request this?
- Joe Xavier
Person
No, they do not. And they do not need to be a Regional Center consumer to request this. We work essentially with anybody that has that barrier to communications.
- Caroline Menjivar
Legislator
Thank you. Colleagues, any other questions? We're going to hold the item open and close our Department of Rehabilitation. We are now going to do public comment. I'd like to make sure our ASL interpreter. We're all good. Everyone can see our interpreter. Please raise your hand if we need to accommodate any further. We need to make sure you can see. Okay. Perfect. All right, so we're going to be doing public comment for issues 1 and 2 on Department of Rehabilitation only. Please proceed.
- Carl London Ii
Person
Madam Chair. Carl London. On behalf of the Alliance Supporting People with IDD, we are an organization of community-based agencies around the State of California that provide a range of services to people with intellectual and developmental disabilities. I'd like to speak very quickly on item one and also to sort of reinforce the comments and questions raised by Mrs. Grove. Our concern is that as we look at the implementation of the elimination of the sub-minimum wage option, she's right on target.
- Carl London Ii
Person
There are about 15,000 people, we believe, that have lost their opportunity for employment statewide, and there is nothing going on at this Department or the Department of Developmental Services at scale to help those people have a shot at employment. You guys have been asked to give money over the past couple of years for competitive integrated employment, for paid internship programs, and we think you deserve the right to have the data on how successful those programs are. How many of these people are successful at transitioning?
- Carl London Ii
Person
And I think the other implication here is that if they don't stay in some kind of employment program, the question is where are they? And many of them are sitting at home, or they are moving to a day program, which, rate-wise, just by rates, costs the state more money. So it has a budget implication. We think you ought to be asking the departments for data on this to get a clear picture as to what's going on, not just this Department, but also Developmental Services.
- Caroline Menjivar
Legislator
Thank you so much. Any other public comment on issue 1 and 2? Seeing none. Thank you, Director, for coming in. We're moving into our Second department, Department of Developmental Services. We're going to start with issue number one, which is the DDS overview. I asked the Department to come step on in.
- Carl London Ii
Person
Thank you.
- Caroline Menjivar
Legislator
Hello, Director, you may proceed with question number one.
- Nancy Bargmann
Person
Okay, thank you, Madam Chair. Nancy Bargmann, Director of the Department of Developmental Services. And I have with me my colleague, Deputy Director Jim Knight that's going to assist with answering questions 1 and 2. I'd just like to flag a couple of things with the Chair's permission to just highlight some of the things that are going on at the Department of Developmental Services.
- Nancy Bargmann
Person
We have been working diligently over the last several years on making sure that we have an incredible amount of investments and policy changes to really support the vision and the guiding principles of our Department. Just highlighting that our community has really expressed the interest in making sure that we are really lifting up the fact that we want a system that is supportive of equity and choice and options.
- Nancy Bargmann
Person
And over the last several years, many of the investments that we've been able to start leading with include things that lift up the importance of outreach, lift up the importance of workforce issues, lift up the importance of making sure that we're addressing the service, access, and equity and many of those initiatives.
- Nancy Bargmann
Person
I wanted to commend the Chair and the staff and on the agenda, there's many of the things that are outlined in there, and we also acknowledge and recognize that not everybody's experience is to the standard of our values and our guiding principles. We are aware of that. We are aware that we have to continue to build on those initiatives, and I appreciate lifting up some of the key areas in the agenda that we're going to be able to speak to those.
- Nancy Bargmann
Person
But I do want to just give you some updates on some of the initiatives. I'm very pleased with the fact that I got a chance to meet with a couple of people today on some of the initiatives and hearing about how they're advancing on workforce. But also listening to my colleague, Director Xavier, talking about technology, really realizing that these advancements are really life-changing for individuals.
- Nancy Bargmann
Person
We get the opportunity with many of these things that we're doing right now on focusing our youngest population and affecting a lifelong journey as they look for services and supports that meet their unique needs at various times of their ages and stages of life. So we look forward to continuing the work with this Committee and our community on advancing important initiatives and improving those experiences. So with that, answering questions 1 and 2, I'm going to turn to my colleague, Jim Knight.
- Jim Knight
Person
Thank you again. Jim Knight, Deputy Director with the Department of Developmental Services. So the first question you asked was about information related to the decrease in expected expenditures in the current year. And so kind of taking a step back at a high level. When we develop our estimate, we're looking at, with most current data available and trying to project trends and looking at trends over the years to see where expenditures have gone.
- Jim Knight
Person
As the agenda notes, that during COVID we saw a significant difference in the expenditure level. And so when we were developing the enacted budget, which would have been about a year ago, the expenditures at that time were still impacted and influenced by the expenditures that we were seeing during COVID. As we now come to, in this Governor's Budget, you notice that there was an assumed reduction of estimated expenditures in the current year. And that's really because now we have a look at more current data.
- Jim Knight
Person
So last fiscal year, and it's been, as we've gone through with COVID trying to determine when that new trend or where that new baseline is, we think we're kind of starting to see it now. Even though this is a reduction in estimated expenditures, if you look at actual expenditures over the last several years, those have been trending on average about 11% increase year over year, whereas caseload has been about 5%. So that's been relatively stable. And this adjustment really gets us back to that trend.
- Jim Knight
Person
So over, from 22-23 to the current year. And then for budget year, that trend is reflected in our current estimate now. I know there was a question about could it possibly be related to access or provider and workforce at a high level. That data, again, it's not really sure. Certainly we're very much aware of the impact of the workforce and what's going on, not just in this system, in the state, but everywhere. But really what we're talking about here is more at a higher level.
- Jim Knight
Person
Certainly Director Bargmann touched on some of the workforce issues, and I think we'll get into some of those initiatives later on in the agenda as well. I think your next question was about where we are with meeting the home and community-based services final rule or the setting requirements. The agenda does a real good job of laying the background and really what the spirit of those quote, rules are about.
- Jim Knight
Person
And even though we call them rules, it's really setting that expectation for individuals and what their rights and really how services should be provided. And we were, and we talked about last time, given an extension from the Federal Government to make sure that all the providers are delivering services in line with those requirements. And so that involved us over the, through August for the Regional Centers, mostly doing visits at each of the locations where services are provided.
- Jim Knight
Person
So we outlined kind of incremental steps where we'd get to 25% by the end of February and so on, until all visits were completed in August. As you pointed out, that on a statewide level seem to be tracking pretty well, but there are some Regional Centers where we're seeing they're not at that same pace. So we are having continuing discussions with them. They've outlined and worked with them to develop a plan to meet those.
- Jim Knight
Person
Those visits have started, and we will continue to follow up with them to make sure that those are completed and we get to where we need to be. And it's more, I just also want to point out it's more than just the work with the providers. As I said, this is about expectations for people who receive services and what their experiences are.
- Jim Knight
Person
So continuing to do that work of not only training, information sharing, and the like, so that everyone is aware of really what the importance of these quote, rules are and so that we can continue to move forward. So thanks.
- Caroline Menjivar
Legislator
Does Department of Finance or LAO have any additional comments to this?
- Christopher O'Neill
Person
Christopher O'Neill, Department of Finance. Nothing further to add, Madam Chair.
- Caroline Menjivar
Legislator
Okay, can you clarify a little bit further on the remaining Regional Centers that have not been able to meet our statewide trajectory in the right direction? I will want to note, though, last year it was a different conversation. I know we've done so much better since last year, so I do want to commend the Department on that.
- Caroline Menjivar
Legislator
But on those single one-offs, can you share a little bit more about not just merely talking to them, but what are the remaining barriers for those centers to get on par with the rest of the centers?
- Jim Knight
Person
Yeah. And in one case in particular, it's about them kind of organizing themselves even though they're having some challenges, workforce challenges in particular, of trying to bring some extra folks on, of helping reprioritize and making sure that this gets done. So it's not just talking, but working through. And hey, what is the plan? How are we going to get there?
- Caroline Menjivar
Legislator
Okay. And then, Director, I don't have questions, and we didn't put this on the agenda because we have a heavy-packed agenda. But three items that I'd like to make sure for the May revise are considered as we're looking to find some unspent dollars. When it comes to Porterville.
- Caroline Menjivar
Legislator
How the Governor has asked to replenish the 20 extra positions, even though our numbers haven't increased in residents wondering if we really do need the money for the extra 20 employees, for the workload investments, there's potentially some unspent funds in that area ensuring that we're really looking at that space as well. And finally, for the complex needs home. We haven't really done a lot of that building. So, again, unspent funds there that we can track back this year.
- Caroline Menjivar
Legislator
Those are the three things that came to mind.
- Nancy Bargmann
Person
Okay, thank you.
- Caroline Menjivar
Legislator
LAO, do you have any comments on that? I mean, you're not LAO. Department of Finance, do you have any comments?
- Christopher O'Neill
Person
Apologies, Madam Chair. Chris O'Neill again, I'm just clarifying on the Porterville request, not 20 positions. We always budget departments based on their authorized positions. And so when we did our numbers at Governor's Budget, we looked at what was a reasonable savings in current year based on the vacancy rate, and that ended up being $20 million that we scored.
- Caroline Menjivar
Legislator
Maybe that's where I got budget.
- Christopher O'Neill
Person
Yes, exactly. Just wanted to clarify. $20 figure not.
- Caroline Menjivar
Legislator
Thank you. Thanks, LAO, AAny comments on. Great. And then my other question is regarding. I know you spoke about in regards to the first question, potentially the work case ratios, can you dive a little bit further on the bigger umbrella workload? I mean, workforce. Right. But do we also see that it's also some barriers that still exist that could potentially impact our ratios as well? They are impacting our ratios.
- Nancy Bargmann
Person
Yeah. Thank you, Madam Chair. So I think your question is related to the ratios for the Regional Centers and the workforce. With the Regional Centers, we are seeing varying kind of compliance.
- Nancy Bargmann
Person
I hate to use the term compliance, but it is when we take a look at our caseload ratios across the State of the 21 Regional Centers, we're seeing some Regional Centers that have really been able to achieve kind of hiring to, for example, our birth to five caseload ratios that we've invested to get to the one to 40. So we have many of the Regional Centers that have actually accomplished being able to get there.
- Nancy Bargmann
Person
We have other Regional Centers that have really struggled in hiring the staff. So there's a couple of Regional Centers that we're looking to provide technical assistance in getting a work group, to provide supports and think of strategies of hiring, and how do we kind of build around that? We had the investment of the tuition and helping with providing tuition reimbursements for some of the employees within the Regional Center to advance kind of their education.
- Nancy Bargmann
Person
But we also know that there's still some workforce challenges, particularly even beyond the service coordinators, clinicians. We still continue to see a shortage of clinicians. It is high on our radar. And we're looking to see, are there additional kind of collaborative efforts that can be done in being able to help some of the centers that are lagging behind in looking at strategies and effectiveness to be able to hire the service coordinators.
- Caroline Menjivar
Legislator
Follow up on the ones that are falling behind. Is that further expanding our racial disparities? Is it the Regional Centers that are in the areas that mostly serve black and brown communities or BIPOC communities?
- Nancy Bargmann
Person
It's a great question. California is a very diverse state, so largely the majority of the Regional Centers really do support our black and brown communities. The particular Regional Centers. I would say that it's not the majority of the individuals, but it impacts all of the individuals. Certainly, we're very concerned about any community that's marginalized and making sure we're supporting them.
- Nancy Bargmann
Person
But we do have a couple of Regional Centers that are very far behind in hiring the staff, and that's why we want to put some focus on it and see how we can assist them in being able to advance and be able to fill those gaps.
- Caroline Menjivar
Legislator
Okay, my last question I'll turn to my colleagues, is regarding last year in the budget we allocated for positions regarding the enforcement of AB 1957, for Assemblymember Wilson to be able to track data on the IPPs and so forth, have we started, have those positions been working with the Regional Centers to collect that information?
- Nancy Bargmann
Person
Yeah, we've been hiring positions. We also had a large number of positions that we needed to kind of fill and ramping up. I can get back to you. I don't have in front of me today exactly how many of those positions, but we have been working with the Regional Centers. We have an electronic record system that helps us track much of the information that is centralized. I won't get into too much of the detail.
- Nancy Bargmann
Person
The complexities of being able to update that system is not the most intuitive and flexible. So we have more work to be done.
- Caroline Menjivar
Legislator
No system is apparently.
- Nancy Bargmann
Person
Right, so I will tell you we're not as far in that particular initiative and mandate that I'd like to be. We are somewhat behind in that area, but we are developing the strategies to make sure that we're collecting it, getting it posted, because it is information that we also want, but know that we need to do it for the transparency intended for this bill.
- Caroline Menjivar
Legislator
Okay, Senator Roth.
- Richard Roth
Person
Thank you, Madam Chair. You know, I view this as sort of a core function of government, the services that you provide and you supervise, and it's sort of a unique situation, at least it seems to me somewhat unique in that the management and control is not at the county level.
- Richard Roth
Person
I mean, locally is not at the county level, but instead, as with nonprofit organizations that are referred to as Regional Centers, we've had some issues with payments to vendors out of the Regional Center in the district that I'm privileged to represent. And it appears to me that this whole system that we've set up long ago, not to change it, by the way, but that the system itself lacks standardization in terms of process and systems and performance.
- Richard Roth
Person
It must be very difficult to audit and to get data that you can actually crunch together that means anything, seems to me. So I guess my question is this, how do you propose or what should we do? I'm a military guy, to strengthen the command and control of this whole thing.
- Nancy Bargmann
Person
Thank you, Senator Roth, great question. If you will, I'd like to go and highlight some of the more recent investments, but not only the investments, some of the policies that have really been outlined through some legislative action, certainly things that have been put forward by the Administration. Standardization. You're right, it is hard to be able to provide oversight when you don't have standardized measures to be able to evaluate.
- Nancy Bargmann
Person
Much of the work we're doing right now in looking at how do we standardize vendorization for each Regional Center, we know that it's been very frustrating for service providers sometimes when they have to get vendored and go to 21 different Regional Centers and may have to follow 21 different rules. We also know intake has been a challenge for families, that for us to even provide oversight to how individuals are experiencing intake.
- Nancy Bargmann
Person
A great example of this is I've been hyper-focused on data recently because we're only going to be able to make changes based on the information that we have. One of the areas is certainly an early start in intake when we have a mandate under our federal grant to have from 45 days, from the point of contact with a Regional Center to the point of their individual family services plan, and then ultimately to services.
- Nancy Bargmann
Person
Well, when we were monitoring to that, we were seeing that, gosh, we're really close to 100%. Then we started drilling into that data. We realized there is a different definition of that point of intake. So some Regional Centers were doing it from the point of completing an application. Some were doing it from the point of a phone call. So I think this gets to your point. How do we provide oversight if we don't have some of those standards?
- Nancy Bargmann
Person
So we've implemented now a standard definition of that point of contact so we can hold Regional Centers accountable for that timeline. That's just one example of the things that we're really drilling into the data that we're getting while we're still trying to catch up with modern-day technology on some of the data.
- Nancy Bargmann
Person
We had far advanced in the last two to three years, further than we've had, I would say, since I've been at the Department for the last 10 years. This data, which we're ultimately also starting to put into dashboards, what can be transparent for the community as well?
- Nancy Bargmann
Person
Because not only do we have a responsibility as a Department for oversight and accountability, we also want to make sure that it's transparent to the community so we can also have the community be able to take a look at some of these measures. So much of the work that we're doing right now is really getting to it. I will flag the next item on the agenda, I think doubles down on those efforts to say, from a master plan perspective, where are those gaps still?
- Nancy Bargmann
Person
What is that future? What is it that is modernizing and really evaluating the Developmental Services system? And then where can we go? So I hope that kind of answers your question of saying we're not waiting to see what is kind of a system in the 21st century. What is it that we can do today to meet the promise of the Lanternman Act and to provide that oversight and accountability? Many initiatives are there. It's exciting to see.
- Nancy Bargmann
Person
And if I had my magic wand, they'd all be done today. But we're still going to need a little time to implement them.
- Richard Roth
Person
What seems to me the problem is we're dealing with nonprofits, I think, that have boards, executive directors, set their own drumbeat, despite the fact that the money passes through us. And this is a core government function of the state, to provide assistance to folks who are most vulnerable, who need our help. And the fact that things are not standardized, regardless of what things we're talking about, is interfering with our ability as a state to perform our core government function.
- Richard Roth
Person
Unfortunately, this is not like one of those famous TV shows where we say, you're fired and bring some other team in because you can't do that.
- Richard Roth
Person
It's highly disruptive, won't work, creates problems for the individuals that we think about, talk about, work for every single day who are in their most vulnerable situations, seems to me that we ought to come up with what our template is for how Regional Centers should perform, whether it's systems, whether it's policies, process timelines in a way that you can monitor, you can measure, and you can take action.
- Richard Roth
Person
Put it out there, give them a period of time, all of the Regional Centers, a period of time to get in line. And it may take a while, it may take a year, may take 2, may take three if we're talking about systems compliance. But then everybody's on the same playing field and everybody can be measured at the same way. I think the incremental approach, unfortunately, I'm concerned that we'll never get it done. But that's just my thought.
- Richard Roth
Person
And we do have an agenda that is 10 miles long, so I am going to zip my lips. Thank you.
- Caroline Menjivar
Legislator
No, Senator, I think you hit it on the nail for this. And just last year, or with our trailer bill language, we did a big chunk of that. And issue three is to see how far that effort has come, or did we really fall short? So, issue three, we're going to learn about some of the standardizations that we've implemented and then see how issue two, on the master plan of aging can then support our efforts and expand on that.
- Caroline Menjivar
Legislator
So I think you hit it right on the nail, and you're on the agenda of why we're here today. Senator Eggman, I just have one final thought, a question for you, Mr. Knight. On question number two, you spoke about what we're doing and how we're helping the Regional Centers, but I don't know if I remember you answering the last portion. The consequences of providers that do not come into compliance.
- Jim Knight
Person
Yeah, sorry. So kind of a graduated way that we're working with providers. So if we find that there are some areas that need to be addressed, starts with some technical assistance. If that doesn't work, work up to a corrective action plan. Ultimately, if they're still not meeting that, we'll then move into where there'd be a moratorium, if you will, on referrals for new individuals to serve. Ultimately, though, it could lead to that the provider would no longer be able to provide services anymore.
- Jim Knight
Person
We certainly don't want to get there, but we want to be able to work through and meet the requirements.
- Caroline Menjivar
Legislator
Is that within a six month period, one year period, we're talking in five years, maybe we come back to that provider or.
- Jim Knight
Person
No, it wouldn't be for five years. I don't know what I can get you the more details on what timeline we laid out in the directives that we have.
- Caroline Menjivar
Legislator
Okay. And it's a standardized timeline for every provider if they don't meet a certain goal benchmark.
- Jim Knight
Person
Well, right now, with what we have with the Federal Government, we said we have to be in compliance or meet all the requirements by the end of this year.
- Caroline Menjivar
Legislator
Perfect. Thank you. We're going to hold that item. We're not holding, Senator Grove.
- Shannon Grove
Legislator
She has the habit of looking that way to her. Right.
- Caroline Menjivar
Legislator
It's because she doesn't always grace us with her presence in here.
- Shannon Grove
Legislator
She forgets I'm here. Touche, though, on that. So I do have a question on page 15 of our information. I don't know if it's on yours. Fairview warm shutdown, $11.3 million. What is a warm shutdown, and can you describe that to me?
- Nancy Bargmann
Person
Yes. So for Fairview, just as a reminder, back in 2015, we took action to go ahead and close all the remaining. This was a historical event of closing all the developmental centers in the State of California. Fairview was one of the last ones as well. So there's still effort that needs to be done until the disposition of the property, similar to what we did with Sonoma Developmental Center.
- Nancy Bargmann
Person
So the warm shutdown is making sure that the systems are still in operation because if you totally shut down some of the utilities and the things that kind of generate the work and the lights are on and the things that need to happen even for the next phase for the disposition of the property. So that's what warm shutdown is. Okay. Still making sure we have the staff and the resources to do that.
- Shannon Grove
Legislator
How many staff are at that warm shutdown?
- Nancy Bargmann
Person
I'd have to get back to you on that.
- Shannon Grove
Legislator
Thank you for that. And then on page 16, it talks about the announcement of a master plan for Developmental Services. I'm concerned about the stakeholders and like large providers or even small providers, that.
- Caroline Menjivar
Legislator
Senator Grove, that's the next issue.
- Shannon Grove
Legislator
Okay.
- Caroline Menjivar
Legislator
Yeah.
- Shannon Grove
Legislator
Thank you.
- Caroline Menjivar
Legislator
We're going to have a whole panel on that.
- Shannon Grove
Legislator
Thank you.
- Caroline Menjivar
Legislator
Okay, we're moving on to issue number two. We're going to do our first panel of the afternoon, the master plan for Developmental Services Director, welcome you to stay seated. And there we're going to welcome up the rest of our panelists. Full house, so get comfy in there. Okay. One of you might have to swap off if you need to, but only one LAO chair today. We got one more chair over here. I think we might be okay.
- Caroline Menjivar
Legislator
We might need one more. Oh, no, we're perfect.
- Caroline Menjivar
Legislator
I ask when it gets to your turn to speak, to please introduce yourself so that I don't butcher your names. We will start with our Director who will kick us off.
- Nancy Bargmann
Person
Thank you again, Madam Chair and Committee Members, Nancy Bargman, Director of the Department of Developmental Services, and I'm very happy to introduce introduce this topic for issue two on the Master Plan for Developmental Services. When the introduction of the Master Plan for Developmental Services was introduced and announced by California Health and Human Services Secretary, some immediate questions came up from our community and I just want to kind of lead with that. Some of the concerns were weight is this going to affect our entitlement in California?
- Nancy Bargmann
Person
We're very unique. We are one of a kind in the nation and having an entitlement for individuals with intellectual and developmental disabilities or is this really moving us to manage care or is this going to be a budget solution? So I just want to lead with that's not what the Master Plan is about. It really is about intending a very intentional approach to creating a vision for what the system can look like long term, including the vision and input from the Legislature, our advocates, system partners.
- Nancy Bargmann
Person
When I say system partners, it's outside of Developmental Services, but more importantly from self-advocates and families. It's really about those individuals who the system is their system. And so having the voices at the table and really being able to create that vision with that central point and making sure that we're embracing that is extremely critical. As I shared earlier, there's been incredible investments.
- Nancy Bargmann
Person
We're still in many various stages of implementing those investments to affect change, to make sure that we are strengthening our system, to be responsive, to address the inequities that we have to be able to address the transparency, making sure we're advancing those really critical areas, to make sure that we are getting a system that is measuring quality outcomes at the individual level. But it's more than that.
- Nancy Bargmann
Person
So really having an opportunity for a master plan to take a step back and really take a look at what is the future. So looking forward to the next 10 years, we've been as a Lanternman Act enacted since 1969. And so there's been many changes, historical changes. We mentioned about the closure of the developmental centers. There's been many other things.
- Nancy Bargmann
Person
But right now with many of the initiatives and many of the things we've been doing many a times, it's kind of in reaction to. So what is going to be that very thoughtful way of listening to individuals and families? And that is really the priority of what we're going to be doing. And very authentic engagement with our community, not only by the Committee Members, but also making sure that we're going out to the communities, that we're listening to the various communities.
- Nancy Bargmann
Person
It's going to be a very diverse outreach. It's going to be very diverse in making sure that we're touching all community, whether it's rural, whether it's taking a look at our relationship in talking with our tribal communities, the indigenous communities, looking at our very diverse community, that we're changing as a system, looking at the data, what that means, but again, making sure that we have a master plan that is really written and focused of those who receive services.
- Nancy Bargmann
Person
I'm also really pleased to share with you that the secretary has also selected Victor Duron, who is the Chief Deputy Director of Department of Rehab, to be the Director of the Master Plan. I'm particularly pleased by this. He's just an incredible partner and I'm looking forward to the work that he is going to be able to do with this leadership. I will also flag just a couple of other leaders that are going to be working and supporting the work of the Committee.
- Nancy Bargmann
Person
Catherine Blakemore is the former Executive Director of Disability Rights California. She is going to be a subject matter expert. Dr. Olivia Raynor is the Director of the Charging Center at UCLA, former Director out there, is going to do a comprehensive support for self-advocates. And then further, we have many of the leaderships within California Health and Human Services Agency to include the Chief Equity Officer. And then we're also going to lean in on making sure that we have peer supports for our self-advocates.
- Nancy Bargmann
Person
So right now I'm going to go ahead and hand it off to my colleague and have Victor Duron be able to provide you more detail to the work and important work that we have before us.
- Victor Duron
Person
Thank you so much, Director Bargmann. Thank you Madam Chair and Members of the Committee for this opportunity to share about this really exciting work we're about to embark on. First, I just want to say what an honor and privilege it is to have been asked to support this incredible endeavor that I've no doubt will change countless lives and really set us on an aspirational path for the future.
- Victor Duron
Person
Obviously, the Developmental Services system is core to this work, but we recognize and in this master plan, we want to see reflected that the systems that touch the lives of individuals with IDDD are much greater than just the core Developmental Services system. Recognizing everything from education to employment to health care is a part of the lifespan of any individual, whether or not they have a disability.
- Victor Duron
Person
And so we're looking to develop a master plan that is aspirational, that will lay out priorities and bold goals and help holistically look at the different systems and at the individual as a whole person in order to lay out a vision that looks at what we in California want, the arc of the life of a person with IDDD to look like and to bring all of the incredible resources that we have in this state to bear across all stages of life for a person with IDDD.
- Victor Duron
Person
This master plan will really be anchored in bringing the voices of lived experience forward, bringing diverse voices, making sure that those individuals who are most directly impacted, who have that lived experience are at the forefront of this endeavor. One of the things that I cannot emphasize strongly enough is that that equity lens will be a core part of everything that we do in the Master Plan.
- Victor Duron
Person
Something that is so important to all of the communities as we've been having these conversations and that I'll just share for me personally as a Mexican immigrant, as a family member to people with IDDD is really important part of my core values as well. And to that end, I also want to flag that centering the voices of the community of lived experience will be fundamental in what we create. This is not going to be the Administration creating a master plan.
- Victor Duron
Person
This will be the Administration creating the space and providing the resources so that we can work with the community, work with our stakeholder committee, and have our stakeholder committee help us lift up other voices that need to be at the table to develop a master plan that will set that vision and those bold goals for our future. So I'll touch a little bit on the timeline that we're looking at. We have just launched this endeavor. We are so excited.
- Victor Duron
Person
I've begun meeting individually with members of the stakeholder committee and we've planned out the first series of meetings. These meetings will be open to the public and we will be building in robust public comment opportunities throughout all of our meetings. Our first full stakeholder Committee meeting will be scheduled, and we've shared this information with your staff ahead of time, but I'll just restate here that it will be scheduled for April 10 here in Sacramento with a virtual option.
- Victor Duron
Person
We will have a second meeting on April 24 that will be all virtual, and we will have a third meeting in Los Angeles on May 15 that will also have a virtual option.
- Victor Duron
Person
In that first meeting, we're really going to focus on what are our shared values that are going to guide our work and begin thinking about what is that aspirational vision for the future that our stakeholder committee and Members of the public who are available to participate want to set forth that we will anchor ourselves in as we develop this master plan.
- Victor Duron
Person
In that second meeting, we will focus a little bit more on the logistics of how we will conduct our business moving forward, but really get into the brainstorming of what will those top priorities look like and how will they inform working groups and subcommittees that will develop to carry out this work.
- Victor Duron
Person
And then in that third meeting, really focus on equity, a shared understanding of what are the equity issues at play, how are we looking at equity, and what does it look like to achieve success and achieve equity in the different parts of the Master Plan. We intend this process to run about a year. Our goal is to have a draft of the master plan that we can present by March of 2025.
- Victor Duron
Person
And of course, trying to maintain some flexibility in that, given that this will be driven and really centered around participation with the community. And we intend to share the full calendar of the rest of the meetings before that May 25 meeting so that everyone, members of the public, members of the committee, and other stakeholders are able to plan and be aware and participate to the extent that their availability permits in the meetings and in the process.
- Victor Duron
Person
The intent is that by the time we complete this process, we will have a master plan that not just has bold goals, but that's a roadmap for how we achieve them. What does it look like for us to know that we are actually on the right track? So it's aspirational, but concrete. We will have milestones and we will have a way to track whether we are making progress towards achieving that aspirational vision.
- Victor Duron
Person
And again, cannot emphasize enough that all of the priorities, all of the goals will really be driven by the voices of lived experience, which is the members of the stakeholder committee, and through our engagements, through a number of other venues that I'll be happy to describe. And also lifting up the voices at the advisement of the stakeholder committee that we need to make sure are represented at the table.
- Caroline Menjivar
Legislator
Sir, can you answer one of the last questions within three? Are we looking to create a cabinet working group, seeing as the services are offered by a variety of departments, like we did for the Master Plan on Aging?
- Victor Duron
Person
So at this time, a cabinet working group is not currently planned, but we're remaining open to a variety of options. And again, we really want to be cautious about not prematurely deciding which direction we will or we won't go in, because we really want this to be driven by the feedback that we'll be getting as we go through this process.
- Caroline Menjivar
Legislator
Would you feel comfortable in the stakeholders that have been announced, have expertise in other areas, not outside of DDS oversight?
- Victor Duron
Person
We selected the stakeholder committee members with the intention of getting diverse voices with a wide range of views and expertise, recognizing that even with a committee as robust as this one, it's 36 members, there will be more perspectives and more work that we will need to look into. And so in addition to the stakeholder Committee meetings, we will be using a variety of different strategies. We will be looking at public roundtables, we will be looking at focus groups.
- Victor Duron
Person
I want to thank the Members of the Legislature that have already reached out and said they would be interested in helping host some of the roundtables and where we may have gaps. We will be looking to our stakeholder committee and to the other engagement to figure out where are those gaps and where is the expertise that can help us fill it.
- Caroline Menjivar
Legislator
Can you clarify? You mentioned that you are looking to have bold goals, but with milestones and a way to track that. Were you speaking in relation to what is going to be inside the plan or to how we create the plan as a way to also track our goals while we are achieving the plan?
- Victor Duron
Person
Thank you for the question. That's a really good point of clarification. That's with respect to what we expect will be in the Master Plan. We want the Master Plan to not only set that aspirational vision for the future, but that also built into the Master Plan, what does success look like? What do those milestones, those goals that we will achieve, and how will we track that we are actually achieving them?
- Caroline Menjivar
Legislator
Are we going to replicate that as we implement this or creating this plan, or how are we going to be tracking that? We do hit that March, potentially March draft date.
- Victor Duron
Person
Well, again, we want to make sure that we have some level of nimbleness and flexibility. So some of it will be iterative as we get feedback and start identifying what are some of the areas that we're going to want to focus in on.
- Victor Duron
Person
But regardless of what ends up being built into the plan in terms of priorities and goals, one of the intentions from the outset will be to create opportunities to evaluate and reevaluate the plan after it is implemented so that we can see where we need to pivot, right?
- Victor Duron
Person
Recognizing that when we develop a multi-year plan, there may be changes in the economy and technology in kind of our landscape, and we want to make a plan that is both resilient and stands the test of time, but that is nimble enough to pivot as sort of realities in our society change.
- Caroline Menjivar
Legislator
Do we anticipate which programs this plan will impact, or are we looking to address every single service under that covers this population?
- Victor Duron
Person
So I think for me, that will really be a core part of the conversation with the stakeholders and with the public and with the focus groups. I have some thoughts, and I don't want to be presumptuous, and I want to approach this with humility, recognizing that while I might have some ideas about what will be the systems or areas or priorities that are absolutely top of mind, I really want those voices of lived experience to be the drivers behind that.
- Caroline Menjivar
Legislator
Does the Department anticipate any funding requests to ensure that this plan is implemented to support it?
- Nancy Bargmann
Person
Yeah. Thank you. Right now, the areas in which we're seeking, like I talked about, peer supports and looking at being able to have some of the consultants that's helping assist us, the Department had already started a strategic plan process, and so the funding that we have from other kind of major initiatives and looking at some of the work we're doing is currently funding these efforts, and we don't have any proposals for extending those requests.
- Caroline Menjivar
Legislator
A little devil's advocate here, Director, just because I've heard it from some advocates. Given the proposed delays in this section, how do we find this to be the appropriate time, if we found some funding for this, to not fund the things that are being proposed for delay in this Department?
- Nancy Bargmann
Person
So when aligning the strategic plan work, I was going to wanting to do strategic planning work because these are really important priorities to make sure that we have that roadmap to implement programs, especially those that are experiencing some of the delays. So this is the work that I really believe is extremely important to be able to do currently.
- Nancy Bargmann
Person
And so being able to marry that with a master plan is really where we identified the priorities so we could achieve some of the other things that are priorities. And I'm certainly happy to see if our colleagues at Finance have anything additional to say. But the priorities that we put forward is where we want to make sure that we're able to continue to focus on.
- Caroline Menjivar
Legislator
I guess continuing with my devil's advocate here, or pushing back a little bit, because I would then say the DDS rate reform was a huge priority of the Department, and I'm wondering how we then shift to this being the new priority of the Department.
- Nancy Bargmann
Person
Well, when we take a look at the amount of kind of funding that we have, because we're not looking at a large number of dollars for an administrative effort to be able to provide kind of this support for this effort when we take a look at the proposals for delay, and I think that that's certainly on the agenda for today as well. So I don't want to get too ahead of that.
- Nancy Bargmann
Person
But I think we need to make sure that we're identifying that what I'm talking about is some of the administrative efforts that we're trying to implement, and that's why.
- Caroline Menjivar
Legislator
Easily absorbable.
- Nancy Bargmann
Person
It's very easily absorbable. It's within our current authority. It's not new authority. And it's something that I had already identified as making sure that we're doing our work that we need to do and then now sharing that for more of a forward-thinking along with the work that we need to do today.
- Caroline Menjivar
Legislator
Thank you, colleagues. Any other questions? We're going to move on to our second panelist from Disability Voices United.
- Judy Mark
Person
And I apologize for having my back to you. I'll try to turn a little bit. My name is Judy Mark, and I am a parent of a 27-year-old, a son who's served by a Regional Center who's moving out on April 20 from our house. And so this is very important and a very exciting time for us. I'm also the President and co-founder of Disability Voices United. We're an organization directed exclusively by people with disabilities and their family members.
- Susan Talamantes Eggman
Person
Madam Chair, I just want to say to the panelists, you're up on the TV, too, so you're okay.
- Nancy Bargmann
Person
When you talk, you're on TV so I can see.
- Judy Mark
Person
Thank you.
- Judy Mark
Person
I feel so bad having my back to you Senator Eggman. Our organization is extremely supportive of the Master Plan for Developmental Services, with its priority of making the system equitable, accountable, and person-centered with quality outcomes. Our organization shares these goals for the system and hopes that this process will improve the services and ultimately the lives of people with intellectual and developmental disabilities. The Master Plan on Developmental Services is an exciting opportunity for us.
- Judy Mark
Person
It's so rare to get the chance to step back, think collectively about whether the system is working and how it can be improved. For far too long, our system has been focused on compliance rather than outcomes, on bureaucracy rather than freedom and inclusion. So in preparing my testimony today, I actually read through the Master Plan on Aging, which is a model for this effort as you know, and as Victor said, it contains five bold goals.
- Judy Mark
Person
And that inspired me to think about the hopes and dreams I have for my son and his future and the system that is supposed to support him for the rest of his life, and to think about those bold goals for our system. And so I was bold, and I came up with some of those goals in advance for today. So goal one that I think is a priority is to restore trust in the system.
- Judy Mark
Person
We will experience a system that is transparent and accountable, where we feel heard, comfortable, safe, and supported. Goal two is equity and access to services. We will receive services from culturally humble and responsive Regional Centers and service providers without institutional biases and complex processes, regardless of our race, ethnicity, language, or where we live. Goal three, equal opportunities for inclusion, good health, employment, and social lives.
- Judy Mark
Person
We will get the supports we need to have high expectations for our lives and our health, be active Members of our communities and workplaces, and have opportunities for meaningful relationships. Goal four is agency over our lives. We will be self-determined from the earliest age and receive support to make decisions about how and where we live and who works for us. Finally, goal five, a system that conforms to us.
- Judy Mark
Person
We will be supported by an authentic, person-centered system that respects us and our unique needs more than it respects compliance and standards. But these bold goals for the Developmental Services system cannot be achieved by tinkering around the edges. It requires a fundamental reexamination of the way the current system is structured. The Master Plan process must ask us to reimagine the lives of people with developmental disabilities and the system that supports us. But is this even possible?
- Judy Mark
Person
Many self-advocates and family members have been part of work groups and task forces for years and haven't seen meaningful improvements. I am already hearing from communities of color that they are expressing skepticism of the Master Plan. That shouldn't surprise us. Why would they trust a process being sponsored by the same system? But keeping with this bold theme, I am here to say that I am heading into this process with enthusiasm and optimism. I am very encouraged by what we are hearing so far.
- Judy Mark
Person
The leaders of the process are already reaching out to the community to build trust. They are offering to hold sessions in the community to meet us where we are, in the languages we speak, and to listen, even if we communicate without speaking. My enthusiasm is only tempered by the process being conducted in the middle of a budget crisis.
- Judy Mark
Person
We can't let our visions of the long-term future be constrained by the immediate issues, but we can learn from these times that our investments need to be focused on the services people need and the staff that directly support us, not in the bureaucracy that surrounds that.
- Judy Mark
Person
Ultimately, regardless of the economic climate, if the result of the Master Plan is that the Lanternman Act's Bill of Rights are fully realized, which many people don't know, but it states where persons with developmental disabilities have the same legal rights and responsibilities guaranteed all other individuals by the constitutions of the United States and California. Well, that would be pretty damn bold. So I look forward to working with everyone here and to get started with the Master Plan.
- Caroline Menjivar
Legislator
Thank you so much for that energy. I appreciate it. Moving on to our third panelist from Integrated Community Collaborative.
- Miguel Lugo
Person
Good afternoon, Madam Chair, as well as the Members of the Committee. My name is Miguel Lugo and I am a self-advocate and I am also manager for community programs for the Integrated Community Collaborative. I am encouraged by the potential of the Master Plan to reshape the developmental disability system, which currently fails too many individuals, especially people of color. However, I am deeply concerned about the lack of diversity within the Master Plan Committee.
- Miguel Lugo
Person
As a Latino self-advocate, I feel underrepresented as there is only one Latino member on the Committee. This is despite the fact that Latinos make up the largest group served by the Regional Centers at approximately 42%. While the leaders of the Master Plan process have pledged to engage deeply within the community, the composition of a committee matters. Currently, only 17% of the Committee members are Latinos, and many of them are professionals in the field rather than individuals directly impacted by disabilities. Representation is crucial.
- Miguel Lugo
Person
It is vital that the leaders of a master plan do not tokenize self-advocates on the Committee. Historically, individuals with disabilities have been marginalized or disregarded in such forums. You asked for my input on what the Master Plan should prioritize and what aspects of the system need fixing. While the list is extensive, I will highlight a few key points. Firstly, the Master Plan must prioritize rebuilding trust in Regional Centers and the system as a whole.
- Miguel Lugo
Person
Many of us have faced rejection or exclusion for years, making it difficult to enact meaningful change without addressing these trust issues. Secondly, there is a critical need for improved communication and information sharing with individuals and families. Too often, families are unaware of available services, leaving individuals without necessary support. Thirdly, the Master Plan should address the pervasive focus on deficits within the system. Individuals should not feel compelled to vilify themselves to access services as I have often done myself. This perpetuates stigma surrounding disabilities.
- Miguel Lugo
Person
Furthermore, cultural humility must be integrated into a system. Unlike cultural competency, which generalizes experiences based on race or ethnicity, cultural humility acknowledges that individuals are experts on their own lives. Additionally, while person-centered has become a buzzword, its implementation remains lacking. True person-centeredness means offering a range of services and providers and respecting individuals' choices, including participation in programs like the Self-Determination Program. Lastly, envisioning an ideal system, particularly for people of color, entailed universal access to the Self-Determination Program.
- Miguel Lugo
Person
This model empowers individuals to lead self-directed lives free from the constraints of institutional control. In conclusion, the Master Plan presents an opportunity for transformative change, but it must prioritize diversity, trust building, effective communication, cultural humility, and genuine person-centeredness to truly serve all individuals with disabilities. Thank you for your attention and the opportunity to share my reality.
- Caroline Menjivar
Legislator
Thank you, Mr. Lugo. I appreciate that. Quickly, Victor, maybe I'm just assuming. I was looking at the list of the stakeholders. I guess I don't want to assume based on the last name. Do we have a demographic breakdown?
- Nancy Bargmann
Person
There we go. Nancy Bargeman. So we do have a demographic breakdown. Happy to provide that to you. And also representation from self advocates. So I will acknowledge that while attempting to make sure that we are representing the diversity of the entire kind of population, it was a bit of a challenge of making sure the representation also included some populations that are very small in the percentage of representation. And that's why it's so critical, the focus groups and the roundtables and going to the communities.
- Nancy Bargmann
Person
But I think that the voice you shared is incredibly important, and we need to make sure that we continue to evaluate to make sure those voices are lifted.
- Caroline Menjivar
Legislator
Director, is it correct that there is only one Latino individual?
- Nancy Bargmann
Person
I believe that's referring to a self advocate, and so of the self advocates? I believe that that is correct.
- Caroline Menjivar
Legislator
Okay. Is this set in stone? I know we announced it already. It's already a big group. Is this the group that will be moving forward officially?
- Nancy Bargmann
Person
So it is the group that's moving forward. But I think it's important for us to listen to, because I've heard from other communities that feel that it's not been represented based on geographics, based on other areas. And I think it's really important for us to make sure that we're looking at, if it's not within the Committee itself, how do we make sure that nobody's being left behind?
- Caroline Menjivar
Legislator
Right.
- Nancy Bargmann
Person
We have to make sure that all those voices are heard, and it has to be done in a very meaningful and purposeful way.
- Caroline Menjivar
Legislator
Helpful.
- Caroline Menjivar
Legislator
Okay.
- Caroline Menjivar
Legislator
Thank you so much. We're going to move on to our next panelist from San Diego Regional Center.
- Mark Klaus
Person
There we go. Now it's on. Good afternoon, Chair Menjivar, Committee Members and staff. My name is Mark Klaus. I'm the Executive Director of the San Diego Regional Center. San Diego Regional Center serves two counties. We serve San Diego and imperial counties in support just shy of 42,000 individuals with intellectual and developmental disabilities in our catchment area. I'm honored and looking forward to participating as a Member of the Stakeholder Committee.
- Mark Klaus
Person
I see this as an exciting opportunity to be forward thinking and address the systems and supports that is changing in our system and changing in California on a daily basis, some say by the minute, not just the day, but to develop a system that is person centered, equity focused, data driven, and that has the opportunity to improve outcomes for individuals and families receiving services.
- Mark Klaus
Person
The master plan, in my opinion, should seek to answer the question or the questions to what our collective vision for the future of California DDS, IDD system in California looks like and working together as Judy mentioned this is working with our very diverse community, self advocates, families, community, and all of our stakeholders. I have the opportunity to hear from families, individuals every day about the great things that are happening, and there are great things happening in the Regional Center system throughout California every day.
- Mark Klaus
Person
But we can do better, and we need to do better and better is community inclusion. Supporting inclusion and active participation is something that the Committee really needs to look at. Equity, ensuring equitable access to everybody. When I look at the demographics for San Diego Regional Center, we have 73% of the individuals that we support are non white, non English speaking, and or have a hearing loss, 73% of the roughly 42,000 individuals. So what does that equity look like?
- Mark Klaus
Person
And there's access, choice of providers, choice of quality services are needed. It's easier to find options if you're in the greater San Diego community. But if you're in Winterhaven, which borders the Arizona border, how do we ensure that services are offered to the tribal communities out there and residents of that community? Consistency. There has to be greater consistency amongst Regional Centers. How we provide services, how we access services, how we're open to our families and our communities.
- Mark Klaus
Person
I've had the honor of being the Executive Director for about two and a half years, and what I heard from many family Members, and I still hear from many family Members, is, you're the best kept secret in town. We shouldn't be the best kept secret in town. We should be continuing our outreach efforts to all of our communities.
- Mark Klaus
Person
I also would see the better in terms of the master plan as being actionable, a living document that is not just developed and put on a shelf, but something that is reviewed on a regular and ongoing basis to adapt to the changes that are happening. 2024, we're sitting here in March of 2024 looks a little bit different than March of 2020. I don't know what 2026 is going to look like, but we have to be forward thinking, look at those actionable items.
- Mark Klaus
Person
And then finally, Senator Menjivar, you mentioned a cabinet working group. I really think it's important that we pull all agencies and systems that serve individuals and their families together to improve those services and to improve those communications. The system in which we operate, the systems that families try to navigate, can be. Well, actually, it is difficult and confusing. I think we have so many players, including Regional Centers. We have schools, we have IHSS, we have housing, we have employment.
- Mark Klaus
Person
And what we hear from many of our community partners is, "oh, they're a Regional Center client, they're yours". And that's not the best coordination of services, and that coordination of many times, most of the times, falls as a burden to families. So really getting everybody at the table to really understand how that works is something that I think is critical. As I said, we hear they're yours. No, they're ours. We're all in this together and how we can work better together.
- Mark Klaus
Person
I think there's a lot of great examples that we've been successful in San Diego in different work groups and reaching out to our county partners. But it starts at the top. It starts at the state level in terms of different departments. How do we become more effective? How do we become more efficient? How do we become more user friendly? We'll have better outcomes for families and individuals.
- Mark Klaus
Person
So I want to thank you for the time today, and I'm looking forward to working with Victor, our first meeting on April 10. So thank you.
- Caroline Menjivar
Legislator
Thank you so much, directors. I want to double down on that, actually, because I think some of the feedback that we hear back is that these areas work in silos, and I think you hit it right on the nail that, "oh, well, they're in the school age now, so schools are responsible for that". So if we could continue looking at how we replicate what we did for the Master Plan on Aging, because that worked. It's a beautiful plan. Right.
- Caroline Menjivar
Legislator
I think it'd be important that we include all the departments to make sure every service that this individual touches or department is working smoothly together. Senator Eggman,
- Susan Talamantes Eggman
Person
Director Bargmann. So, I mean, just so far from what we've heard, right. Is there's a history, right, of people not feeling heard of not feeling served, if you will. And so we've already begun to hear that in the issue of silos.
- Susan Talamantes Eggman
Person
And then going back to the last topic we covered, when folks aren't getting in line, then we start with a series of reprimands or consequences. How do you do those things together? Right. I mean, you are dependent upon multiple services that are out there that you don't have direct control over with a population that has often been overlooked. And unless they have parents and real advocates, oftentimes get left behind. Everyone can speak for themselves as well as our panelists today.
- Caroline Menjivar
Legislator
So how do you do those two things at the same time? Right. Try to bring everybody on, but try to make everybody feel heard at the same time. It seems incredibly complex. And what are your strategies for making sure you're going to be able to be successful with this?
- Nancy Bargmann
Person
Victor. No, it's not that simple. But I'd like to also have Victor have a moment to say, I think that's an incredibly important question. I have heard from our community way too many times about how hard it is to navigate multiple systems. I've said when I'm working with families and listening to families, and we're looking at how families are the ones who are having to navigate kind of these complex systems, it's difficult.
- Nancy Bargmann
Person
So how do we then bring through this master plan work of the silos and connecting those dots? That's the beauty of it being housed at California Health Human Services. And we have a secretary that has just really doubled down on breaking down silos. And that's the work we do with our sister departments.
- Nancy Bargmann
Person
We already have a number of initiatives that are, I think, really incredible examples looking at the 2083 work, System of Care work, for children in foster care, looking at other ways that we're already doing connections and services in the work. We work incredibly close with Department of Rehab on making sure we're looking at advancing employment. So we know that there's still work to be done.
- Nancy Bargmann
Person
And that's the beauty of having this master plan and being able to look at how do we collaborate and not have individuals with IDD be left behind. So how do we build on those incredible efforts from other systems and kind of bring those two things together? That's the work that the master plan has an opportunity to do and see if Victor has anything more that he can add to that.
- Victor Duron
Person
Thank you.
- Victor Duron
Person
Thank you.
- Victor Duron
Person
So I think to answer your question, first and foremost, it starts with beginning from a place of humility, right? So how do we make sure that we have everyone at the table to figure out the answers? Well, begins by recognizing that not only do we not have all the answers, we don't even know all the questions yet. Right.
- Victor Duron
Person
And so making sure that we have a robust process that not only includes the stakeholder Committee, but as I shared, we will be looking at a wide variety of roundtables to engage different communities, Members of the public, a range of focus groups.
- Victor Duron
Person
I have a running list of different communities that we want to invite to different focus groups and making sure that those spaces are held and facilitated in a way that is culturally responsive, linguistically accessible, and through there, lifting up those voices, those issues that may not even be on our radar. I've worked in a number of different systems and both in an administrative role and having begun my career as a frontline service delivery staff.
- Victor Duron
Person
And what I often find is that regardless of which system you're talking about, whether it's Developmental Services, Employment Services, Housing, Nutrition, when you are somebody who does direct services, and an individual comes to you, you want to solve the whole constellation of issues that that person has, because they come with their whole selves. They don't leave the parts of their identity that aren't relevant to your program at the door.
- Victor Duron
Person
And oftentimes that's where that feeling of strain, gosh, this system just doesn't have the resources to solve everything. And so the beauty of a master plan is that it helps bridge those different systems and help people say, it's not about we're going to burden other systems, it's we're actually going to lift the burden by saying, no one system has to solve it alone. Right. How do we identify those best kept secrets and make sure that they're not best kept secrets?
- Victor Duron
Person
So that frontline service delivery staff is working across systems and recognizing that when somebody comes to them and they're well positioned to address their employment needs, but they see that this person has housing needs, health needs, recreation needs. There is that alignment across systems that supports that seamless whole person approach.
- Susan Talamantes Eggman
Person
Ms. Mark, if I can ask you, when you refer to the system, I've heard a lot of people talk about the system. What system? Are you talking about the whole. Everybody you interact with. Are you talking about the Department? Are you talking about what system? Tell me the system.
- Judy Mark
Person
In this context, I'm talking about the Developmental Services System, which starts with DDS moves to the 21 Regional Centers. And then the service providers, they are.
- Judy Mark
Person
The system to us.
- Judy Mark
Person
We are the disability community, and the system is what is supposed to be supporting us.
- Susan Talamantes Eggman
Person
And when you went through your list of, If you had a magic wand, right, how you would do that? So I want to ask you, if you did have that magic wand, you woke up tomorrow and that was realized. How would you know?
- Susan Talamantes Eggman
Person
Okay.
- Judy Mark
Person
That's a really great question. First of all, we parents would wake up a lot less stressed out. Our lives would be joyous, and our lives would be so happy for our children and what they are able to achieve in their lives. Happiness is completely underrated in this world. We've got to be happy. And our kids, my happiness is based on whether my kids are happy. And so that would be how I'd wake up in the morning, for sure.
- Susan Talamantes Eggman
Person
Thank you.
- Caroline Menjivar
Legislator
Victor, I think we do have a lot of the questions. I think we've heard a lot of the questions in the past couple of years. I think that's why we're doing this plan, right? Because we have a lot of the questions. Actually, I'm not a fan of any more study on anything. We have all the information we need. Now it's time for the action part. I want to make sure that what we're doing here is investing, not in coming up with more questions.
- Caroline Menjivar
Legislator
It's like to invest on the answers of the hundreds and thousands of questions we have in this space and every other space. I would just say that. And then Director, I know we work great with our sister departments within IHSS, including IHSS. But I think the education part is the big part. I mean, I think that's just one of the biggest thorn for IDD family Members or self individuals as well.
- Caroline Menjivar
Legislator
So I think that's the part that we want to make sure that also gets included in this as well. Do you have anything to add to that?
- Nancy Bargmann
Person
We agree, and I just will flag that we've been working fairly closely, especially with early childhood efforts, with our partners in special ed at CDE. And these are really good examples and connections that have already started. Because if you recall, some of the investments recently is IDEA specialist at DDS and then investments at each of the Regional Centers and then working with CDE on kind of those transitions and that collaborative. So also CDE is part of the 2083 work.
- Nancy Bargmann
Person
But I think it's a really important area to lift up because it's talking about what are those other systems where individuals are touching. And certainly for a very large portion of their life, you know, education is really critical. But we want to make sure that we're keeping that door open for all those discussions within the master plan.
- Caroline Menjivar
Legislator
I don't know if this is a question either you Mark or Director can answer, but why only 21 Regional Centers? 42,000 people is a lot of people. I mean, who's responsible in that lucky number?
- Nancy Bargmann
Person
The lucky number?
- Caroline Menjivar
Legislator
Like why 21?
- Nancy Bargmann
Person
Well, another historian is probably going to correct me, so don't write this down, but the legend would have it, is that the 21 Regional Center. So going back to 1969 and when updated the Lanternman Act and looking at because it started with a pilot of a couple Regional Centers and then there was a look of how do we have with a concept of community kind of community, local based nonprofit organizations. And it was really established in a population, community population of a million.
- Nancy Bargmann
Person
And so you have 21 Regional Centers. Our community populations have evolved and changed.
- Caroline Menjivar
Legislator
Right.
- Nancy Bargmann
Person
So you could see where Inland Regional Center, North LA Regional Center, other Regional Centers have grown.
- Caroline Menjivar
Legislator
The fire Department, they do these studies and they look at their fire stations and they say, 'hey, that fire station is doing a lot of calls. We're going to ask for another fire station in that same area'. Why don't we approach that the same way for Regional Centers?
- Nancy Bargmann
Person
Well, and I think through the years, the Lanterman Act has been kind of a pillar to how do we deliver services? And one of the areas was establishing the 21 Regional Centers for decades, I would say, and this is what that door is, open conversations that are going to be brought up from the Committee to what makes sense of delivery of services.
- Nancy Bargmann
Person
I'm not suggesting, I'm not taking a position whether it's right or wrong, but I think this gives that space for that conversation to happen, of how are we delivering it? Committee Members may ask the question like you just asked. Well, why? Sometimes it doesn't hurt to ask the question, why is X?
- Caroline Menjivar
Legislator
Yeah. Okay, thank you. Moving on to our next panelist from the California Community Living Network.
- Mark Melanson
Person
Good afternoon, Committee Chair Members. My name is Mark Melanson. I'm Chief Executive Officer of the California Community Living Network, CCLN, a statewide membership Association, agencies large and small service providers across the State of California. I'm also honored to be appointed to the master plan stakeholder group and looking forward to those meetings happening and excited that the first roundtable that they'll be conducting as part of their community outreach is going to be at our CCLN annual conference in April.
- Caroline Menjivar
Legislator
I would consider this the first roundtable.
- Mark Melanson
Person
Second, in San Diego. This type of long term, systemic development of quality community living services planning has been missing from the intellectual and developmental disability community in California. When the Master Plan for Developmental Services was first announced, our attention was immediately drawn to the Master Plan for Aging, much like Judy. And what we saw was hope and opportunity. Hope that a plan for our future system can be comprehensive and can be all inclusive.
- Mark Melanson
Person
A plan that touches on all aspects in a full life of a person with an intellectual and developmental disability opportunity to have one plan, one plan that could include the critical issues of today and tomorrow that our community faces, housing and homelessness needs, benefits, income and poverty, health care disparities and discrimination in health and accessing care, workforce issues, transportation, inclusion and equity, community access and integration, emergency preparedness, employment and volunteerism, protection from abuse, neglect and exploitation, enabling and assisting technologies, and possibly more. Wow.
- Mark Melanson
Person
Sign us up. This master plan must include interagency representatives, commitment and support for this effort to be successful and result in a system that meets the whole person needs of Californians with IDD. In preparing for today, I learned that there are 233 state agencies in California. So not all of them, but the ones that intimately interact and potentially touch the lives of all the people within this community should be invited to be at that table. An all in approach.
- Mark Melanson
Person
Most importantly, individuals and family advocates from the IDD community must have the loudest voice at the table in the development of the master plan. While progress is being made, there's much more work to be done. This planning must address the challenges faced by people in breaking down the silos and the disparities in service equity and access that currently exist. And our system, like others, struggle with. The challenges faced by people when accessing generic resources and other services.
- Mark Melanson
Person
Service provider rates and provider capacity the rapidly growing and potentially catastrophic direct support professional workforce shortage. Measuring the meaningful outcomes that matter most to people receiving services ensuring compliance with home and community based services settings, rules and requirements. Ensuring services are true to the Center for Medicaid CMS waiver federally approved guidelines all topics that the Master Plan must confront, head on. To discuss the work through to identify to discuss and work through and identify strategies for implementing solutions and the Master Plan Stakeholder Group has to be a safe place for these open and honest discussions.
- Mark Melanson
Person
The work that CCLN is leading in partnership with the Department of Developmental Services on the Service Quality Outcomes Project PAVE, person centered advocacy, vision and education and the direct support professional University DSPU training is the invaluable work happening right now that can help inform the work ahead in the Master Plan. The department's current work and the initiatives already underway are the foundation to build upon in the Master Plan, ensuring that person centered and whole person approaches are there.
- Mark Melanson
Person
While this plan is needed immediately, its construction should not be rushed and the overall fiscal needs of the system's sustainability must be acknowledged. CCLN looks forward to the continued partnership with the Administration, the Legislature, and our entire community on this critical initiative and to create a California Master Plan for Developmental Services. Thank you, Committee, and for the opportunity to speak today, and happy to answer any questions.
- Caroline Menjivar
Legislator
Thank you so much. I say all the panelists have stayed within their time frames. Really good. It's like the first time ever will. So no pressure to close us off. Here.
- Caroline Menjivar
Legislator
Before we turn over to LAO, our final panelist from Disability Rights California.
- William Leiner
Person
Thank you and good afternoon, chair and Members. I'm an attorney with Disability Rights California. My name is William Leiner, and I'm also a sibling. I have a brother who served by our system. These are the professional and personal lenses that shape how I approach this work. I'm honored to talk about our vision for the Master Plan. And I know there's skepticism out there. I know there is.
- William Leiner
Person
But I would not have agreed to be part of this process, if I, like others around this table, didn't have hope, didn't have hope that this process has the potential to better the lives of people served by our system. And I have four points to make that I hope will do just that.
- William Leiner
Person
First, we share California Health and Human Services vision for a DD system that does not operate in silos and for a master plan that builds bridges from the DD system to those systems around it. It's a really good vision, but it can't be realized today while our current structures are still premised on this belief on this island's mentality that siloing is somehow necessary to comply with what we see as payer of last resort rules.
- William Leiner
Person
The rules we've talked about, where in practice people are told that they need to chase down services from other agencies before a Regional Center will step in and help. It's like instead of building bridges, we're pointing people to a distant shore and telling them to swim. No wonder why people say they're drowning. And maybe an lucky few, they get a kayak or they get a guide to help them navigate these choppy waters.
- William Leiner
Person
And a common thread that we've seen across new initiatives in the DD space has been a focus on systems navigation navigators. Funded by disparity grants. Navigation is a component of coordinated family supports. There's a new employment navigator pilot that's new to DDS. And at one point we need to ask, I hope, through the Master Plan process, why is all this navigation necessary? Why do our systems need to be this complex? It shouldn't be this way. So what does it mean for the master plan?
- William Leiner
Person
Well, it means that we need to place the burden not on individual navigators, not on individual people, but on systems, on systems to solve systems problems like payer of last resort rules. So in other words, we need more bridges and fewer kayaks. So more bridges means better cross system coordination so our agencies can figure out what's a generic resource anyway. When do payer of last resort rules even apply? Let's figure out when they do, but more importantly, when they don't.
- William Leiner
Person
It means closing the loop when referrals are made across systems so people know the outcome. Right now, we have no way to track the outcome when referrals are made, and it means exploring and looking at no wrongdoor funding models that support and reflect the values of whole person care. And I know we've talked about this, but I want to underscore this point. We need other state departments at the table as part of this process. We need education, social services, healthcare services, aging, Department of Rehabilitation.
- William Leiner
Person
Our system can't do this alone. My second point, in addition to looking across systems, we have to look within. We need to look at our governance structures, the structures that give rise to, what we see as sweeping discretion from Regional Centers, to set their own policies about what services they're going to fund and for whom. And we've seen these policies limit the ability of people to get services in deeply problematic ways, including in ways that impact race and geography.
- William Leiner
Person
Senator Roth, it's the command and control problem that you talked about earlier. Who's in charge? Who's keeping people accountable? And people still say, they still say, with a shrug of resignation, 21 different Regional Centers, 21 different ways of doing things. But I think we can do better than that. I think people deserve standards that are clear, that are transparent, that are equitable, and shouldn't matter whether someone lives in the Redwood coast or the San Fernando Valley or anywhere in between.
- William Leiner
Person
And while we're at it, maybe it should be 33 Regional Centers that are all doing similar things to support people to live their chosen way of lives. Why can't we have that level of consistency? My third point, we appreciate all of the recent investments aimed at paying for quality. Right? For too long, our system has been driven by metrics that seem to care more about the volume of services provided rather than the outcomes that matter to people.
- William Leiner
Person
But with these investments have come a lot of initiatives, and they're starting to feel kind of fragmented. We have the provider Quality Incentive Program that was part of rate reform. We have the Regional Center Performance Measures program. We have other types of incentive programs about paid internships, employment, coordinated family supports. So let's talk about all these things during the master plan, and we should build on and align all of those funding models from top to bottom, from state to regional, center to provider.
- Caroline Menjivar
Legislator
You're going to have to wrap up, will.
- William Leiner
Person
Okay, I did not stick with the five minutes, but I'll start wrapping up. I broke the streak. I'll make my final point quickly. It's about trust, right, for people. If we're going to trust the outcomes that arise from the Master Plan process, people need to trust that process that led to those outcomes. We need a good facilitator. We need a transparent decision making structure.
- William Leiner
Person
We need to be able to rely on experts from within and outside the Department that can inform the work group members about data, gaps in data, about best practices. But this is the most important point. We talk about involving people with IDD. Yes, but it's got to be more than consultants. It's got to be more than focus groups. They need to be partners in decision making in this process. True partners, real partners. And thank you. I apologize for going over my time.
- William Leiner
Person
I appreciate the opportunity to testify.
- Caroline Menjivar
Legislator
It's Okay. You're just passionate. It's definitely okay. I just want some clarification. You meant you spoke about outcomes when referrals are made. What kind of referrals are you talking about?
- William Leiner
Person
So we're talking about when I was talking about payer of last resort. So a Regional Center says, someone says, we need help. We need help in the family home. Regional Center says, have you explored IHSS first? Have you gone to the county? Have you got in your hours? And they send the family off to figure out how to do that. Now, there's no data. There's no data shared across systems. There's no easy way for a Regional Center to say, 'oh, that worked. We closed that loop.
- William Leiner
Person
We closed that loop for the referral so we know your needs are being met'. That data is not tracked across systems. And that's one example on the IHSS side. But there are many more as well, like around closing the loop.
- Caroline Menjivar
Legislator
Thank you so much.
- William Leiner
Person
Thank you for the question.
- Caroline Menjivar
Legislator
Moving on to Lao.
- Karina Hendren
Person
Good afternoon, Madam Chair and Senators. Karina Hendren with the Legislative Analyst Office. The first point that we want to stress is the importance of legislative involvement in the Master Plan. We recommend that the Legislature consider introducing legislation to ensure that the vision for the Master Plan, as well as its ongoing implementation, reflects legislative priorities and that there is a role for legislative oversight. The second point relates to funding.
- Karina Hendren
Person
While DDS, they've not requested any funding in 24-25 to develop the Master Plan, and the Department earlier spoke about their administrative efforts ongoing with their strategic plan. We want to stress that the Legislature could consider potential cost pressures of the plan's ongoing implementation in future years, and given likely budget deficits through 2027-28 understanding the potential future fiscal impacts of the master plan's implementation will be critical.
- Caroline Menjivar
Legislator
Thank you so much. Actually, one of my next questions, Director, was regarding how much are we going to match the process in which we did Master Plan on Aging to this in regards specifically to the reports that came to us on the implementation side of it.
- Nancy Bargmann
Person
Certainly open to that discussion. So asking how are we going to be reporting back to the Legislature? One of the greatest ways that we've been able to keep the Legislature informed on many of the different priorities and initiatives have been our quarterly briefings with the broad representation of legislative staff. But there's also what the Master Plan on aging did. And so we'd certainly be open to discussions on what would be informative to the Legislature, to this Committee.
- Nancy Bargmann
Person
Happy to engage in that conversation with you.
- Caroline Menjivar
Legislator
Thank you so much. And I know I asked this question earlier, and you did mention this is something that's going to be absorbable this year. What about for what LAO just mentioned, the next upcoming years, seeing that we are anticipating deficits for the next couple of years.
- Nancy Bargmann
Person
Without knowing the work that the Master Plan has done yet, the intent is not to kind of build pressure, cost. Looking at the number of investments that we've already had over the last many years, we can certainly identify incredible investments. It's working within those investments is the intent of being able to make sure that those investments are doing what they're intended to do or taking a look at how we can maximize those investments to the benefit of individuals.
- Caroline Menjivar
Legislator
And then one of my final thoughts on this is this is neither. I think it's good. It holds us accountable, right.
- Caroline Menjivar
Legislator
But when I look at the Master Plan on Aging, I don't know if the correct word is weaponized, because it should be. I feel like it should be, really holds us accountable. But it also shows our failures because it's written in that document. And I know the budget is out of our control. Right. But at times during these situations, conversations I've had is we have this master plan on aging, but our budget doesn't reflect what we put in that plan.
- Caroline Menjivar
Legislator
It's not prioritizing our investments as we said we were going to do in the plan. I don't want to have that kind of sentiment for this Master Plan. Right. For us to be mindful that if we're going to put this on paper, that means that, yes, I, because this will be done during my time, don't have advocates coming to me say, you put this on paper, but it's not being shown in our budget investments.
- Caroline Menjivar
Legislator
I want to make sure if this is print, we're really going to commit to this for the next years and really achieve our goals. That would be my final thoughts on this.
- Nancy Bargmann
Person
Thank you.
- Caroline Menjivar
Legislator
Senator Roth.
- Richard Roth
Person
Well, thank you Madam Chair. You know, I've been listening to the conversation and the conversation about budgetary constraints. I think there's a difference between funding benefits and funding, what I've described and I think is true as a core government function, so that it's coordinated at whatever benefit level we're able to fund as a result of the budget. Difference between that and funding it to ensure through coordination that our clients aren't sent, your clients aren't sent bouncing around the system like a billiard ball.
- Richard Roth
Person
And I think that's pretty important to do. I mean, we're always going to have budgetary constraints in the state and that's going to cause what we're able to fund in the way of benefits to go up and down, unfortunately. Hopefully we prioritize those that are most important as these. But one thing we need to make sure we fund is that we fund a coordinated process.
- Richard Roth
Person
And I appreciate the comments and I know my chair, I know my chair agrees with me and my colleague, both practitioners in this area. And I look forward to seeing what your Master Plan comes up with and that we get it implemented as quickly as possible. In the military, we do planning, but we don't take a long time to do it. And we're more action than plan. And that's not necessarily the State of California, but we're getting there. Thank you for what you do.
- Richard Roth
Person
Thank you, Madam Chair.
- Caroline Menjivar
Legislator
I think thats the frustrating part, know you have these three veterans here and it's with Senator Grover's four. Yeah, everyone, it's just the headlines. That's not what we're here for. The implementation part is key, because California is going to get all this credit. Like, look, we did this first ever Master Plan, aging on Developmental Services, but then there's no meat to it at least. I'm so tired of the headlines, so tired of them. So I'd rather have no press or anything on this.
- Caroline Menjivar
Legislator
And then in two years we're like, look how much we've advanced, right? It's the meat part that's given that brings the attention of the media and so forth. That's what I'm really interested in. Those weren't my final thoughts. I have a little more final thoughts.
- Caroline Menjivar
Legislator
I have one more question, Director, just one, because you're not going to be on the next panel, because the next panel is regarding our oversight, what we include in our Trailer Bill Language and so forth, is this Master Plan, its intention to absorb those efforts. Are they going to be working side by side or how do you see our oversight with our equity and diversity and standardization? We did, or with our TBL on Regional Centers coincide with the work on the master plan.
- Nancy Bargmann
Person
So I think more conversations can be had around that. So the equity side, because the Master Plan is really forward thinking. The work that we're doing on the equity and the oversight that was introduced last year, that's a here and now. Those are the things that we're actively working on implementing in the agenda correctly kind of outlines what those deliverables are and kind of where we are on those. You're going to get some updates from my DDS colleagues on it.
- Nancy Bargmann
Person
So we can't interrupt our current work while we're working on the Master Plan, but I think our current work can inform the master plan. So we just have to keep talking about it. I love that you said this is kind of one of the first roundtables, and we're going to have to have more of those because there are so many initiatives right now that are incredible. And the work of the Master Plan is going to have to be listening.
- Nancy Bargmann
Person
It's going to be authentic and seeing what the vision is, and we're going to have to marry those two, and that's just going to take a little bit of time.
- Caroline Menjivar
Legislator
Thank you so much, Senator Eggman.
- Susan Talamantes Eggman
Person
I just want to ask, Deputy Director, is this your only job now, Victor? Another duties as assigned.
- Victor Duron
Person
This is my top priority.
- Susan Talamantes Eggman
Person
Crafty way of answering that. Got it. Okay. Make it a priority.
- Caroline Menjivar
Legislator
Department of Finance, anything you'd like to add?
- Unidentified Speaker
Person
Thank you, Madam Chair. I think everything that's going to be said was said on this panel.
- Caroline Menjivar
Legislator
Okay. Thank you. We're going to move on to panelists. Thank you so much for coming out. I appreciate it. Thank you. Issue number three. This next conversation is going to be regarding the implementation of our legislative equity and oversight measures as it relates to what we included in the 2023 Budget act.
- Unidentified Speaker
Person
We're not even before yet.
- Unidentified Speaker
Person
Can. It's.
- Caroline Menjivar
Legislator
Are we all here? Believe we're all here. Okay, we're going to get kicked off by LAO.
- Karina Hendren
Person
Thanks, Madam Chair. We had prepared a summary just of the provisions in SB 138, but just wanted to do a quick time check. Did you want us to read the summary or just dive right into the other panelists? Read it?
- Caroline Menjivar
Legislator
Yes, please.
- Karina Hendren
Person
Okay, just checking. So we don't have any comments on this agenda item, but as I noted, we're going to provide a summary just so everyone's on the same page. So SB 138 is trailer legislation from last year's budget that, along with other statutory changes in Human Services, sets requirements for Developmental Services equity and oversight. The legislation was prompted by data showing disparities in the amount spent per person on services when disaggregated by race and ethnicity.
- Karina Hendren
Person
And although the state has provided funding for equity grants since 2016 to address this gap, the racial and ethnic spending disparities still persist. So SB 138 establishes legislative intent that Regional Center service provision should be more uniform and equitable. The Budget Act of 2023 allocated about 8 million in General Fund for these purposes. To help achieve uniform and equitable service provisions statewide, the legislation defined several requirements that DDS and Regional Centers must satisfy between June 2024 and January 2026.
- Karina Hendren
Person
The Department must solicit input from stakeholders as part of these efforts. First, the legislation includes provisions on data collection. DDS must establish common data definitions for Regional Center services and programs to promote service access and equity. Regional Centers must begin recording the race, ethnicity, and preferred language of each individual served, and Regional Centers must also begin submitting quarterly reports to the Department on the number of assessments completed and the amount of time spent determining eligibility.
- Karina Hendren
Person
Second, the legislation aims to standardize processes that determine access to services. The Department must develop a standardized approach to individual program plan or IPP templates, intake processes, respite assessments, and vendorization procedures, and Regional Centers must then implement these standardized procedures. Third, the legislation directs the Department to identify and mitigate potential barriers to accessing services. The Department must organize an effort to identify barriers to accessing services provided by other entities and recommend options to improve coordination of these services.
- Karina Hendren
Person
The Department must also assess whether common services and supports are consistently available throughout the DD system by geography and language, and, if they're not, recommend ways to address any inconsistencies. And finally, the legislation also aims to improve communication with individuals and families served. To this end, Regional Centers must inform individuals on the outcome of an eligibility determination within 15 days of an initial intake and in a consumer's preferred language.
- Karina Hendren
Person
Additionally, Regional Centers must create and distribute standardized information packets that are accessible in multiple languages and formats. And just wanted to note that pages 24 to 25 of the agenda include a table with more details on the requirements and deadlines and implementation updates.
- Caroline Menjivar
Legislator
Thank you so much. Moving on to our Department representative.
- Pete Cervinka
Person
Good morning, Madam Chair and Members. Sorry, it's red. Yeah, there we go. Thank you. Madam Chair and Members, Pete Cervinka, I'm the Chief for Data Analytics and Strategy at the Department. Appreciate the opportunity to be here today. My colleague to my right just stole a number of the descriptive comments that I was planning to make. So I appreciate that. I think we've had already this morning and a number of other panels a robust conversation about standardization in the system.
- Pete Cervinka
Person
This is important, obviously, not just for equity, but also experience that families have as they navigate the system. And so what you heard summarized here, and it's in your agenda on page 22, the front door. What does intake look like? What does the assessment for critical services that many people get look like? What is the vendor experience as they apply to provide services in our system? These are the places where we have decided to start.
- Pete Cervinka
Person
I've said part of my title includes data analytics, so of course, data is important. And one of the other things that enable everything else to happen in the system, measuring how are we doing is good data. And this is the reason that the Administration and the Legislature last year in SB 138, prioritized definitions that should be standardized for race ethnicity, and preferred language that people use.
- Pete Cervinka
Person
I'm going to forecast for you that next week we'll be opening a public comment opportunity on those three topics, as well as the residence codes that people use, as well as sexual orientation and gender identity, and also on what we call status codes in our system, which identify which programs people are participating in. So, really excited for that.
- Caroline Menjivar
Legislator
Sorry. You're going to be collecting data on SOGI data?
- Pete Cervinka
Person
Currently, in our system, we only ask, do you consider yourself to be male or female?
- Caroline Menjivar
Legislator
Oh, okay.
- Pete Cervinka
Person
And so we plan to augment that significantly, and we are seeking public input on what we should be asking. We hope to announce that next week. What I've just described for you is box one on page 24, which talks about the status of our implementation of these initiatives. That's the very first one out the gate. The second one, which we've been working on. This is box two on page 24 about the IPP process, the individual program plan. There's been an ongoing series of meetings.
- Pete Cervinka
Person
There were eight meetings held to begin the development of what a standardized IPP template would look like. Those meetings happened in May, June, and July of 2023. There's been a lot of ongoing work inside the Department on that, and we plan to take a draft back out for public comment. And so those two items that I've described, both need to be completed by June 30 this year pursuant to Senate Bill 138 as it was enacted, and both need to begin to be used by Regional Centers July, January 1.
- Pete Cervinka
Person
Want to use my dates correctly. Sorry. Both need to begin to be used January 1 of 25. 6 months later. So excited to announce progress on those. The other things that have been mentioned are obviously been given thought. They're about six months behind the others in terms of statutory deadlines, and happy to answer any questions. Thanks.
- Caroline Menjivar
Legislator
Could you actually answer the questions in the agenda?
- Pete Cervinka
Person
Yeah, absolutely.
- Caroline Menjivar
Legislator
The first one is, how are you collaborating with stakeholders, including individuals and families served?
- Pete Cervinka
Person
Yeah, happy to do so. So I give an overview of the collaboration that's already happened and what's upcoming. Those meetings included our Consumer Advisory Committee, our focus groups with South Asian and Pacific Islander populations, Hispanic and Latino, Latina, Latinx, populations. We met with the tribal community. We have a focus group with African American and Black representatives, and there were three meetings with our Regional Center performance measures group as our operating partners doing those. Those are obviously important.
- Pete Cervinka
Person
As I mentioned, the draft for the individual program plan, or IPP, will be coming back out for additional rounds of input. And as you heard Mr. Lugo State on a prior panel today, implementation is really key, and person-centeredness needs to be a focus of that very central document for our system. In terms of number two, the Department contracted for an analysis of our $11 million Service Access and Equity gGant. We are continuing to work toward release of that.
- Pete Cervinka
Person
We testified last year about some of the preliminary findings for that, and I'm happy to share those with you today. Continuing the grant program was one of them. They recommended that a clear logic model for those grants, kind of what are we trying to accomplish? What are we trying to measure be applied to those grant programs?
- Pete Cervinka
Person
They suggested plainer language be used in terms of describing what we want to accomplish to make it easier both for the people receiving those grants to know what's expected of them and also, on the back end, more standard collection of information on the back end. And they recommended also clear pre and post-survey information, so doing a better job up front of collecting information about where we are now and at the end of the grant, where we will go.
- Pete Cervinka
Person
They suggested to accomplish that through a number of changes. One of them has already been implemented. We've moved from a one-year grant cycle to a two-year grant cycle. That was a significant recommendation. They also suggested that we focus more on things that we wanted to accomplish with those grants and be more targeted. And having said targeted, I'll use that to say that they suggested we stop using the word target to identify which populations and communities we want. those grants focused on.
- Pete Cervinka
Person
Improvements to the data collection systems that we use, more applicants, the solicitation of more applications from potential grantees who can work with people in nontraditional work hours, and doing a better job when we reach out to new populations of measuring the impact of those outreach efforts. So that's kind of a summary of the recommendations and suggestions that that report has made. Again, happy to answer any questions.
- Caroline Menjivar
Legislator
Thank you so much. We're going to move on to our next panelists from our Association of Regional Center Agencies. Welcome back, Amy.
- Amy Westling
Person
Good afternoon. Thank you, Madam Chair, Members and Committee staff, for the opportunity to be here. My name is Amy Westling and I am the Executive Director of the Association of Regional Center Agencies, also known as ARCA. ARCA supports and works alongside the 21 Regional Centers which today serve more than 430,000 Californians with developmental disabilities. I appreciate the opportunity to be here today and to share the Regional Center's perspective on how to continuously improve upon the equity efforts in the Developmental Services system.
- Amy Westling
Person
Similar to other educational, social service, and healthcare organizations, California's Developmental Services system has identified challenges with equitably serving people across racial, ethnic, linguistic, and geographic lines. What sets us apart is that, as we've heard since 2016, there have been concerted efforts and dedicated funding to improve our performance in this area.
- Amy Westling
Person
We're incredibly fortunate that improving equity is now a central tenet of all of the policies and all of the initiatives that have been implemented over the last several years. Even if they are not at their core an equity initiative, what is asked as implementation is rolled out is always, how is this going to impact various communities? How is this going to impact people who speak a language other than English? And how is this going to impact people across the state?
- Amy Westling
Person
We know that the ultimate question to be answered is whether each person's needs are being met and whether the quality of outcomes differ across racial, ethnic, linguistic, or geographic lines. While there's important work going on through efforts such as the PAVE Program and other efforts to help us better understand true individual outcomes today, we have to use the data, we have to define success in this area.
- Amy Westling
Person
And we've not yet clearly said, here are the set of measures that will tell us when we have an equitable system. We tend to focus just on what we're purchasing for people, the quantity, and the amount of service that people are receiving. But there's so much to this story, there's so much more. As Mr. Cervinka spoke about, there is the question of intake and people's experience with the system.
- Amy Westling
Person
So ARCA would recommend that there be a more comprehensive definition of what equity is and that the following measures would be a good jumping-off point for helping us better understand and better track over time how we are doing. And if we better understand and we're better able to track over time, success in key areas that can also drive intervention. It will tell us where we're strong, but also it will tell us where we're weak and we need to do better.
- Amy Westling
Person
We recommend the following purchase of service primarily for people living at home. This is one of the things in our system that we don't talk enough about, which is that the cost of serving someone when they live at home is significantly less. We understand that that's because a lot of times family caregivers are working tirelessly to maintain them in the home environment, and we don't have a good way to account for that from a fiscal perspective.
- Amy Westling
Person
So it really bends the curve in some very interesting ways when we don't control for where someone lives or how old they are, because as people age in our system, the reality is their needs get more expensive. So looking across racial, ethnic, linguistic, and geographic lines at purchase of service for people living at home from birth to three, from three to 21, and those over age 22. And again, the intent is to highlight where there are pockets of excellence and where we need to do better.
- Amy Westling
Person
For instance, when we look at the data for those birth through three, we see that those who are served in our system, there are very few differences among young children in the amount of service that's purchased. So what can we learn about what we're doing well there and apply to other populations? We also have heard from families that family support services are important. So an analysis of respite and personal assistance.
- Amy Westling
Person
Also, there are a number of people in our service system who do not receive purchase services so looking to see are there demographic differences in that population. As Mr. Cervinka suggested, eligibility timelines and differences there, the percent of total population served, the employment rate, because that's one of the measures of how we're doing at helping adults to achieve independence. Were services beneficial? Are families satisfied? Are individuals we serve satisfied with those services? We need to collect that information.
- Amy Westling
Person
We collect it now through the national core indicators. But we're missing the population of people who don't receive purchase services. And so finding a way to measure that as well. Asking people was your service coordinator respectful of your culture? Because that's at the heart of this work, and assessing whether people feel like the service coordinators are responsive and timely with getting back to them, and whether people ultimately have a choice of providers who speak their language.
- Amy Westling
Person
We know that programs like the bilingual stipend program will help to enhance that. But I imagine if you were to ask people today, those who speak English have broader choice, and that's something we're going to need to tackle, and we are in the process of rolling that program out. So while data alone cannot tell any one person's story, it can help us understand ways on a systemic level that we can improve systems.
- Amy Westling
Person
Many of the consistency efforts underway as a result of SB 138 are part of that overall solution. Alone consistency is not going to fix disparity, but consistency and better data will help us to figure out where we need to target interventions next. As Mr. Cervinka mentioned, there has been work going on at the Department level related to improving data definitions, which will help us as Regional Centers to collect more consistent data, but it will also allow our data to be used to compare us to other systems who are using similar definitions.
- Amy Westling
Person
The IPP template and procedures. I started in this field as an advocate, and one of the things that I know is that when you have greater consistency in these central processes, it makes it easier for advocates to help people navigate systems.
- Amy Westling
Person
So while it may not seem directly tied to equity, it is in that way because it allows for more consistent education of people about the process and about the expectations of what they can expect to see in the documents they receive. But also, the IPP is the place where people really get to surface their own interests, their own hopes, and the services and supports that link to those.
- Amy Westling
Person
So the more consistent process we have, the more likely we are to surface those needs in each individual's case. Intake processes. Petting in the door of the Regional Center should be clear, consistent, and as predictable as possible. When you have a child being considered for Regional Center eligibility, there are a range of emotions going on within a family, and we need to ensure that our process is not complicating things and making those already difficult referrals harder.
- Amy Westling
Person
Generic services evaluation. One of the things I've said throughout my career is that everybody who works in the system, and I've worked with people, closely with people who worked in our state's developmental centers I've worked in the advocacy community. I've worked for the Regional Centers, two of them, and I have had the pleasure of working for ARCA for 12 years. But I've always said people who work in this field are incredibly good people, but they're often working within imperfect systems.
- Amy Westling
Person
And one of the things that I think the report on generic services will surface, and certainly there will be a lot of crossover with the Master Plan, is how we can collectively fix some of these imperfections. And one of the imperfections we've heard loud and clear, and I've said it since the days I was an advocate, is around generic services and how we can help people to better navigate that process so that it in itself doesn't become a full-time job.
- Caroline Menjivar
Legislator
Can you start wrapping up?
- Amy Westling
Person
Yes. Respite assessment process. Family needs are not tied to geography and vendorization procedures is something ARCA was working on prior to SB 138, and we have provided our recommendations to the Department. Additionally, ARCA is working on some consistency measures of its own. We are working on a uniform daycare assessment and hope to also bring consistency to Regional Center policies in this area.
- Amy Westling
Person
And a lot of this work will be informed by stakeholder meetings that will begin next month and will answer critical questions around definitions of things like what are natural services or natural supports and generic services. And additionally, we have done work to ensure that each Regional Center's website now has a consistent button, that when you click it, it takes you to that Regional Center's transparency portal. We've heard from our community that these things will matter.
- Amy Westling
Person
And just today, the Regional Center directors met and approved a process that will allow for the transfer of cases in the intake process in a consistent way, so that if people move, which tends to happen more in certain communities in the middle of the intake process, that those timelines won't restart so that we can get to those children more speedily and get those interventions to them as quickly as possible.
- Amy Westling
Person
So again, committed to ensuring that we're all working together to improve equity and to identifying additional concrete strategies to help us along our way. Thank you.
- Caroline Menjivar
Legislator
Thank you. Can you, just for my knowledge, when you speak about controlling for where someone lives, I think you mentioned other things. Just the cost servicing. Can you explain how that works? Is it that there's a cost for every single individual, an overall cost for all the individuals served, and it's not aligned with the type of service that is given?
- Amy Westling
Person
So when I say controlling for those costs, what I'm really getting at is comparing apples to apples.
- Amy Westling
Person
So we know that people for instance, who live in residential care, those settings are very expensive, and we know that individuals living with families or caregivers, that their costs are always going to be lower in our system, in part because you're not paying for round the clock supports, and in part because people living in home may be getting some of their services and supports from outside our system, like IHSS, where that's not the case for people living in licensed residential care.
- Amy Westling
Person
So when you begin to peel apart the data and to look at what is the Regional Center spending on an average person of school age, who lives at home, who's White, and one who's Hispanic Latino. When you say look at the age grouping and you look at the residential setting, then it tells us that there's about a 12% gap in spending there instead of the number that's often used is a 50% difference in just the average person who's White versus the average person who's Latino.
- Amy Westling
Person
We know that age and residential setting play a tremendous role in some of those additional costs.
- Caroline Menjivar
Legislator
Okay, I understand now, you gave a lot of suggestions on some of the things we should be striving towards, the definition of what it means to be equitable, and so forth. Do you anticipate or are hopeful that the Master Plan is going to be addressing that?
- Amy Westling
Person
I certainly hope so. I mean, if we're not addressing issues of equity, then what are we doing? We know that one of the guiding principles of the master plan is to help us figure out how to serve people well and serve people equitably. And I also anticipate and heard Director Bargmann speaking this morning, that one of the goals is also to address the generic services issue. So there is a lot of overlap between this panel and that.
- Caroline Menjivar
Legislator
And then perhaps for either of you, the Department, and you, the collaboration, what does that look like when we have one Regional Center perhaps falling a little behind in meeting XYZ? Is it just a Department coming to that Regional Center?
- Pete Cervinka
Person
Sure. I think at the simplistic level, the Department is looking at a number of things in the operation of Regional Centers over time. And when we see things that merit attention, either sunshine through observations at Board Meetings, looking at purchase of service data, which we give them annually, or whether we're listening to what we see come through a complaint or due process system, the first step is always a conversation about what else might be going on, and then technical assistance to that Regional Center.
- Pete Cervinka
Person
And that can take different forms depending on what the issue is, where that coordination needs to happen. We have a fairly robust allocation of staff to looking at Regional Center oversight, that we call them our Regional Center liaisons, and that's generally the interaction.
- Caroline Menjivar
Legislator
And does the Association play a part in preventing TA there?
- Amy Westling
Person
Yes. So what I wanted to add is that as an Association, we're in the process of a significant cultural transformation, and one of the pieces that we are undergoing is building in a technical assistance structure so that centers are encouraged to access it if they are falling behind in certain areas.
- Amy Westling
Person
So we have a group that is working to make recommendations to our board about what are some standards that go beyond statute and regulation and Regional Center contract that we expect as an organization that Regional Centers will adhere to and will rise to.
- Caroline Menjivar
Legislator
Is it more reactive, though, or does Association help police your own?
- Amy Westling
Person
I wouldn't call it policing, and I don't think it's reactive. I think that as an Association, we've always had a very open culture in terms of supporting one another when Regional Centers have raised their hands and said, I'm struggling in this area. But I think the question that this allows us to answer is how to best respond if we see someone falling behind or we have concerns as an Association, if the other Regional Centers want to help bring someone along.
- Amy Westling
Person
And so it's not intended to be reactive. And I've got to be honest, in the years I've worked with the 21 Regional Centers, I can tell you with all honesty that every single one of them has pockets of excellence, and every single one of them is not as strong as some of their peers in other areas.
- Amy Westling
Person
So part of the role of the Association is to leverage the strength to bring others along and then to wrap those who are struggling in particular priority areas in support to help them come along.
- Caroline Menjivar
Legislator
What would you say, and both Director and ED here, is our plan? Because we can pass these, Management can be on board, Association is on board.
- Caroline Menjivar
Legislator
But the rank and file of each Regional Centers, what does that campaign look like? As we're looking to the first things that we're going to be implementing in January of next year, what does that campaign look like to get every single employee of each Regional Centers, the ones that are going to be working with the individuals, to be 100% knowledgeable of what exists, what template exists, and the new path moving forward?
- Pete Cervinka
Person
I'm going to try not to give you a kind of textbook policy answer, but what you're talking about is really how are we going about change management and organizational change management? We're talking about what's important, defining what we're intending to accomplish, what the end goal looks like. We're giving time to people to understand that. We're updating the IT systems that enable that to happen. We're giving them training on how to use that IT system to do it.
- Pete Cervinka
Person
We're reminding them that the people that they encounter will come with different strengths and aptitudes and that we need to approach that in a way that people will understand. And so there's a non-IT training component to that, about how to interact with people. I mentioned, for example, currently in our system, we only ask about gender being male and female, but there's obviously a number of questions about that.
- Pete Cervinka
Person
And for minors in front of their parents, for example, where how we ask that, and particularly in different cultures, could be extremely sensitive. So a lot of training for service coordinators about how to ask that, when to ask that, when not to ask that, how to do it publicly or privately in the course of the conversation. That's just one example. So a lot of training.
- Pete Cervinka
Person
And to echo what my colleague Ms. Westling said earlier, there's no point in doing something if you don't know how well you're doing it. What's the outcome of it? So knowing from the get-go, what does success look like and what are we going to be measuring in order for ourselves to get there? Is it just the completeness of the data field in the IT system? Is it a survey of the families about how they feel after they just went through the new IPP process?
- Pete Cervinka
Person
What is it that we're going to measure or what combination of things are we going to measure to make sure that we're on the right track, doing well, and where those supports are needed that we just talked about.
- Caroline Menjivar
Legislator
Okay, we're going to move on to our next panelist. Joining us from Integrated Community Collaborative Alianza de Hombres.
- Oscar Mercado
Person
Thank you, Madam Chair. Good afternoon, Senators, fellow panelists, and members of the public. My name is Oscar Mercado. I'm a 21-year-old Mexican American with autism, served by the Regional Center system and a participating Member of the ICC, Alianza de Hombres. I'm here today to give public testimony on my experience and why it is essential for services and diagnosis to be accessible and addressable for all special needs individuals provided at the earliest point in their lives.
- Oscar Mercado
Person
As a small child, I would demonstrate certain behaviors that gave an indication of being on the spectrum. My parents discovered that I had autism. However, they were at a loss as to where to seek assistance. The Regional Center didn't provide any guidance or support at the time, leaving my parents feeling overwhelmed and defeated. Regrettably, this is a narrative we often hear from many families, especially those who are non-English speakers and feel intimidated by the system.
- Oscar Mercado
Person
Growing up, I received no early intervention services from the Regional Center, which plunged me into some challenging times. But my real troubles wouldn't begin until I went to school. Starting in kindergarten, my condition started to become more apparent to the people around me, to my parents, and even to myself. The most recognizable trait was my lack of understanding social cues, which would later worsen and cause a drift between myself and my peers. The second issue was the academic portion.
- Oscar Mercado
Person
Teachers would give a lecture and after school, I would completely forget about it. I would forget about the lessons and it made it extremely difficult for me to assimilate the information given, thus leading to me having a very difficult time completing assignments and studying for exams, as it would take the entire portion of my afternoon and sometimes early evenings to complete. The third issue was sensory-related, specifically regarding noises I could not stand, rallies, people screaming, and especially the monthly required fire drills.
- Oscar Mercado
Person
Whenever those alarms would go off, I would always enter in a state of panic and completely shut down. I would have no control over the situation whatsoever. All of these attributes led to my parents and the school to think that I could most likely be on the spectrum. Yet, like many others similar to my situation, these were not enough qualifications for the Regional Center for me to pass their rigorous intake process.
- Oscar Mercado
Person
In November of 2012, my parents and I went to VMRC searching for support and services, but I only got a quick screening and they deemed me ineligible for Regional Center services, leaving me vulnerable due to not knowing the laws and rights I was entitled to under the IEP from the school as a student and under the program, my parents and I were victims of the constant bureaucracy that confused us further.
- Oscar Mercado
Person
The overwhelming and complex system made me feel like a failure due to the lack of services alongside my personal issues and I was to face the darkest times of my life alone with only God and my parents as the only sole and trustworthy foundation and support to rely on. Upon graduating from high school, my need for assistance increased significantly.
- Oscar Mercado
Person
Consequently, my parents once again attempted to gain services from the Regional Center and I finally became a client at VMRC right after graduating high school, losing all of the previous years that I needed support. As a client of the Regional Center, it paved the way for the Self-Determination Program I started at the beginning of last February of this year, and in this short amount of time, I have learned so much about being independent, how to engage in the social world, and everything required for being an independent adult.
- Oscar Mercado
Person
I'm grateful for this program as it has given me hope and purpose. If applied as it was originally meant for, it can and will improve lives. What I really like about the Self-Determination Program was the fact that I felt that I was cared for by people who were not just my parents, and this was something I didn't see anywhere else. Regarding the impact of last year's SB 138, let me address the intake process. There's a growing concern about a surge in eligibility denials.
- Oscar Mercado
Person
Becoming a Regional Center consumer is extremely challenging and time-consuming. Individuals like me lose precious years of much-needed support. The Legislature aims to standardize the intake process for more equitable treatment statewide. However, today we are not sure what that means and how it will be implemented. Furthermore, denial of eligibility disproportionately affects people of color and those from lower-income backgrounds. Some families resort to costly independent evaluations to qualify for Regional Center services, a luxury that many people cannot afford.
- Oscar Mercado
Person
These disparities underscore the racial biases entrenched within our system, perpetuating the inequitable distribution of services, particularly among Black and brown children. I also like to discuss generic services. It's important to note that Latino families are unaware of Regional Center services, let alone generic alternatives. Requiring families to navigate generic services first often results in their child receiving no support at all. Regional Centers mandate the use of these services without facilitating access, leaving families feeling stranded and unsupported.
- Oscar Mercado
Person
It's a frustrating cycle where it feels like nobody's advocating for us, leading many to lose hope and disengage. This is why I say with a sincere heart as a self-advocate, I implore you all to ponder on the words stated today in this hearing and help promote a State of equity and equality based on respect and trust so that we can begin the healing process and move forward towards the journey of liberation. Thank you for your time, and God bless you.
- Caroline Menjivar
Legislator
Oscar, thank you so much for coming up and sharing your story with us. I really appreciate that. Our final panelist is going to be from also Integrated Community Collaborative.
- Fernando Gomez
Person
Yes. Good afternoon, Madame Chair, Committee Members, and staff. It's a pleasure to be here and be part of this conversation. My name is Fernando Gomez. I'm the father of a 17-year-old with Down syndrome served by the Regional Center system and also a 14-year-old who we're in the process of, similar to what Oscar shared, trying to have him become a client of the Regional Center system. And as skilled as we are in our advocacy, it is overwhelming and it has been extremely challenged.
- Fernando Gomez
Person
And in this conversation today, I'm also a co-founder of the integrated Community Collaborative, which we're parents and self-advocates who have come together to help unite in advocacy, unite in voice, and unite in effort to try to talk about what are these challenges, to your point, Madam Chair, to figure out what can we do today?
- Fernando Gomez
Person
In my testimony, I was going to reiterate what you probably have already heard in previous testimonies, and you've definitely read in many of the reports about the challenges that cause disparities with the barriers and the roadblocks. And earlier in the earlier panel, Senator Eggman asked Judy a really interesting question. Given the ability to know that everything got resolved and so forth, when would you know that you're there? And it was really a great question and really probably the only time I've seen Judy tongue-tied.
- Fernando Gomez
Person
It's not easy to do so kudos to Senator Eggman, even though her answer was on point. Joy, happiness, release. That's not the answer. The answer for someone like me, dad, apologize. I don't know how much time I have.
- Fernando Gomez
Person
When I see Oscar and I look back and look at all the individuals in this room. We can't afford to wait for a magical moment when maybe a master plan may become a reality. We've heard that before. Not too long ago, Georgetown was our shining star. Today is a master plan, and we embrace it, and we're going to give it everything we have to try to make it work. And we pray to God that it does work. But we don't know how much time we have.
- Fernando Gomez
Person
Because the reality is today, Oscar just shared that it took him a whole lifetime. It wasn't until high school when the Regional Center system stepped up to support what he needed from the get-go. And his story is not the only one. Today we see a room full of individuals. Many of them don't even speak English. They have to be here. They know that. We take your live video feed, put it into a Zoom, and are doing simultaneous translation in Spanish right now for several hundred people who want to know, what can we do today
- Fernando Gomez
Person
The question is, there's a lot. Amy just shared about the differences between someone living at home, as they should be with their families, and being supported by the one people who care for them, having less services than the ones who don't. And we know that over 42% of the individuals served fall within that age group of people living at home. But why are we penalized?
- Fernando Gomez
Person
Why do we have to work harder and be more challenged to do what's really the right thing? So in my testimony today, I wanted to allude to several things. Is the reality of what can happen today. Director Bargmann has embraced us from the get-go. She's empowered an organization like the ICC to become what it is today. And we know that her heart's in the right place, and she uses data, she uses feedback.
- Fernando Gomez
Person
But in reality, that the resource is within us, within Oscar, within myself, within the others, and everyone in this room. Don't just rely on data, rely on that individual who's here today saying, I want to be part of the system. I want to help the system, help me, because it is our system. And when we look at where the battleground is, we see that it's at the service coordination level.
- Fernando Gomez
Person
We recognize the immense challenges that are faced our service coordinators, and they have to not only navigate policies, but they have to adhere to the system directives and they maintain compliance while striving to be person-centered. They're really caught between a rock and a hard place. Service coordination in this system is virtually impossible. There are some amazing people, but I do want to share a situation that just recently came about. It's important to increase service coordination numbers, reducing the case rose ratios.
- Fernando Gomez
Person
We believe that this can be beneficial, but it's evident that the service delivery process still falls short of meeting the needs and expectations of the community that it serves. This disconnect has been highlighted at a recent Regional Center board meeting where dozens of service coordinators expressed their unhappiness with their caseloads and pay. But unfortunately, their criticism did not stop there, and many of them turned their anger to consumers and parents.
- Fernando Gomez
Person
One service coordinator candidly shared via the chat, and I quote, I recently had to go on antidepressants due to the constant stress and intimidation tactics that are used by parents and advocates to get their point across on why they need services. Who cares about my needs? Who provides me with respite, attendant care, daycare, or social rec. Unquote. And this statement was quickly followed by another comment that was said service coordinator's lives matters.
- Fernando Gomez
Person
Well, these candid and polarizing statements offer a rare insight into the mindset of some, not all, but some, service coordinators and the reality faced by families. That is where the battle is. That's where we need to put focus and attention. And I can see where the service coordinators are coming from. I don't know if they see where we're coming from, but this isn't a Lanterman Act. This is an entitlement system. And somehow or another we got to figure it out.
- Fernando Gomez
Person
And I can honestly say as a father and only God knows how much more time I have, we got to get it right. We got to get it right. And I do apologize if I'm going over time, but I would like to make a couple of comments on 138 if I still have a couple more minutes. The other category on race, ethnicity, and the language data. I know the DDS has started their efforts and being one of the key catalysts in introducing this language, we're hoping that we're part of that conversation.
- Fernando Gomez
Person
We haven't had that yet, but we're hoping that we will be because the other category at 14%, in many cases it's the third largest group served by a Regional Center. But you don't have to go very far. You look at Inland Regional Center, that's at 29%. Mr. Director Klaus, who was here earlier from San Diego, his other category is at 20%.
- Fernando Gomez
Person
The reason that this matters is because I'm the first firm believe that the other category is comprised mostly of Latinos and they are even receiving less services than the Latinos. And we know already how many, how wide the gap is. And there's a lot of reasons that I believe that attributed to that. It's confusing. How do you identify yourself? Because I'm not really white, but I'm not either this because we're very diverse. We know that for a fact.
- Fernando Gomez
Person
But to identify myself either White or Black as a race and then define an ethnicity is very hard for many people to really truly understand it. So they've just kind of many cases deferred to other.
- Caroline Menjivar
Legislator
Mr. Gomez, just final thoughts?
- Fernando Gomez
Person
Yes. My final thought is that I would hope that in the midst of all of these conversations that are going place that the most valuable resource that the system has available are the very individuals that are served by the system. And the parents and that we would be part of not only the ability to sit around the table, but be part of the conversation. Thank you very much.
- Caroline Menjivar
Legislator
Thank you so much. Second year doing this. Last year I didn't know how this meeting was going to go, right? Last year it was a big shock to my system. And then this year I knew coming in, I think today, I don't know if you noticed, I was later than usual to show up because I was honest, scared. I was scared, scared of the feelings, hearing the stories and so forth, stories that I knew from last year, right?
- Caroline Menjivar
Legislator
I will say, though, since last year, at least on paper, we've moved forward on paper. Since last year, we passed in the budget act this portion. Since last year, we have the announcement of the Master Plan with hope, like you said, Mr. Gomez, with hope.
- Caroline Menjivar
Legislator
So I can say it looks like we're moving forward, but I think one of the things, and I forgot if it was you, Oscar, or you, Mr. Gomez, who said it is until I no longer hear stories from self-advocates or family members, in this case, data is not going to do it.
- Caroline Menjivar
Legislator
I think we can have all the data in the world, but if we continue to hear stories from clients or Regional Centers and so forth, that this is still happening, then it's still happening. Because data can always be skewed sometimes and it's not going to capture every single person, right? I don't know when we're going to get to that point of it.
- Caroline Menjivar
Legislator
Grinding my teeth over here, Mr. Gomez, and I get super emotional during your story, and you too, as well, because I shared my niece next week turns four, and they just started their self-determination program for the first time. And they are so lost, they are so confused in that program right now. And I have a Bill on this program this year and I can't even offer any support.
- Caroline Menjivar
Legislator
You share that even as an advocate, you're navigating that with your 14-year-old and still hitting barriers. The Senator, and I'm still hitting barriers with my niece and my sister, are navigating this process as well. This is so personal and it's so frustrating to hear, and I know no one here is up here to create barriers.
- Caroline Menjivar
Legislator
We, I hope, we're all here looking to collaborate as much as possible to make sure that Oscar doesn't have to come up here anymore and share his story regarding your experience, right? That is the end goal.
- Caroline Menjivar
Legislator
But when I hear stories about when somebody shares their internal thoughts about where they're thinking about that population is why I asked you what campaign are we going to have to really train the rank and file of these Regional Centers because Amy can be the most perfect ED of this Association. But how is that going to trickle down to every single person? Right? Doesn't matter if we train our management level, it's every single case worker.
- Caroline Menjivar
Legislator
It's every single person that's going to be at the front line. I think more important than training our EDs, talking to our board members, and so forth. That's the part that I'm worried about is implementation of how that person. So I think about employees and our rights. They're plastered all against the walls, right? What are we looking at? And when someone walks into a Regional Center that shows all their rights, this is how you're intake.
- Caroline Menjivar
Legislator
That'd probably be a whole slew of sheets, but just how visible are we about what the rights are of everybody that goes into a Regional Center that you don't have to utilize any other service to get social rec that's on top of whatever you're already getting? Does everybody walking in through the Regional Center see that? And do the employees see that every single day? I want to know more as to how we're really going to make sure this campaign works and everyone knows about it.
- Caroline Menjivar
Legislator
This is really early on in the game, this panel regarding our implementation, right? June 30, we're going to see more information on the first two. I do want to note and reiterate ensuring the involvement. We heard from a previous panel. Yes, we have one stakeholder who's a self-advocate on the Master Plan, who's Latino, but I don't know what public comment is going to look like this year. But last year it was monolingual Spanish speakers that came up to share the consistent barriers.
- Caroline Menjivar
Legislator
So if we're seeing that, that's the consistent demographic. And that's not to say there isn't barriers for other ones, but it seems that it comes up a lot. Then we should have more of that demographic be represented or really focus when we do our roundtables and stakeholders and so forth. The past couple of months I've dived into this topic. I've had meetings with you, Mr. Gomez, and over 300 people on Zooms more than once where I've listened in from monolingual speakers share their constant barriers.
- Caroline Menjivar
Legislator
I watched the video and this is probably just a personal ick of the orientation you need to do to start SDP. It's not even a native Spanish speaker. That's what pissed me off even more. The language barriers, even when you get someone, is not even a native Spanish speaker. I would never want to sign up to translate something in Spanish. Even though I speak Spanish, I would never be able to do it justice.
- Caroline Menjivar
Legislator
I would want someone who is a true Spanish speaker to be the one to give instructions on things that are so technical. So even that small piece, I feel like that's an easy fix to show the respect we have for people who don't speak English to ensure that their language is adequately being translated so they can understand it equally. Mr. Gomez, outside of this rant, I do have a question.
- Caroline Menjivar
Legislator
You kind of started talking about it, but I was going to ask you a different version of what Senator Eggman asked. Ms. Judy. What is equitable to you? Because Amy asked. Ms. Westling, I apologize. Ms. Westling asked to define what is equitable. How would we define equitable when we're talking about equitable measures?
- Fernando Gomez
Person
If I can briefly use an example, when I first started my advocacy journey because of my son, the Regional Center, that was my catchment area, the director. At that point, we believed in many others as well, was that that center was the leader in the space, and what made it a leader was because of the director's mindset. In other words, let's find a solution for what the need is, and then we'll find how to justify it.
- Fernando Gomez
Person
That type of service delivery was really what I believe was equitable because you feel respected, you feel like you can trust the system. Many times if I open up, because this is an emotional situation, we're here, we're dealing with lives, and when we're looking to get to that equitable space where it's not just about access to services, that's just the very beginning because we still have to look at safety. You heard about this young child.
- Fernando Gomez
Person
I'm not going to go there, but there's still other big mountains to climb. We have a long ways to go, but this is our system, and equity means that we're embraced. We're not having to fight tooth and nail in order just to get what is right.
- Fernando Gomez
Person
And I'll share with you that for, like my son, in trying to get him the services that we know they need, and the person that's across the table from me at the center knows that he needs them, but says, I can't give them to you because the system does not allow me to based on the criteria. So that is the issues, the challenges that when we can figure that out, then we're where equity means.
- Fernando Gomez
Person
I'm not saying that we get yes on everything, and no, we shouldn't. We just should get what we need, and it's going to make the difference. That's it.
- Caroline Menjivar
Legislator
Ms. Westling, I know you asked that question, but do you have a definition of your own?
- Amy Westling
Person
I think my definition probably is not that different from Mr. Gomez's. I think equity means meeting the needs of each person we serve in a way that is responsive to their own needs and that our services are flexible enough that we don't have to tell people, I know your child needs it, but I can't do it because. And that's one of the kind of balances that our system has walked over time.
- Amy Westling
Person
We want to achieve greater levels of consistency, but we also need to ensure that on the individual level, we have the flexibility to tailor services to meet individual needs. And so whether that means we need to support families in more creative ways, that's one of the things we strive to maintain, in all honesty, in our system, is the ability to string together services in a way that's going to be most responsive to each individual's need.
- Amy Westling
Person
We know that there are regulations about what we can, about funding and about the structure of services, but really at the planning team level, there's that ability to be creative, to put things together to meet the need. And that's my vision of equity.
- Amy Westling
Person
And the fact that our system in the last year has added over 1,000 service coordinators means that we are getting to a place where service coordinators will have additional time to spend with people, not only to explore the needs through the consistent IPP process, but also to think through in a more flexible way. How do we identify the need and then say, and what's our role in meeting it?
- Caroline Menjivar
Legislator
I'm going to allow some final thoughts from any panelists.
- Fernando Gomez
Person
If I could just briefly respond that I believe that in an ideal world, I would say, wow, awesome reality. And you'll probably hear a lot of this in some of the public comments, is not what's happening today. And if you even go back to the service coordinator or the individual who told Oscar that he didn't qualify, and later on in life, we know that he should have qualified at that time, and you ask him why not?
- Fernando Gomez
Person
The only thing that this coordinator is going to say, or this individual is going to say, I'm sorry, and that's it. And I'm sorry is supposed to be enough for a whole lifetime, and it doesn't cut it. I'm sorry, it's not good enough. You know, I'm not sure what I'm trying to say, but there has to be accountability. There has to be, because if what Amy just said was more of a reality. I would be sitting here with a whole different mindset. But it's not. It's not.
- Oscar Mercado
Person
I'll be very quick with this. I want to clarify on the equity issue, since that is the issue on the floor right now, today. I'll be very basic with it. We're all equal as human beings. We can confirm that. Look around each other. You can see through your right to your left. We're human, but our needs are different. Your needs are different, my needs are different. The people here, the people watching at home, everyone has different situations, different circumstances.
- Oscar Mercado
Person
And I'm not going to get too technical about it because I'm not too knowledgeable on what's going on. But the basic essence here is that all people, whether it's people with some sort of disability or not, have their own needs to look to. And I would appeal this to everyone that, especially now for the people who are in most need of the services, that their needs should be addressed, just as the needs of the common folk are also addressed.
- Oscar Mercado
Person
So for me, my vision of equity is simple. We're all equal as human beings, but our needs are different. And that should also be addressed and should be thought about.
- Caroline Menjivar
Legislator
You know, I think where we're trying to standardize templates and all that, that should be the only thing we standardize, right? And then when we provide the services for each individual, it's an individual plan for every single person. Because you're right, we all have different needs, and we shouldn't be utilizing a template for the services that we give, right?
- Caroline Menjivar
Legislator
Anyone else? If not, we're going to turn to Department of Finance for final. Ms. Westling?
- Amy Westling
Person
Yeah, and I apologize. I keep playing off Mr. Gomez, but I think one of the things that Mr. Gomez said is that people who are imperfect and make the wrong decision, then what they're left with is just, I'm sorry, but there are some of us who have the honor of having positions like this, where we get to help be a part of shaping policy.
- Amy Westling
Person
And so the roles certainly that you play, Senator, those of us who will be serving on the Master Plan work group have a way to then say, based on my experience, here's changes I suggest we make to the system. So, Oscar, I am sorry to hear what happened to you, but know that cases like yours are what led us collectively to a place where we now have an eligibility category for Regional Centers known as provisional eligibility.
- Amy Westling
Person
So that at ages, for our kids who are between three and their fifth birthday, we have the ability to hang on to those kids and continue to work with them. And the impetus for that was kids like you. Kids who, it broke our hearts at age three to turn them away, but we didn't have enough evidence that they were eligible. And so those types of situations then give us the power to make policy change and to make it better for the next generation.
- Amy Westling
Person
It doesn't fix it for you, but know that those things then do shape public policy.
- Caroline Menjivar
Legislator
Department of Finance, do you have anything to add?
- Christopher Odneal
Person
Thank you, Madam Chair, for the opportunity. Chris Odneal, Department of Finance. And just want to thank you both for being here today and sharing your stories. And no further comments for this panel.
- Caroline Menjivar
Legislator
Great. Thank you so much for this conversation.
- Unidentified Speaker
Person
Thank you.
- Caroline Menjivar
Legislator
We're now moving into issue four, where we will be talking about the rate reform delay. This panel will be having a conversation discussing the Governor's Budget proposal of a year delay of the final phase of the Service Provider Rate Reform. We're going to start with.
- Caroline Menjivar
Legislator
We're going to start first with Department of Finance, who will then tag team the Department.
- Christopher O'Neill
Person
Thank you, Madam Chair, Christopher O'Neill with Department of Finance, and I'll present initially on the summarizing the proposal on behalf of the Administration and then pass it to my colleague Carla Castaneda with Department of Developmental Services for other updates and discussion. The proposal you have before you today is driven by the General Fund situation and is one of a number of approaches included in the Governor's Budget intended to help address the overall funding shortfall in the upcoming budget year.
- Christopher O'Neill
Person
The outlined approach would return full implementation of DDS service provider rate reform to the original timeline adopted through the 2021 Budget act. What this means is that the next round of rate adjustments and associated funding for service providers, scheduled to occur on July 1, 2024 would instead take effect July 1, 2025. This approach maintains rates at their current levels through fiscal year 24-25 as well as funding for the quality and fairness program while we continue forward in achieving full rate reform.
- Christopher O'Neill
Person
From here, I'll pass to Chief Deputy Castañeda.
- Carla Castañeda
Person
Thank you. Thank you, Madam Chair, Carla Castañeda with the Department of Developmental Services in the next question in the agenda is asking about potential impacts of the delay on the workforce capacity and access. Given the length of the workforce challenges that we've seen since the beginning of the COVID pandemic, it's difficult to say that specific impact, especially when we're looking at full implementation, being a two component rate model, including up to 10% for quality incentive payments.
- Carla Castañeda
Person
What we did want to highlight, though, are some additional initiatives, and I think I heard one referenced earlier, but some additional direct supports for workforce is the training stipends that are providing up to two trainings for direct service professionals. To date, about 52,000 participants have gone through the training. Almost 45,000 have completed the two sets of training.
- Carla Castañeda
Person
There's the initial phase of the internship program that again would be helping the providers in the community and that would be about 2500 participants and the tuition reimbursement program for Regional Centers. We do have additional ongoing programs for direct support professionals. In progress is the DSP workforce training program, which would provide a tiered wage increase upon completion of curriculum as well as a bilingual stipend that I think was also mentioned earlier for direct service professionals.
- Carla Castañeda
Person
Speaking more than one, sorry, I thought I anticipated a question. For the next question in the agenda, looking at the delay in the rate reform and the impact on quality incentive program. As my colleague mentioned, the Governor's Budget includes $137.5 million to continue the program at the same level of funding as the current year. As the program has continued to evolve, we've modified the measures.
- Carla Castañeda
Person
And so, for example, some of the wellness initiatives have looked to include additional settings, and it's expanded to include early intervention services as well as the current provider directory efforts. So we will continue. This provider directory is one of probably multiple steps to continue to build that infrastructure that does get us towards moving to measuring individual outcomes. Thank you.
- Caroline Menjivar
Legislator
Chief Deputy. Before I move on to the other panelists, um, number two, I really think we just flew by that. Let's dive a little deeper into just how this is going to impact workforce capacity. Because you spoke about a stipend, that's a one time thing. These are permanent rate reforms, so I don't think we can compare them saying that this is going to help.
- Carla Castañeda
Person
Sure. The delay in the rate model implementation. So the current level of funding that got the additional 25% increment, that included language in statute that specified the majority of that rate adjustment would go to direct service wages and benefits. These additional initiatives were also part of that same acceleration to support the workforce. So the delay, it just pauses the next increment.
- Caroline Menjivar
Legislator
Let me see if I can ask a different way. Given that this workforce is, I mean, I say this, it's struggling, but every other, given that in this workforce, the rate is really really low compared to what we're seeing now, great for fast food workers. That's phenomenal. I think everybody should get paid at that level, but we're not so much in this level. Right?
- Caroline Menjivar
Legislator
I hear stories that we don't have enough drivers to pick up, clients to go to day programs, jobs and so forth, that this is directly impacting rates, the capacity for workforce-travel is not being reimbursed. That's a whole other conversation. But if the rate were to increase, that could offset some of the travel costs that is associated, not reimbursed. So I guess I don't see from the Department, correct me if I'm wrong, the Department does not feel like this will cause a workforce issue.
- Carla Castañeda
Person
Definitely did not mean to convey that. Recognizing that that is a pause in a potential improvement in the amount that's available for direct service professionals. The proposal is to delay any increase, not a reduction. But we definitely recognize that that is the intent. The augmentations are intended to support wages and benefits for direct service professionals.
- Caroline Menjivar
Legislator
I apologize. Chief Deputy I guess I'm not really thinking, I'm getting, not that I'm looking for a specific answer.
- Christopher O'Neill
Person
Senator Chris O'Neill, Department of Finance. Again, I think as I mentioned in my presentation, the proposal you have before you is very much driven by the General Fund situation. That's been the theme, obviously, this budget process and I don't think, the Administration doesn't minimize that there are potential impacts and that we've been in partnership with the Legislature since the outset of rate reform in 2021, we're able to look at acceleration in 2022, it was adopted, and a couple of years later, we're having to relook at, look at some harp proposals related to the budget.
- Christopher O'Neill
Person
And so I would want to say that we're not minimizing a potential impact, and we have met with stakeholders and we are aware of concerns in the community. But this proposal you have before you is very much driven by the budget situation.
- Caroline Menjivar
Legislator
Right. Of course. I know that's a lot for our proposals. Right. The reasoning, I 100% get that. What can then, as a Department, are we looking at to help minimize this impact, should this proposal go through?
- Carla Castañeda
Person
I think continued efforts on the direct service professional benefits in place today. So some of the initiatives mentioned, additional flexibilities that are available, should there be concerns for a provider. There are health and safety waivers that people can access. To the extent there's a broader issue, then there's another process for waiving specific requirements.
- Caroline Menjivar
Legislator
This is before my time and I see the Assemblymember, yes? Who helped push this years ago. These rates were based on a time from when was it 2019? Those rates don't even live up to the standards that we're in right now. If we further push that back, are we potentially looking at then setting a different rate? Because if we push it another year back, we're going to be further away from the living standards right now. So is that our intent?
- Caroline Menjivar
Legislator
Because, A. we're already further back. We're already back from these rates. Great. But it wouldn't even match living standards. Right. We push it one more year, we're further away from matching the living standards. So how do we then adjust or offset the further falling back from everyone else's rates?
- Carla Castañeda
Person
I think to address that, I can just highlight some of the items in play now, not that there's additional proposals before the Legislature. What the budget does include, and as you mentioned, these are some of the lower wage wages in the categories, but it does include the adjustments for minimum wage, and there is a streamlined proposal for that so that it addresses the providers who models incorporate the minimum wage.
- Carla Castañeda
Person
Historically, providers have had to demonstrate that need before those adjustments were made, and then some of the additional ongoing programs like the DSP training program that would offer the tiered wages upon completion.
- Caroline Menjivar
Legislator
Chief Deputy, I don't know if you have a lot of things on your plate. Listen, a couple hearings ago, I mentioned we were talking about HCBS funding for IHSS career pathways and so forth, and while I would love, ideally, for all that funding to go there. If we don't spend the hundreds of millions of dollars we have left over, I don't want that Federal Government to go back.
- Caroline Menjivar
Legislator
I'm wondering since then if any has talked about in this Department if we can utilize that for additional stipends here or just use some of that Fund to help offset the potential impact. Or maybe. Yeah, this is.
- Christopher O'Neill
Person
Senator, can you clarify the HCBS spending plan funding?
- Caroline Menjivar
Legislator
Yes, the X is amount that while you feel very comfortable that will be spent, I don't know if we're going to make that mark right. Perhaps utilizing some of that for additional stipends. I don't know that part. If it can be fully for, it probably can't, for the rate relate of the rate reform because it's only for six months. Let me rephrase that because I confuse myself. Okay. HCBS funding expires at the end of this year.
- Caroline Menjivar
Legislator
I know we can't utilize that for this rate reform delay because it's only six months of it. Now I'm wondering, with the potential unspent dollars in that section, could we then maybe add more stipends to what the Chief Deputy just shared to at least offset the blow that could potentially be coming down?
- Christopher O'Neill
Person
Are you speaking to unspent dollars like in other-
- Caroline Menjivar
Legislator
I just meant career pathways
- Christopher O'Neill
Person
Specific to. I'm not familiar with the details of the IHSS career pathways proposal in the spending plan and would need to circle back with maybe even staff on the mechanics of how that could work. But I believe in the HCBS spending plan globally. There's a number of federal approvals, obviously, that need to occur for how we've submitted the plan, and they're understanding how we're spending the money.
- Caroline Menjivar
Legislator
And it's my understanding that we've moved around funding within there with the approval of the Legislature. I know there's room to do that for other things, so long as they're new programs. So I just want to see that we're being as creative, literally as creative as possible when we're dealing with this budget deficit. To not leave a single penny on the table from the Federal Government to help offset anything. I've suggested other things for IHSS as well, to be creative.
- Caroline Menjivar
Legislator
I'm just saying if all the sister departments could talk to each other how we can if necessary, i'm throwing everything on the table here, Chris. I'm just like, whatever we can do to grab, right. So I just want to bring that up. Not necessarily looking for a response here, but just to flag that for you.
- Christopher O'Neill
Person
Thank you, Senator.
- Caroline Menjivar
Legislator
Let's move on to our next panelist from the California Disability Services Association.
- Wendy Forkas
Person
Madam Chair and Senators, thank you so much for the opportunity to speak today. My name is Wendy Forkas, and I am the CEO of Adjoin, a nonprofit organization that has provided services to, honestly thousands of individuals with intellectual and developmental disabilities over the past 40 years. And I am also the President of the California Disability Services Association.
- Wendy Forkas
Person
I want to start off acknowledging the challenging budget reality the state is facing, requiring some very hard decisions that need to be made, the difficulty and the responsibility that comes with making tough choices that ultimately impact people's lives and their well being. Honestly, if anyone can understand it, it would be the IDD community.
- Wendy Forkas
Person
As we have been facing these hard decisions within our budgets for the last 16 years, due to our services and our rates being chronically underfunded, the governor's current proposal to delay their full rate implementation threatens to significantly devastate and destabilize the lives of the individuals with developmental disabilities.
- Wendy Forkas
Person
And it's going to erode all the progress, all the progress that has been made in the recent years to help strengthen the system and at least ensure that we're able to be here and to provide services to the people we support. And when I say the progress we've made, I truly mean that, that is between the IDD community and the legislators. You have been right there with us. You have made decisions that have helped us in the past get wage increases for the workforce.
- Wendy Forkas
Person
And it really is essential and is important to having that strong foundation to ensure that we're meeting the promise to have one of California's most vulnerable populations be able to live in the community. I recently spoke with Ed, who is a self advocate and has been with Adjoin for almost two decades, about this proposed delay. And this is what he said. He said, "I'm tired of training staff". And I had to say, Ed, we're tired of training staff, too.
- Wendy Forkas
Person
And that is the reality that unfortunately, because we have difficulty in retaining hiring individuals to provide our services, we not only have to train them, but Ed and other individuals that they support have to spend time getting to know them, building trust, having them understand what it is that they need and how best to support them in doing that. And again, for us having the delay only, only. All it does is just push this problem out.
- Wendy Forkas
Person
And I've heard a lot about what you've been saying, Madam Chair, and you get it. You understand that if we don't have a quality workforce and a workforce in general, we really cannot ensure the health safety of the needs of this vulnerable population. And we've made that promise,we have made that promise through the Lanterman act. The other part of this is, how can you expect us to provide quality outcomes when we are constantly having to start over with new staff?
- Wendy Forkas
Person
Or what we've had to do in the last few years is actually ration staff hours.
- Wendy Forkas
Person
And what I mean by that is, for example, if an individual wants to go to a day program, and the day program is five days a week, because we don't have adequate staffing, we have to tell them, we're sorry, you can only come three days a week and you have to find something to do on those other two days because we don't have the staff to be able to do that for them.
- Wendy Forkas
Person
If it's a one to one service, maybe somebody is authorized for 30 hours of independent living skills coaching a month. Well, we're saying, hey, we're going to give you 10 because we can then also give another individual 10, and we have to start rationing that. And again, that really makes it challenging for us to be able to ensure that we're able to provide those quality outcomes that we know are not just expected, but are important to the people that we support.
- Wendy Forkas
Person
Um, I cannot stress enough that there will be, there will be a direct impact if this is delayed, and it will have a significant impact on the lives of the people that we support, people with disabilities, on our growing waiting list, the waiting list that we shouldn't even have, because this is a state that we have an entitlement for and also the inability to develop sufficient services to meet the growing population.
- Wendy Forkas
Person
And also, it makes it very challenging for us to ensure that we have staff and a workforce that can access and have the culturally appropriate supports for the people that we're supporting. But I honestly want to just make sure we don't forget the families. These families bear the brunt of these-
- Caroline Menjivar
Legislator
You'll have to start wrapping up.
- Wendy Forkas
Person
Okay. I had a parent that actually contacted me. She had gone through multiple service providers for her son. Due to staffing issues, she was forced to stay home multiple times during the week. And at this point she was telling me tearfully that she was going to have to quit her job to be able to stay home with her son. So I just want to really stress that the delay of this full rate implementation is going to have a significant impact on our continuing issues with workforce.
- Wendy Forkas
Person
We are not going to be able to hire staff, we're not going to be able to retain them, and
- Caroline Menjivar
Legislator
We're going to close out there.
- Caroline Menjivar
Legislator
Sorry. Thank you. We're going to move on to our next panelists from the Association of Regional Center agencies.
- Wendy Forkas
Person
Thank you.
- Tony Anderson
Person
All right, I think I get hidden. Okay. Sorry about that. Good afternoon, Madam Chair and Senators and staff. My name is Tony Anderson, and I am the Associate Director of the Association of Regional Center Agencies. So I just got there, I just started there on the eight of January, so I'll be seeing you.
- Caroline Menjivar
Legislator
Welcome to the fun.
- Tony Anderson
Person
Thank you. Thank you. But I'm not new, although I look very young, I'm not new to the system. I've been involved since 1987, which is a couple of years after the Director of the Department. So age wise, you do the math, no. I wanted to also give some context. I love the report that we had for this Committee. The background was really good, very helpful. So I don't have to get into any of those things.
- Tony Anderson
Person
But there were a couple of points that I thought were really important that were missed, and I wanted to highlight them because they have to do with the issue that we're talking about and it really is the workforce shortage in 2016, as it notes that there was a major investment made into this field, and that was wonderful. It was hard fought, but it was made at that time and at the same time, there was a recognition that this was not going to fix the problem.
- Tony Anderson
Person
This was the first time that we were making a significant impact on the issue of the rates. And it had followed over two decades of freezes and delays, or we called them discounts. At the time, there were different things, there were different words that we used, but they were all cuts to the system. So there was a recognition there.
- Tony Anderson
Person
Then the other thing that's important with this is that at the time, as soon as we provided the providers with the increased rate, and it also had a good portion that had to go to the workers because that was very important to the Legislature and the Administration, that the workforce would receive the money that was concerned that they wouldn't. So that was built in. Then shortly after, then the state's minimum wage started to change. Right.
- Tony Anderson
Person
And then, so each year, the providers were paying more and more a higher rate. So these are all also part of the context of the rate of problem that we had. Then you noted in there, that 2019 is when we really moved forward to make a difference. So I thought that those were important to add as well. And then the other piece I didn't see too much on is the current state that we're in today with our community service system.
- Tony Anderson
Person
All of us sort of, we dealt with COVID, we've gone through that. Many of us have moved on in our lives. We've been able to move on in our lives, and we're out in public forums and doing fun things. But what really surprised me, I'm a former Director of a Regional Center as well.
- Tony Anderson
Person
And what surprised me is that we couldn't just flip the switch on and then provide the services to the people who have been desperately needing services because they, like all of us, had been isolated and had been removed from their friends. And loneliness is an issue that is historic in our community that many times we don't want to talk about. But it's a very serious personal issue that comes up over and over again. So that was exacerbated at the time.
- Tony Anderson
Person
So we couldn't flip the switch back on. There was this thing called the great resignation during that time where so many people left in different jobs, right? And so when they did that, they left our field in a much higher rate. And it's not just in California, but it was all over the country in this field for the direct support professionals. They left because of the rates. They also left because the job had changed and people were moving around.
- Tony Anderson
Person
But what happened for us is that we didn't get them back. Right. So because of that, we couldn't get people back into the programs that are in their person centered, individual program plans. That's their goals, what they want in life. With the Regional Centers, we're working with people with disabilities to get them back into their world that they want to live in and yet many of them are still at home with their families.
- Tony Anderson
Person
Many of them will be maybe a licensed home, and they're not able to get to the day program, as Wendy had mentioned, on the basis that they want to. So maybe we were getting them one or two days a week, but that's not their goal. That's not what's important to them, that their friends are there or their support employment opportunities were lost, and that's work. So we're struggling here. Right?
- Tony Anderson
Person
So the Regional Centers, our purpose is to get people to be able to achieve the goals that are in their IPPs, their Individual Program Plans. That's why we're here. So if we don't have the services to get people to those programs. What else do we do? So our service coordinators and families and people with disabilities getting together and coming up with some other things to sort of patch that together while this is happening.
- Tony Anderson
Person
So sometimes we can do that and other times there's just nothing that's appropriate that's going to meet their needs. And so those people are still there at home. It's not everybody, but there are many people that are still not able to move forward. So you hear about the waiting list. I should be clear about what we mean too because they're, the providers are the ones with the waiting list.
- Tony Anderson
Person
So California, we're excited that we don't have a waiting list like other states do because you're eligible, you're in, right? You don't have to wait to get in, but in today's world, you've got to wait to get to the program in many cases that you want to get to because that's the one that will meet your need.
- Tony Anderson
Person
So I think I wanted to make that point real clear that it's not that and that Regional Centers are also then trying to find some other different types of services that you would match and present to the person that would meet some of their other needs. So we have a responsibility to create a network of service capacity, and all of our great community services departments and throughout the Regional Centers do that all the time.
- Tony Anderson
Person
We still bring in new providers, but this is not one of those problems. This workforce shortage is not one of those problems that's going to go away by us creating and bringing in more and more providers. We can't develop our way out of this particular problem. It's the worst I've seen it. And like I said, I've been in here for a while and we never do well when there's a healthy job market in this field. So we've got to compete.
- Tony Anderson
Person
And this healthy job market has been going on for quite some time. So that's on top of all of these other problems that are going on.
- Caroline Menjivar
Legislator
To your final point
- Tony Anderson
Person
Okay, well, there was the question on the individualized measures, and I will just say quickly on that final point and then we'll get to my other one, is that we really want to get to a really robust system where we've got meaningful individual outcomes.
- Tony Anderson
Person
And if this scenario I just painted for you, or we're using different types of services, patching things together, what are we really measuring? Are we measuring something that the person really didn't even want or that's not meeting their full goal? I just say that we've got to get a handle on the workforce issue if we want to do there. And then a real fast fast point is our purpose as Regional Centers when we were created was to be the alternative to the developmental centers. Right.
- Tony Anderson
Person
The institutional model that segregated people with developmental disabilities, separated families, that created isolation for people with disabilities. We were created so that that would not happen and that we would get people to the lives that they want in the community.
- Caroline Menjivar
Legislator
Thank you.
- Tony Anderson
Person
The scenario I gave you shows isolation.
- Caroline Menjivar
Legislator
Thank you. Thank you so much.
- Tony Anderson
Person
So we need to get past that.
- Caroline Menjivar
Legislator
Thank you. Our next panelist from Disability Rights California.
- Tony Anderson
Person
Thanks for your help.
- Vivian Haun
Person
Good afternoon and thank you, Madam Chair and Subcommitee Members. My name is Vivian Haun, and in addition to my day job at Disability Rights California, I also have a brother who has autism and has been served by the Regional Center system for most of his life. I'm so grateful to be asked to talk about rate and payment reform.
- Vivian Haun
Person
I can think of few things more essential than making sure we know what outcomes we want to get out of our system, what we need to fund and how much and where in order to achieve those outcomes, and whether in the end, we're getting what we paid for. As part of the rate reform enacted in 2021, the Legislature and the Administration committed not only to increasing provider rates, but to tying those increases to individual level outcomes.
- Vivian Haun
Person
And that's a fancy way of saying if we're going to be paying more for something, we want to make sure that we're getting more in return, and not just broadly at the state level, but at the individual level. So in other words, are we investing in the kinds of supports and services disabled people need to live the kinds of lives that they want for themselves? Because that's what's at stake here.
- Vivian Haun
Person
Our discussion today must be anchored in how the proposed delay and the potential erosion of our workforce would show up in the everyday lives of the children and adults served by this system. But I want to focus more on one component that I think we don't talk often enough about, which is the quality incentive program. Quality incentives and rate increases have been linked in statute from the beginning, and that's for a reason. They go hand in hand.
- Vivian Haun
Person
I want to talk a little bit more about why. How will the shift to a truly outcomes based funding system help transform what we do, while at the same time helping us to better fulfill the promise of the Lanternman act? First, one of the core principles of the Lanternman act is that services are supposed to be cost effective. We hear that a lot at Disability Rights California, but in practice, how that's often been applied is Regional Centers approving the service or provider that's the least expensive.
- Vivian Haun
Person
But cost-effective doesn't mean cheapest. It means you get the most bang for your buck. Buying only what's cheapest in the moment is often pennywise and pound foolish, as the saying goes. But that's what our system defaults to too often, because we haven't really known how to tell with any certainty what provides the most value in the long run. Where and how, when we buy something, Is that the thing that really gives us the most value for our dollars?
- Vivian Haun
Person
So what would a system truly driven by outcomes look like? It would look at the impact of services on the quality of people's lives and whether they're able to achieve what they want to be achieving.
- Vivian Haun
Person
It would look at things like the degree to which an individual is able to live, where and how they want to live, spend their time doing things that are meaningful to them, have the support they need to be able to make both big and everyday decisions in their lives, and not just be physically present, but seen and known and valued in their community. It's a system that would cover the whole of people's lives, not just the services that they get through the Regional Center.
- Vivian Haun
Person
It would be based on research and best practices regarding quality measurement for home and community based services and would make this data available to drive service improvement and inform what training and resources we need to improve quality and outcomes for people. We don't have that system yet, but we're close. We can and we will. It's in the process of being piloted right now at a few Regional Centers, or will be piloted soon. It's called Pave. Many of us have heard about the Pave project.
- Vivian Haun
Person
It's funded by DDS and spearheaded by CCLN, the California Community Living Network, in partnership with many different stakeholders from the IDD community, the National Quality Forum, the Institute for Community Inclusion, and other national experts on quality and outcome measurement for services for people with IDD. And here's where I will go off script a little bit and just respond to some of the things that I've heard today. I'm with you on implementation.
- Vivian Haun
Person
Like I am not here for just making changes that look good on paper and sound like they might work. I'm with you, Madam Chair. I want to stick around and make sure that those changes actually show up in the lives of people in the way they were intended. One of our problems is that we have not really had many good tools to make those changes happen, to operationalize them at a systems level.
- Vivian Haun
Person
And one of the reasons why I'm so excited about the potential for pave and the potential for quality incentives. Quality incentives are a tool for making sure that the things we think are most important that we want to have happen, actually happen. Because when you pay for the things that are most important, you make it easier for people, for staff, whether it's Regional Center staff, provider staff.
- Caroline Menjivar
Legislator
Vivian, you're always a joy to listen to, but you're going to have to start wrapping up. Please.
- Vivian Haun
Person
Okay, It is, It's a tool. You can use it to incentivize and make it more financially rewarding to do the things that actually lead to the outcomes that we want when we measure it. That is not really a tool we have ever leaned into in our system yet, and we are on the cusp of being able to do those kinds of things. We're so close. The current delay in rate increases, that is not even the end. As many people have said.
- Vivian Haun
Person
That is not the promised land in any way, shape or measure. There's just a life raft we're just like climbing on, and we're just trying to cling to it so we can get to that destination where we can actually do these things, the things that we're starting to do through pave, which is to really make it more possible to drive that change.
- Caroline Menjivar
Legislator
Thank you so much. Thank you. Our next panelist is from the California Community Living Network and Director of public policy.
- Jacquie Dillard-Foss
Person
I'm trying not to break things like Tony did. So I'm trying to behave. Hi, my name is Jacquie Foss. I'm the Board President for the California Community Living Network, and I'm also the Founder of Strategies to Empower People. On April 1st, strategies to empower people will celebrate 30 years in business. We serve Alta California Regional Center, North Bay Regional Center, and since the start, we have done all inclusive supports in the community supported living and independent living.
- Jacquie Dillard-Foss
Person
As the January budget was released, my first question was again, why? The state always says that the budget is a statement of priorities and our values. If that is true, then why are people with intellectual and developmental disabilities always prioritized last? Why? What does that say about the California value? Why is it that when the budget deficit after 30 years, I know DDS's services are going to be targeted once again?
- Jacquie Dillard-Foss
Person
Why is it that 118,000 direct support professionals will again be asked to provide high quality support for poverty level wages? The DSPs are expected to go into the home to teach cooking skills and yet they're going home with food insecurity. Are they able to feed their family and their children? They're asked to access the community, but they're worried about having enough gas to get to work.
- Jacquie Dillard-Foss
Person
Majority of our workforce are single mothers, and what we knew from a questionnaire we did a couple of years ago is that majority of them also access CalFresh and Medi-Cal. I wonder, is that also a California value? Yes. If we value high quality outcomes, then shouldn't we want a well trained workforce that chooses and can afford to stay? That will not happen with poverty level wages. The most important why?
- Jacquie Dillard-Foss
Person
Why is it that over 400,000 individuals with developmental disabilities and their families are faced once again with fighting to protect only the very basic services? Is this a California value? I want to introduce you to Debbie. I'm going to show you that picture first. I'm going to show you her favorite picture. She told me to share with you. That's her favorite picture. That's Debbie at Venice beach. Well, muscle beach. And that's Aj. Debbie is a 59 year old woman with cerebral palsy.
- Jacquie Dillard-Foss
Person
She requires total assistance with her daily activities, from eating to dressing to bathing and personal care. She was placed in a 45 bed nursing facility when she was 14 years old. Can you imagine the fear she experienced as a 14 year old going from her mother's home to a room she shared with three other strangers? Her mother at that time had to make that difficult decision as she had no support in the home. The system failed the mother and the daughter.
- Jacquie Dillard-Foss
Person
At the age of 31, she had had enough of this segregated life and she finally said, I'm done. So in 1995, she packed her bags. She wheeled out of the gardens with the CNA, who said she could live with her. When she was told she was not chosen to be part of the SLS pilot, she said, too bad, which is my Deb. After a few bumps in her new independent life, Steph was chosen to be her supported living agency.
- Jacquie Dillard-Foss
Person
Debbie's GSPs must provide the most intimate care for her, such as bathing and toileting. In her past history, she was a victim of sexual abuse. For Debbie, having to teach people over and over again to do the most intimate care is traumatizing. She has to extend that trust over and over again. She expresses to me she just wants consistent, quality staff that help her live her life her way, the way she chooses. Turnover is not just a number for so many people like Debbie.
- Jacquie Dillard-Foss
Person
It's personal, consistent, quality supports matters. I share the story of Debbie because this is why we are here today. These decisions directly impact Debbie and thousands of Debbies across the state. This is not a mathematical formula. This is her life, a very intimate life that must always be at the forefront of the decisions we make. At the last hearing, there was a conversation with Department of Finance and how they came to the decision to propose the delay in implementation. Was there any other determinant besides math?
- Jacquie Dillard-Foss
Person
The answer was it was due to the current budget and that was how the decision was made. The conversation led me to really look at the other numbers that should have been part of the equation. This is what we know from the 2022 national data on the workforce from the national core indicators across responding agencies. The turnover rates for DSPs on average is 41%, with a high level of 59%.
- Jacquie Dillard-Foss
Person
36% of those who answered the survey had been employed at their agencies for one year or less. Of the 62% who left their job in the first year, they had worked there for less than a year. From the LAO from their report on minimum wage, high, Low or somewhere in between, the majority of low-wage workers are defined as those who earn an hourly wage of 17.50 or less their home health care and personal care aides.
- Jacquie Dillard-Foss
Person
That's the majority of the low-wage workforce in the State of California. Obviously, it frustrates me for fast food workers. They make up the second largest low-wage occupation, but that likely won't be the case on April 1 when they go up to a $20 an hour that kicks in in April. In other words, the largest low-wage work group is home health care and personal care aid. The fast food worker wages needs were addressed, and that's great.
- Jacquie Dillard-Foss
Person
But yet again, our workforce that should be looked at as invaluable continues to be invisible. Is this a California value? I bring these facts forward to emphasize that the delay in the rate implementation will only worsen an already critical workforce shortage. People with intellectual and developmental disabilities should be a core California value if we are to achieve quality outcomes they deserve and we should expect no less. California made a promise, and it's time we keep it. Thank you.
- Caroline Menjivar
Legislator
Thank you so much for your remarks. Now, finally, LAO for your remarks on this proposed delay.
- Karina Hendren
Person
Karina Hendren, LAO, we wanted to start by noting that the proposed delay would help the budget problem by providing about $600 million in General Fund savings in 2024-25. Nonetheless, as has been discussed by many on the panel, the proposal could introduce workforce issues as well as delays in service provision to individuals served by DDS. The Legislature could therefore consider alternative approaches that advance part of rate reform in 202425 while still providing some degree of savings.
- Karina Hendren
Person
For example, the Legislature could consider targeting select service provider codes where the DSP shortages are the most acute, and those targeted codes could receive the rate increase scheduled for July 1st, 2020. For under current law. Oh.
- Caroline Menjivar
Legislator
We are working on it.
- Caroline Menjivar
Legislator
There we go.
- Karina Hendren
Person
Okay.
- Caroline Menjivar
Legislator
Your wish is my command.
- Karina Hendren
Person
Okay, I'll continue. We wanted to note, though, that if the Legislature is considering alternative approaches that funds some degree of rate reform form, this would require working with the Administration to determine what type of targeted or scaled-back approach would make the most sense administratively. And a key point to keep in mind is that alternatives that reduce the amount of funding delayed would still require dollar-for-dollar solutions elsewhere in the budget. And the LAO is available to assist the Legislature in identifying any alternatives.
- Karina Hendren
Person
And we can also provide technical assistance on evaluating trade-offs.
- Caroline Menjivar
Legislator
Thank you so much, LAO. I have one sub chair fellow for Sub Five, I think, Senator Wahab, that already committed to all the cuts in her Subcommittee to save this Subcommittee. So I just got to get all the other Subcommittee chairs to be on board in cutting everything there to save everything on HHS, particularly Human Services portion. I think I forgot one of you who said that.
- Caroline Menjivar
Legislator
I think maybe it was you, Jackie, that you saw the budget proposal in January and you said, of course CDS is going to get some cuts. I looked at it in January. I said, of course Human Services is getting cuts. I think for some reason why. I still don't have an answer, Department of Finance. I would like something more than, given the situation, how we prioritized some of these things.
- Caroline Menjivar
Legislator
And I think every single Department under HHS has heard me loud and clear as to why did some things not get cut that haven't been off the ground. Why are other things that have been working for a while or were really promised for a long time have been proposed for cuts and delays? And I hope in the May Revise we have a better answer to that. I know things are getting worse in this situation.
- Caroline Menjivar
Legislator
I am actively looking for ways to supplement dollar for dollar if we're proposing to keep this in place. I appreciate your other suggestion as to looking at service provider codes and see the ones that need the help the most to keep part of that promise moving forward, everything is on the table.
- Caroline Menjivar
Legislator
And I just want to make sure when we see each other again, departments in May is that we have a little bit of a better methodology to explain how we got to some cuts in some areas and no cuts in other areas and delays and so forth, because these are issues, only in Sub Three, that really impact the actual life of an individual, their quality of life and so forth. I've been part of my tours.
- Caroline Menjivar
Legislator
I visited adult centers, I visited skilled centers for jobs and the IDD population, and so forth. I see the success. And then I think if we don't invest now, a couple of years, it's going to be worse. The reactive cost is always going to be more expensive.
- Caroline Menjivar
Legislator
So I think you shared the cheapest option is actually the more expensive option, because then we're going to have to repeat it and repeat it versus investing in a one-time, really qualitative approach to then get a better return for our buck. Vivian, I feel like you're ready to share something else.
- Vivian Haun
Person
Yes, just very quickly. Thank you, Senator. I just wanted to share, I very much appreciate the LAO's suggestion, trying to look at possible ways to find some kind of compromise or some middle ground to fund some services earlier rather than having to wait until July 2025.
- Vivian Haun
Person
I will say, though, that what concerns me is that while it makes sense logically to try to focus on services where the shortages are most acute, I worry that we don't really know that. Our system does not really have the data yet to tell in any concrete, reliable way where that is. We can't pinpoint. I wish that we could, because that logically makes sense. But I worry that if we say, okay, well, let's do that, how are we going to pick? How can we tell?
- Vivian Haun
Person
I don't think we have the numbers to back it up. So while I appreciate the approach to problem-solving, I worry about that approach for that reason, and that it will feel unfair if we go down that route without good data.
- Caroline Menjivar
Legislator
Senator Roth, do you have anything on this? I would like to also add for the May Revise. I think it'd be really helpful. I know, Chief Deputy, you shared these stipends and so forth, but I think it's for any of our proposed cuts or delays, how are we really going to offset the hits? Better understanding of the strategic planning behind that. I mean, in an ideal world, this doesn't get delayed, right?
- Caroline Menjivar
Legislator
But how are we really going to work with stakeholders to make them whole or have them survive one more year? I stand firm with my Assembly chair on Human Services and saying this is one of our top priorities. Really one of our top priorities. I think I have maybe like four. I'm trying to be really realistic in this and really keep it to the most most most most dire situations that we want to protect as much as possible, given the situation.
- Caroline Menjivar
Legislator
But it'd be helpful for you to come back to me and say, yes, we're delaying, but this is really what we're going to do. I would prefer you come back saying, we're not delaying, but I'm worried. I know you're worried. We're really worried that this is a community that continues to not be made whole in anything, whether it's Regional Centers, whether it's being autonomous in their life, whether they're going to adult day programs, whether it's sub-minimum wage.
- Caroline Menjivar
Legislator
It's hard to pinpoint one thing that we're like, hey, we're doing a great job in this situation. There probably is, but the overarching theme here is like, there's a lot of work that still needs to be done with the IDD population. That just worries me as a whole. If there's nothing further, we're going to hold that item open and take a quick five-minute recess. We will now reconvene on Budget Subcommittee Number Three, Health and Human Services. We have now moved on to issue number five.
- Caroline Menjivar
Legislator
This will be the last issue before we break for some public comments and then go back to the rest of our agenda. We are joined back in the hot seat with the Director, and our second participant is going to be on Zoom. So we're going to start with the Director on issue number five, individual program plan meetings.
- Nancy Bargmann
Person
Thank you, Madam Chair and Committee Members. Nancy Bargmann, Director of the Department of Developmental Services. I've been asked to on issue five on individual program plan meetings, there's two questions that are part of the agenda today, and the first one is just to provide an overview of the trailer Bill proposed. And that on the agenda, page 33 really provides a summary of what the proposed trailer Bill is. I'll just give a little bit of background and then the intent language that is included.
- Nancy Bargmann
Person
So during the pandemic, it became evident that we needed to be able to be flexible, to have access not only to services, but make sure that individuals and service coordinators were coordinating and continuing the work on IPP meetings and also any other check-ins that needed to happen. So that's when we had implemented the remote option. Regional Centers had gone. We had funding available to access technology to be able to support individuals and Regional Centers during that time.
- Nancy Bargmann
Person
So as we move forward, we extended over a period of time, but now we're proposing to go ahead and stop that flexibility. That's in the trailer bill language that we have proposed. We have heard serious concerns from some of our community as to the benefits of having the remote service IPP, that the benefits were being able to have advocates present during the meetings. We're certainly not looking to remove the opportunity for advocates to attend. We're merely really looking at prioritizing having the intent of the value.
- Nancy Bargmann
Person
We talked a lot of conversation today about trust. My background was a service coordinator and one of the things that I really valued and what I was able to do working with the families is really that time spent in person. So why is it that the IPP meeting in person is something that lifting up is a priority is because that is really a time when you're talking about comprehensively, what are the supports and services, particularly during times of transition or changes for the family.
- Nancy Bargmann
Person
It could be going into education. It could be leaving education. It could be changing jobs. There's different times. Right now there's only a mandate of an IPP every three years. There's times it's much more frequent. But over time I've just become increasingly concerned about, let's make sure we not lose those contacts because we keep getting further and further away. During the Great Recession, that's when IPP meetings started going once every three years as opposed to annual IPPs.
- Nancy Bargmann
Person
The other thing that I'll just note is that the meetings we're talking about really are for those that are in family homes. There's mandates for in-person visits when services are being provided outside of the home. So I just continuing getting a little concerned about having the importance of having that relationship building, working with families, and recognizing changes in development or being able to see and talk about what supports are needed.
- Nancy Bargmann
Person
But I also do understand and we're acknowledging that the trust factor plays a role in this. I want to also just flag that as we talk about many of these issues, we're talking about kind of this in isolation, saying, okay, here's the trailer bill for the IPP remote meetings. Earlier you had the standardization and looking at the equity and oversight. So that included a standardized IPP that we need to implement.
- Nancy Bargmann
Person
I think that's really important to also consider kind of holistically when we take a look at this, because as we're standardizing it, we've worked on it over the last year in meeting with stakeholders, getting input on what should that updated, person-centered looking IPP be available? So we have a draft, we've had input from the community. We're redrafting. We're going to get additional input.
- Nancy Bargmann
Person
I think folks are going to be very pleasantly surprised in seeing how it's really leaning into a standard of a person-centered approach, really working with the family and the individual. The other elements that's going to be included in it is the way for after the IPP process, having an opportunity to take a survey. Were their questions answered? Do they feel satisfied with what was being, information being provided? Did they feel like they had a choice?
- Nancy Bargmann
Person
So all of these things I think are really important because as we have those meetings, I do want to make sure that we're also doing a check back to see is it really kind of meeting the needs. So with that, the trailer bill language, we're not extending the remote is what our proposal is, but with the intent of saying let's take a look at it.
- Nancy Bargmann
Person
Updating the language for intent of the value of in-person, the value of making sure that we are having those opportunities, building those relationships, and being able to take a look at services from a whole person and a whole individual, person-centered approach. I'm happy to answer questions to this issue.
- Caroline Menjivar
Legislator
Since it's really short panel, I'll turn over to the one on Zoom from Children's Law Center of California.
- Rose Frihart
Person
Hello. Thank you, Madam Chair and Subcommittee Members, for the opportunity to speak with you today. My name is Rosie Frihart and I want to begin by apologizing that I am appearing remotely. It is maybe apropos given this issue, but it is not a reflection of this issue's importance. I wish I could be there in person, in what I understand as a packed house. I am an attorney at Children's Law Center of California.
- Rose Frihart
Person
We provide court-appointed counsel to the foster youth of Los Angeles, Sacramento, and Placer counties. That's roughly 25,000 youth, many of whom are duly served by the Regional Center system. My job at CLC is to focus on those duly served youth. In my years in this role, I have worked to support close to 1000 foster youth in accessing Regional Center services from 13 different Regional Centers, which means I have attended many, many IPP meetings, both remotely and in person.
- Rose Frihart
Person
One thing I have learned doing this work is that for Regional Centers to properly serve consumers, there must be an option to hold the IPP meeting remotely. Director Bargmann correctly points out not only the importance of the IPP meeting, but also the importance that they be used to build trust, they be collaborative and person-centered. For IPP meetings to be effective and for the resulting plans to meet consumer needs, consumers and their support system must be equal partners to the Regional Center collaborating together.
- Rose Frihart
Person
And while there are advantages to holding these meeting in person, there are also advantages to holding them remotely. For example, holding meetings remotely makes it easier for busy social workers, probation officers, public defenders, mental health professionals, and service providers to attend, improving cross-system collaboration.
- Rose Frihart
Person
But the problem that I really want to point out is not that these professionals may be excluded from the meetings, that they're only in person, or that they might need to call in, though that is a concern, but that there are situations where people who are so crucial to the IPP meeting are excluded that the meeting doesn't meet the basic legal requirements to even be called an IPP meeting. Foster children present a clear example of this issue.
- Rose Frihart
Person
When a child enters foster care, they are detained from the home of their parent or legal guardian and placed in another person's home, or sometimes a group home. They could be with a relative who knows them well, or a total stranger who has no idea they even are a Regional Center consumer, let alone what their specific needs are.
- Rose Frihart
Person
And just because a child is in the care of a foster parent or group home does not mean that the person or staff providing care has any authority to make decisions regarding their Regional Center services. We call these Developmental Services decision-making rights, and those remain with a parent even when a child is removed from their care. It is only when the court finds that limiting that right is needed to protect the child that that would change.
- Rose Frihart
Person
And when the court does grant those rights to another person, it must grant them to someone who knows the child whenever possible, even if that person does not live in the same household as the child. My point is that there are Regional Center consumers who do not live near the person who knows their needs or the person who holds their Developmental Services decision-making rights. For these consumers, there may be no convenient location to hold the meeting if it must be in person.
- Rose Frihart
Person
I'm already seeing Regional Centers insist that meetings be held in person in situations where our clients and whoever holds their decision-making rights live apart. I've seen Regional Centers respond three different ways. The first is that the Regional Center asks that the developmental rights holder call in while everyone else attends in person. This is not a viable option. This does not build the trust that Director Bargmann correctly points out is needed. When one person is calling into a meeting where everyone else is attending in person, it doesn't create the collaborative environment we all know is needed.
- Rose Frihart
Person
It just alienates a person who may already be marginalized during this process. That is not a proper IPP meeting. As troubling as that is the second response I've seen from Regional Centers is even more troubling, and that is to proceed with the meeting in person without including the parent or the person who holds decision-making rights. For example, I have a client whose grandmother holds his decision-making rights, but he lives in a group home.
- Rose Frihart
Person
His Regional Center held an IPP meeting that included my clients, a minor, and group home staff who had only known him a few weeks because his grandmother could not travel to the meeting. This Regional Center just held the meeting without her. They held it not only without anyone who knew this child well, but also without anyone who had any legal authority to make decisions about his services. That is not an IPP meeting, and the results for this youth were disastrous.
- Rose Frihart
Person
This Regional Center took all of the services that were in his previous IPP out of his plan at this meeting without ever discussing it with his Developmental Services decision-maker. This Regional Center was so focused on seeing him in person that they forgot it would mean a crucial person would be excluded from the meeting. I am extremely sorry to say that this happens with shocking frequency.
- Rose Frihart
Person
In fact, I estimate that roughly 20% of the IPPs that I review were created at meetings that did not include the Developmental Services decision-maker. Now for the third thing I have Seen Regional Centers do, and that is rise to the occasion and be nimble. I have seen service coordinators say, okay, we need to hold an IPP meeting. Given this consumer situation, let's hold the meeting remotely, and next week I'll stop by their home or their school or their job, or their day program and see them and check in and build that trust.
- Rose Frihart
Person
These service coordinators got to have the in-person interaction, but still held an IPP meeting that met the consumer's unique needs. All it required was some flexibility. I am speaking about foster youth because that's what my experience is. But this isn't just an issue for foster youth. Every Regional Center consumer is different.
- Rose Frihart
Person
They all have different support needs and different support systems. It is critical that these meetings that are meant to be person-centered respond to each consumer's unique situation. We cannot make the assumption that in-person meetings will meet their needs. The proposed language makes that assumption and not only offers no guidance on when a remote option will be permitted, it removes the option altogether.
- Rose Frihart
Person
I can confidently say that requiring that meetings be in person without any flexibility will lead to inadequate meetings for some consumers because that is already happening even before this language has taken effect. Thank you for your time today. I welcome any questions you might have.
- Caroline Menjivar
Legislator
Thank you, LAO, any further comment? Department of Finance? Director, I agree with you. I know the importance of in person. It's really, really important, especially when we're dealing with vulnerable, complex situations and so forth. I get it. I'm wondering if we can get to a compromise here because you mentioned move forward with this language with the intent. I'm wondering, I'm hoping that within the language we add more flexibility while we work on the intent, right?
- Caroline Menjivar
Legislator
The final goal. I know meeting one time in person in the three years, it's not enough, doesn't really cover anything. And I think meeting in person once a year back before the Great Depression would have been better. I agree with you, but the IPP meetings like, you know, happen more than that, more frequently. If SDPs need a change and so forth. If somewhere we can find a compromise where we're meeting one time a year in person, one time every three year in person.
- Caroline Menjivar
Legislator
But when we have to do those quick IPP meetings to change a plan of the individual, that those can be remote. Or the third suggestion is, what I also heard advocates share with me is that let's have these meetings in Zoom, but also come check up on me when I'm in school, when I'm here, to be able to have that person-to-person contact. I don't know if that's going to require extra human power to do that.
- Caroline Menjivar
Legislator
Adding extra workload to the individual that we already know we have not the strongest workforce, but I'm hoping in the May Revise we get some compromise that meets the needs that you share that I think are very valid, but also for some flexibility to ensure that we do have, like Ms. Frihart mentioned regarding having a social worker, the developmental rights holder, or any other person in that meeting. I think the call-in is not the greatest option, but I do think if you want to share a little bit more, just some kind of extra flexibility.
- Nancy Bargmann
Person
Thank you, Senator. We are in a new age of technology, and I acknowledge that taking a step back and seeing the value of both, of looking at how do we, again, I am a social worker at heart. I wear it on my sleeve. My foundation of my work was as a service coordinator and being able to build those relationships. So I agree. I'm very passionate about this.
- Nancy Bargmann
Person
But I also understand that there's additional ways to be able to make sure that relationships are built if the intent and the supports are there to be able to make that happen. I also understand that in situations, if we are doing this through a person-centered approach, individualized and making sure, I guess I'd say in response, is there a way to have a conversation to look at some flexibilities or to look at a way that can kind of marry kind of two benefits?
- Nancy Bargmann
Person
We're open to those conversations. We've said that also in the Assembly, and we'd welcome conversations to see how do we look at still building that trust, because we've got to build that trust. How do we make sure that when a family or an individual calls a service coordinator, they're calling somebody they know and somebody like, if there's an urgent need? There's times when things happen and they need to make a phone call.
- Nancy Bargmann
Person
If the first time they're making that phone call is only because they've had a virtual kind of relationship, it makes that phone call a little bit harder. So I think that as we have those conversations, if we can think those situations through, I certainly would welcome how do we kind of move forward in a way of being able to help families embrace their advocates or embrace those that know them to be part of those conversations and be happy to do that.
- Caroline Menjivar
Legislator
We're going to be implementing this IPP template starting in January. What I don't want is what we're seeing already, is already Regional Centers saying no more Zoom, even though that's still in effect right now. But Regional Centers, as we've seen, are not all uniform, and they're stopping that. That's why I want to make sure we add some flexibility, extend the flexibility. Hybrid I think for anything post-COVID is like really ideal world, right?
- Caroline Menjivar
Legislator
We've seen in the corporate world or just workplace overall, except for us, we have to come in every single time in person. But we saw the benefits of having things work from home and so forth. But there is benefits of coming in person. Finding a hybrid approach to IPPs while we get this full template standardized in January, just a little bit further now would be great. What I don't want to see is just cutting it off now, six months of waiting, the uncertainty, and then January come back with a new plan
- Caroline Menjivar
Legislator
Again, Director, I get it. I think it's so important. I think about during COVID the cases that we saw. One video went viral of a domestic violence survivor who attended court and their perpetrator was right in front of them and they couldn't tell. I understand. So I get that. I think that's really valid.
- Caroline Menjivar
Legislator
But I also want to provide some flexibility when it comes to, I think about transportation, when it comes to ensuring, having your battle buddy right next to you that makes you feel more confident ensuring what the question is you want to ask. There's the interdisciplinary team surrounding the care of this individual, right? It's so important to be there. So I know, Director, that you want the same thing.
- Caroline Menjivar
Legislator
And I think we can find a compromise for the May revised to give some certainty while we get that standardization. Thank you, Director. Senator? Okay, we're going to hold the item open. Thank you so much for joining us on Zoom. I really appreciate and bringing that foster care perspective. I think that's one of the topics that we haven't really talked about here. Right. Individuals here with other complex issues.
- Caroline Menjivar
Legislator
We're going to hold the item open and now we're going to do public comment on issues one through five under DDS. Issues one through five under DDS. This is not the time where we're going to have call-in public comment. The call-in portion is going to come at the end. I want to quickly note something regarding our public comment situation. You may have noticed that we no longer are doing call-in public comment, that our whole Legislature has moved away from that.
- Caroline Menjivar
Legislator
And what we did today was attempt to get as much of that back as possible to ensure that we were equitable in hearing the voices of as many people as possible. It's not a perfect system, but we did as much as we could to ensure that we heard people that were unable to come to this meeting. I know we have a lot of people that are here to share, so I will be limiting you to no more than 1 minute.
- Caroline Menjivar
Legislator
And I do Reserve the right to decrease that amount as we see more and more of this line get longer. So you may begin.
- Tracy Manch
Person
Hello, my name is Tracy Manch. I thank you for having us here today, Senator. And I just want to say I'm an advocate. I'm an advocate and I get current Regional Center services. I'm a client, but I work in the field also. And I think everything is important of what was said today because I think that we all need to come together as one and help each other get all things together for all of us.
- Tracy Manch
Person
But one of the things that was said just a little while ago about or like staffing issue. Sorry, it's taking me a minute.
- Caroline Menjivar
Legislator
No, you're totally fine.
- Tracy Manch
Person
Staffing issue. I think that we need to really work on that because I live on my own and I have staff come and help me. There's so much turnover because there's not enough because of the wages people. Staffing is way turned over because they're not getting paid enough to help me with my needs and things like that. And I just want to say too, that it's very important. Every issue today that was brought forth for all the agencies. I want to see change in every way.
- Tracy Manch
Person
Possible. Thank you.
- Caroline Menjivar
Legislator
Me too.
- Caroline Menjivar
Legislator
Thank you. And for those who weren't here when I announced, please, if you're not a family member or a self-advocate, if you could go to the end of the line, we're doing families and self-advocates first.
- Mohammed Rashid
Person
Good afternoon. My name is Mohammed Rashid. I'm a self-advocate. I'm served by Valley Mountain Regional Center and I would like to stress the importance of the services, whether it be transportation, day program, caregivers. It's very important that these services are not cut because it is very detrimental to the consumer's life and their Independence. And also, I would like to touch on the service providers.
- Mohammed Rashid
Person
They really need a pay raise in regards to how much they work and they get because they're not getting enough right now. So thank you so much.
- Caroline Menjivar
Legislator
Thank you so much.
- Mohammed Rashid
Person
Have a good day.
- Caroline Menjivar
Legislator
You too.
- Christina Franzoni
Person
Hello. My name is Christina Franzoni. I've been receiving independent lending services from a Regional Center for 27 years.
- Caroline Menjivar
Legislator
1 second. 1 second. Hold on.
- Christina Franzoni
Person
Okay. My statement to you today is, because of my services, I am able to live independently on my own. The skills I get are cooking, budgeting, cleaning, transportation, so I could be out in the community. Without these services, I would not be where I am now. I count on these services because my Independence is very important to me and I am very proud of it. I want to be able to live independently more years to come.
- Christina Franzoni
Person
Please take my speech into consideration is what is important to me and others. I've been living on my own now for 27 years. If I didn't have this service, I wouldn't be able. I gained my Independence. It's not something I want to lose. Thank you.
- Caroline Menjivar
Legislator
Thank you so much.
- Unidentified Speaker
Person
Thank you.
- Elizabeth Drake
Person
Hi, I am a staff...
- Caroline Menjivar
Legislator
Hold on, it's not on yet. 1 second.
- Elizabeth Drake
Person
I'm a staff for Elizabeth Drake, and I will be presenting her speech today. My name is Elizabeth Drake. I'm here today to ask for more money for my staff who need better pay because they deal with lots like our moods and acts. They have families and bills like us.
- Elizabeth Drake
Person
I also think the whole company should get more funding so they can expand their company and provide care to more people with better pay for our staff. I think it would encourage more to join our team. Another reason we could use more funding is so we could get better supplies such as medical equipment like shower chairs, Hoyer lifts, and more to live a more comfortable life and make our staff's job easier. Thank you for hearing me.
- Caroline Menjivar
Legislator
Thank you so much.
- Elizabeth Drake
Person
Yeah, of course.
- Nancy Sager
Person
I'm Nancy Sager, and I represent the Infant Development Association. So the Infant Development Association strongly agrees with, I mean argues, for the rejection of the delay of the increases for early intervention providers and asks that the state to fulfill the rate increase as promised. We are compelled to advocate for the implementation of the rate model, that staff members are properly trained and compensated for their work, so that quality and accessibility of service is struggling. Thank you.
- Caroline Menjivar
Legislator
Thank you. Does the dog have anything to say?
- Nancy Sager
Person
No, he doesn't.
- Caroline Menjivar
Legislator
Okay. Always welcome back.
- Nancy Sager
Person
Thank you.
- Mark Wolfe
Person
Thank you. I've been assigned the tester of the microphone. Doesn't seem to... How are we doing? How about now? There we go. All right, so thank you, Senators. My name is Mark Wolfe and I am a father of somebody, a son with autism who served by the Regional Center.
- Mark Wolfe
Person
I'm also the volunteer President of the Tri-Counties Board of Directors Regional Center, and currently I'm the President of the Board of Directors of ARCA, Amy Westling's organization. My comment is simply this, my son, who works at a grocery store as a cashier, makes more money than his direct service provider, who has to have the skills to work with the complexities of someone with autism.
- Mark Wolfe
Person
The people on the ground working every day for the benefit of others to help the community and contribute to a better society are paid wages that are significantly out of alignment with the times and the work that they do. These folks were promised a rate increase, and now they are told that that might be delayed a year, while their rent, food, and other costs clearly won't freeze for a year. They will go up.
- Mark Wolfe
Person
Senator Menjivar, earlier you said that it's important that the solves for the issues trickle down from the Executive Director all the way down to the ground floor, the people who work directly with our people. To make that happen, we can't drive those very same direct service providers out of their jobs, as it was earlier said that there's an astronomical turnover already attributed to the low wages. The headline is that we could save a billion dollars. And one of the representatives of the finance group was mentioning how we must save money. However, I ask you to consider..
- Caroline Menjivar
Legislator
Final thoughts.
- Mark Wolfe
Person
Pardon?
- Caroline Menjivar
Legislator
Final thoughts.
- Mark Wolfe
Person
Oh, yeah, I'm right there. I ask you to consider not only the unfairness of freezing their low wages, but also that half of that billion comes from the federal government, so we really are saving half a billion. And if you didn't freeze the rates, that billion would be spent by people paid their taxes and come back into the economy. So I'd ask you to look at that. Thank you guys very much.
- Caroline Menjivar
Legislator
Thank you.
- Pat Hornbecker
Person
My name is Pat Hornbecker. I'm Board President for The Arc of California, but today I'm here speaking for my son Joseph with Angelman syndrome, served by the Golden Gate Regional Center. He lives in his own apartment in San Francisco with 24/7 support from the Arc. DSPs assist him with his personal hygiene, dressing, eating, medication for seizures, a sleep disorder, exercising, socializing in his community.
- Pat Hornbecker
Person
He's his own boss and he loves his life. In 69, 1969, California adopted the Lanterman Act, recognizing that people with IDD deserve a life of respect and dignity, equal to any other citizen in California. The Lanterman Act's promise was to fund the system, and that would create this reality. However, we have never been a fully funded system. We took a $1.4 billion hit in 2008, which we never recouped. In 2015, the rate study revealed a $2.2 billion funding gap, and that's now nine years old. And the two year implementation plan agreed to...
- Caroline Menjivar
Legislator
Thank you, ma'am.
- Pat Hornbecker
Person
Is being delayed. No more delay. We need to fulfill the promise. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Raymond Hampson
Person
Thank you, Madam Chair. My name is Raymond Hampson. I'm a parent caregiver to our 33 year old son who lives at home and does receive Regional Center services. We have endured years and years of budget cuts and delays. I ask you why my son and his peers have been constantly treated like fourth class citizens?
- Raymond Hampson
Person
Why has the Governor and the legislature always balanced the California budget on the backs of our community? We have consistently seen the decline and delay of services provided by Regional Center. Services that are in my son's IPP are not being fully provided. We have been told that the lack of providers and staff are the reasons why these services cannot be provided. When does our IDD community become a priority? Without a quality workforce, the Master Plan doesn't matter. The Governor's rate reform delay must be rejected. Thank you.
- Caroline Menjivar
Legislator
Thank you, sir.
- Rosemarie Pérez
Person
Good afternoon. You can hear me, right? My name is Rosemarie Pérez. I serve on the ARCA board and the regional North Bay Regional Center board. My sister Susie lives in a residential facility in Santa Rosa. Her caregivers are the most important people in her life. She also attends a day program. Consistency is crucial to her because she is intellectually disabled, doesn't speak, and she's also blind. So she really needs caregivers to guide her through her through her day.
- Rosemarie Pérez
Person
She also has a seizure disorder. Her medications are very fragile. It is important that her caregivers understand and don't make mistakes when it comes to her medications. Her caregivers are underpaid, which is, and have been underpaid, and this delay is not going to fix that. So I'm asking that you really reject this delay.
- Caroline Menjivar
Legislator
Thank you, ma'am.
- Rosemarie Pérez
Person
Thank you.
- Edith Arias
Person
Good evening. My name is Edith, and I'm here on behalf of my 32 year old Ulysses Arias, who was born to immigrant parents from Mexico and San Francisco. It is important to us that he has received services from the Regional Center since he was four years old and was thriving until the pandemic. Last year, I became his sole caregiver and now also appointed member of the work group for the Master Plan. When Ulysses transitioned from school to the community, he was attending an adult program in person for five days a week and found a job placement in his community. He was being trained to travel independently and was part of diverse leisure activities.
- Edith Arias
Person
But after the pandemic in 2020, he stays home for two days a week to do virtual class meetings. He only goes out three days a week with the adult program for a limited amount of hours, and at times, less days if the staff person is not available or needs a day or week off. Presently, he works 6 hours a week.
- Edith Arias
Person
Despite our local advocacy, Ulysses has not been able to receive independent living services, job coaching, leisure activities, or other services that would help him thrive in the community and live the quality of life that he deserves. This is due to the shortage of staff, the agencies that have already authorized his services for him since his last IPP in 2023. Direct support services need livable ways to support our children.
- Caroline Menjivar
Legislator
Thank you, Edith.
- Edith Arias
Person
Thank you.
- Kelly Pennington
Person
Hi. Kelly Pennington. Thank you, Senator and Committee, for changing the way that this worked so that many of our clients and family members could be here to testify and give public comment. I'm here today on behalf of 30 people and families that were here from 8:30 to 12:30 that had to leave due to busing problems with their day programs. But we truly appreciate you making that alteration so that many people were able to speak. I asked them as they were leaving, I stopped and chatted with them.
- Kelly Pennington
Person
I'm a parent of somebody that, Bradley's my son, and they play Special Olympics with him. And I asked them, what's your message? Yes, Senator, I'll send you that picture. I asked what their message was. And they said that most of the families are familiar with self determination and said that that would not work for them due to their schedules and things. They really appreciate the support that the Regional Center provides for them. They know that it's not a perfect system, but it has helped them tremendously. And the other thing that most of our clients asked me to say is, please hear us, please see us, and please support us. Thank you.
- Caroline Menjivar
Legislator
Thank you so much. I hope the photo came out good.
- Norma Reese
Person
Hi, Senator. My name is Norma Reese. I am a self advocate for myself and my co-workers from the Arc from Fresno. And please help us. Please. Because I've been to seven different job coaches in my program. And that hurts me that if they don't pass this, that would I just stay home, would just live in a necessary place. And CVRC did a lot for me. And I live independent on my own for many years, since I was 27 years old. And I've been with CVRC since I was 31 years old. And please help us. Please, so they can get more staff to take us, to help us. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Alicia Conley
Person
Good afternoon, Senators. The Central Valley Regional Center system is imperative to me and the people I serve. My name is Alicia Conley. I am a person centered advocate with The Arc Fresno Madera Counties. I have personally witnessed the life changing impact of the services Regional Center provides. The delay in the rate reform will negatively impact the individuals I serve. Please keep your promise to Regional Centers regarding rate increase to ensure services for the individuals I serve. Thank you.
- Caroline Menjivar
Legislator
Thanks.
- Ishmael Gaines
Person
Hello, my name is Ishmael Gaines. I'm from The Arc Fresno Madera Counties. I'm here today to hopefully have the fund be up so we can keep the staff. Because I do not want to lose staff anymore. I've been through staff for nine years. They helped me a lot. And hopefully that does not change. Hopefully it keeps staff. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Norma Ramos
Person
Buenas tardes a todos. My name is Norma Ramos. I serve as the Immediate Past Chair of the Board of Directors of the San Diego Regional Center. I am a parent to a young man who is served by the Regional Center. He's 19 years old, and he has been served by the Regional Center since he was 18 months. So we've been in the system for quite some time. The reason for me being here from San Diego is to share that I have the unique perspective of being a board member and a parent, so I know the frustrations that parents feel when trying to access services.
- Norma Ramos
Person
But I also know how hard the staff at the Regional Center works for the families that they serve, so I could get to see both sides. So, again, my son, I have pictures here of him living a full life because we support him. Regional Center provides 40 hours of respite hours for my son, but we only use 20 hours because we don't have the staff that is needed for his care. He needs help with toileting, with bathing, with feeding, with getting him dressed. We can't hire somebody that gets paid close to minimum wage to do the work that is required. Please reject the rate delay. Thank you very much.
- Caroline Menjivar
Legislator
Good luck in the Master Plan Stakeholders...
- Lucero Lopez
Person
Buenas tardes. Mi nombre es Lucero Lopez. Soy madre de dos hijos especiales que pertenecen al Centro Regional Redwood Coast. Estoy aquí para hablar sobre las multiples fallas hijos con los sistemas regionales y uno de ellos, por ejemplo a tan alta para la autodeterminación por mas de un ano para llegar a este proceso. La otra de los problemas cuando llegas a proceso de la autodeterminación con la ayuda de un fácil dejan a la mitad del camino y cuando entona facilitador.
- Lucero Lopez
Person
Que te ayude a terminar el proceso tienes que empezar de cero y es un cuento de nunca. Este hay mucha perdida de tiempo y como yo hay muchas personas que están en la misma. Espera parte de este proceso yo en mi experiencia. Nosotros batallamos mucho para que nuestros hijos especiales puedan tener un servicio de avisos que le dan a nuestros hijos.
- Caroline Menjivar
Legislator
Gracias señora. Gracias.
- Juanita Santa Cruz
Person
Buenas tardes. Mi nombre es Juanita Santa Cruz y vengo del Centro Regional de Redwood Coast. Soy mama de dos hijo con autismo, uno de 21 anos y la niña de 3 anos. A vinimos desde hace tres horas de aquí de camino, dejamos nuestras familias. Familias por venir aquí voy a hablar de la equidad pedimos servicios del personal, naciste en recreación y respiro la del personal. Naciste en recreación y respiro las trabajadoras.
- Juanita Santa Cruz
Person
Siempre nos intimidan diciéndonos entonces, cuando vas a ser? Madre no tienen empatía con los clientes y nos sentimos intimidados cuando nos niegan los servicios. Seguimos sufriendo otro replica de hace un mes vino un grupo. Y dijo que ellos tenían todos los servicios, no se si sera por la raza de color blanco. Pero yo mucha discriminada este. Siempre pedimos un interprete neutral. El nunca se pone atención al pedido que hicimos siempre traen un interprete con perdón, termino por el centro regional es un mini coordinador del centro region y haciendo la mismo revelación. Gracias.
- Caroline Menjivar
Legislator
Muchas gracias. A quick question. Is there anyone from the Department that's understanding the Spanish?
- Unidentified Speaker
Person
Yes.
- Caroline Menjivar
Legislator
Okay.
- Fabiola Reyes
Person
Hola. Mi nombre es Fabiola Reyes. Yo soy madre de una niña que tiene síndrome Down y autismo. Por primera vez no conocí al centro regional y ellos no ofrecieron nada hasta que ay si. Su ay si me empezó a ayudar por ello por ahi. Si, si, yo tengo servicios. Gracias.
- Caroline Menjivar
Legislator
Senator Roth, there's one comment I want to make sure you hear too. And this isn't the first time I've heard it from monolingual Spanish speakers, is that when a mom comes to a Regional Center to ask for support, one of the phrase they get is when are you going to start being a real mother? Because they're coming to ask for help.
- Caroline Menjivar
Legislator
And for them coming to ask for help at Regional Center deems them as a bad mother because I guess they need to do it on their own. And that tends to happen a lot with our BIPOC communities. You may proceed.
- Jill Martin
Person
Okay, thank you. Madam Chair and Senators, my name is Jill Martin. I work at Avenues Supported Living Services. And these individuals are with me, they're also with Avenues. And I wanted to talk about what it boils down to, which is the quality of life.
- Jill Martin
Person
I'm representing the people that I work with, that I coordinate and support, I have for almost 30 years. Some of them have serious health issues, some of them I've actually seen through hospice. And without that extra support and extra training, we can't do those things. And I've got some people with serious health issues. So we need that funding not to be cut. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Scott Shepard
Person
Ready? Go ahead.
- Tracy Whitehorse
Person
My name is Tracy Whitehorse, and I live in my own apartment by my... for 22 years, receiving limit services from Avenues. I am fortunate enough to have receive Section 8 housing voucher, 1993. My Regional Center service are permitted... costs to pay for Avenues. And the coaches who assist me in getting jobs. Thank you.
- Caroline Menjivar
Legislator
I'm glad you were able to get that voucher.
- Cheryl Mayfield
Person
And this is Cheryl Mayfield, and I'm just going to do the intro and turn it over to her. I am a Christian, a board member, a friend and an author. And she lives near you in Mission Hills.
- Caroline Menjivar
Legislator
This is my constituent.
- Cheryl Mayfield
Person
Yes. And Buddy and Jill also, all of us.
- Caroline Menjivar
Legislator
Did I hear him say Reseda?
- Cheryl Mayfield
Person
Yes.
- Caroline Menjivar
Legislator
I thought I heard a Reseda.
- Cheryl Mayfield
Person
As someone who has relied on services all my life, I've had a hard journey because the system is underfunded making it difficult to hire the staff I need. The people most important to me are the people who support me and have daily conversation with me, not the people who sit behind a desk. Thank you.
- Caroline Menjivar
Legislator
Thank you so much. I'll see you in Mission Hills, okay?
- Cheryl Mayfield
Person
We're going to come see you in April. We got a call.
- Ruby Gonzalez
Person
My name is Ruby Gonzalez, and I am from Sylmar, California, close to Mission Hills also. And I come in supporting Cheryl and my brother. My brother also have genetic disabilities.
- Ruby Gonzalez
Person
En mi experiencia tengo 30 anos trabajando con ella y lo que veo es que mucha gente viene a trabajar y yo creo que no reciben el como debería de ser, pero te vengo a pedirle, se puede ayudar en esto? Gracias.
- Caroline Menjivar
Legislator
Gracias.
- Scott Shepard
Person
And I'm Scott Shepard, and also with Avenues Supported Living Services. We provide supports in San Fernando and Santa Clarita Valley areas, and over 70% of the people we support need 24/7 care, but they all live in their own place, have jobs, and we provide the support they need. Over 40% of our staff have been with us for 10 years or more.
- Scott Shepard
Person
It's not because of the wage, it's because of the relationship they develop with people. And we all have gray hair. So we're hoping that before we die that the Master Plan will be implemented. I've got to say I'm not incredibly optimistic because I think, as you said earlier, Madam Chair, that the need is now. So again, we hope that I'm wrong, but a Master Plan for the system is a system whose quality has been unraveling the past decade due to underfunding seems to be a pipe dream.
- Scott Shepard
Person
Again, thank you for your comments, and we urge you not to delay the provider increase. And maybe for that warm shutdown at Fairview, maybe we find a way to either sell it or keep that money in the system. That would be good because we serve some people that used to live in that place.
- Caroline Menjivar
Legislator
Thank you, sir.
- Hércules Perez
Person
Mi nombre es Hercules Perez y soy mama de Pamela de familia y gracías. Nacio la vida de miga cambio y gracias a ICC. Que me ayudo a navegar el sistema del Centro Regional. Muchas gracias.
- Caroline Menjivar
Legislator
Muchas gracias.
- Pamela Perez
Person
Y me gusta la zumba, me gusta con mis amigos. Y gracias.
- Caroline Menjivar
Legislator
Yo no puedo bailar.
- Helena Vargas
Person
Buenas tardes. Mi nombre es Helena Vargas. Soy mama de tres hijo maravillosos atendidos por un centro regional necesitamos que la plataforma digital se sean una opción para las familias en las reuniones de IPP necesitamos que nuestro circulo de apoyo nos acompañe hacia dichas reuniones. Gracias.
- Caroline Menjivar
Legislator
Gracias.
- Maria Gutierrez
Person
Buenas tardes para todos. Mi nombre es Maria Gutierrez. Soy mama de David Gutierrez. Necesitamos mas consistencia y transparencia de los centros regionales y trabajar este mano a mano para hacer la vida esta mas felices de las familias.
- David Gutierrez
Person
Me llamo David Gutierrez. Gracias por terminación... muy feliz contento y que nos digan manteniendo con eso hace fácil nuestras vidas. Gracias.
- Caroline Menjivar
Legislator
Gracias, David.
- John Arriola
Person
Hola, buenos tardes. Mi nombre es John Arriola y quiero hablar un poquito de… I'm talking about... I don't speak too much English. But I want to try to explain. I want to speak about the self determination program. This program is created in October 2013 for the Governor Brown. He set into the law to create the self determination, provide individuals in their families with a more freedom, control, and responsibility in choosing service and supports. So means this is create, this is the law. And then today I hear about this program, about the plan. Let's see.
- Caroline Menjivar
Legislator
Master Plan?
- John Arriola
Person
Yeah, the Master Plan. Why not add in self determination? The Master Plan. Why not put the transportation, the education, add to the self determination. The Master Plan. Put, add over there like housing, employment, and transportation. Those words say in DDS page about the Master Plan, self determination today. Thank you for the people following this plan. Or thank you for the Fernando Gomez, Judy Mark, ICC, Elizabeth Gomez.
- Caroline Menjivar
Legislator
Thank you, John.
- John Arriola
Person
Many people do it for all these plans.
- Caroline Menjivar
Legislator
Thank you.
- John Arriola
Person
Thank you for everyone.
- Unidentified Speaker
Person
You didn't say you were... He's Pamela's brother, the zumba.
- John Arriola
Person
Sorry. Thank you for 22. For Valley Center Regional, the Stockton. The Director.
- Juan Perez
Person
Juan. My name is Juan Francisco Perez. My name is Juan Francisco Perez. I would like to choose my own services providers.
- Unidentified Speaker
Person
I would like to choose my own services and providers. I support SB 138. I support SB 138. Thank you.
- Caroline Menjivar
Legislator
Thank you so much.
- Unidentified Speaker
Person
[Foreign Language]
- Caroline Menjivar
Legislator
[Foreign Language]
- Unidentified Speaker
Person
[Foreign Language]
- Caroline Menjivar
Legislator
The previous young man that came and spoke with the voice device. She has been working with the client and hasn't been paid by regional center to close to almost six months and hasn't left the client. And so the mom was here sharing another story how it lags for regional centers to pay vendors and so forth but she's continued to work with the client.
- Unidentified Speaker
Person
[Foreign Language]
- Unidentified Speaker
Person
Hello, my name is Omar Granados. I am 26 years soon to be 27 and I was born with autism. I live with my parents still and I actually have a few hobbies that I actually like to share that I enjoy digital sketch drawing and I go to the gym in my hometown five to six days a week.
- Unidentified Speaker
Person
[Foreign Language]
- Unidentified Speaker
Person
[Foreign Language]
- Unidentified Speaker
Person
Good afternoon Madam Chair and committee members. I am here in representation of my son who's 25 years old and has autism and IDD. Unfortunately, he couldn't be here because crowds like this make him become dysregulated. My son is in the self-determination program. I am here to express to this committee with support the self-determination program.
- Unidentified Speaker
Person
It's a wonderful program, but we are here to request the state, you guys, to help us break down the barriers participants. So participants are facing in the program so they're to have the right to choose their services and providers and the goods they choose. Finally, I ask you to give us the option to maintain the zoom options. Thank you. Thank you for your time.
- Josue Munoz
Person
Hi, good afternoon everybody. My name is Josue Munoz. I have a younger sister who is on the spectrum and is a participant in the self-determination program. The impact that the program has had on my sister's life cannot be understated. It has provided her with the confidence and foundation to lead a normal life. Although this is true, we have identified many barriers that keep the self-determination program from being as effective as it possibly could be.
- Josue Munoz
Person
We ask that you support each individual's freedom to select the providers and services that they see best fit for their individual scenarios. And along with this freedom, I hope that we all acknowledge that not everyone is in the position to spend months waiting on the end of the program, and we require the regional centers to promptly and effectively authorize FMS so people like myself and I imagine many others in this room do not miss out on vital opportunities for services. Thank you. God bless.
- Caroline Menjivar
Legislator
Thank you so much. I would want to point a privilege here. I have SB 1281 that is looking to modernize the self-determination program and I highly encourage advocates to show support for that bill. Point of privilege over. Go ahead.
- Unidentified Speaker
Person
[Foreign Language]
- Unidentified Speaker
Person
[Foreign Language]
- Dora Contreras
Person
My name is Dora Contreras.
- Caroline Menjivar
Legislator
I didn't know you were going to speak.
- Dora Contreras
Person
These are all people from the same area that come together. I think you've seen me before, right? I'm grandmother to a 31-year-old young man that I raised from the time he was a toddler. He's had a lot of trauma in his life. Consequently, he's very aggressive and has a lot of behaviors. When he was 12, the regional center never advocated for him. In fact, they suggested that I put him in a care home.
- Dora Contreras
Person
I was single, I was a single grandma. So working full time as a school teacher and a principal. So at 12 years of age, I put him in a series of group homes, which caused him a lot of trauma and terrible things that happened to him. When COVID hit, I brought him home and thank you to the ICC that I discovered. They helped me be able to get services for him to have the 24/7 care.
- Dora Contreras
Person
Now he has providers that come to the home and that he calls his friends. So I wonder why at 12 I was not offered a personal assistant. Why I did not have any other services offered to me at that point so that I could keep him at home? It had to be the COVID for me to say I have to take my grandson back. Because in congregate settings we all know what could have happened. Please help us hold the regional centers responsible for young men like my Sergio. It's time for the regional centers to be held accountable for those families with zero services or no services that provide equitable services for all.
- Caroline Menjivar
Legislator
We have to give everybody the same amount of time. Thank you.
- Maureen Fitzgerald
Person
Thank you for taking the time to hear us. I'm Maureen Fitzgerald and I have friends who are served by the regional center system. I would like you to fix the $14 billion data hole in the DDS master plan. What I mean by that, all the departments public education are under the California Public Records Act. Regional centers aren't. We need them to be. If you're going to really let us do a master plan, we need access to the data, and the regional center data is very important. And lastly, I don't think most people realize that 14 of the 21 regional centers are members of CalPERS. I'd say if they're members of CalPERS, they're public agencies. And I hope you'll potentially strip it out of AB 1147, which is on Senate third reading with not a single no vote, and put it in the trailer bill. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Unidentified Speaker
Person
Hello. My name is Guerra. I represent the Arc, Fresno, Madera counties as a special project coordinator. As a DSP myself, I have seen the drastic cuts of staff that has resulted in the loss of individual relationships. It breaks my heart more and more after each conversation we have with our individuals that their DSP is no longer with the company. It brings me such sadness to see our individuals lose a little bit of themselves when they grow an attachment to a DSP and they have to leave because of pay. I have seen too many DSPs come and go within our program, and unfortunately, pay is a huge reason to why they leave.
- Unidentified Speaker
Person
I'm not here for pay because once I started the Arc, I knew this was my calling. But ultimately, this will benefit those who have a voice, but somehow they are being ignored, which are our individuals. Let's move forward with this budget so we can support those who need it the most, our individuals. Thank you very much.
- Caroline Menjivar
Legislator
Thank you.
- Jeannie Ryder
Person
Hi, my name is Jeannie Ryder, and I'm a mom of 14. Eight of the children that I have have been served by regional centers. So I picked one because I knew I didn't have time to talk about all of them. But Kayla came to me when she was four, and she had been abused and neglected and has autism, and so her trust levels are really low. And when I first got her, she wouldn't even leave my sight for about six months. She would scream every time I even went to the bathroom because she was scared. And now she's 32 years old. She lives independently in her own home.
- Jeannie Ryder
Person
24-hour awake staff, because she requires to have awake staff at all times. When her staff leaves her because they get a better job, it's really tough for her. It's really hard. And they're not making a living wage. They're qualifying for food stamps, having to go to the food bank to get food to feed their families. We need them to get a living wage. It's so, so important for all of our people.
- Caroline Menjivar
Legislator
Thank you for sharing her story.
- Sandy Martin
Person
Thank you for your time this afternoon. My name is Sandy Martin, and I have a son with Down syndrome and autism. Additionally, I'm also an ARCA delegate and I'm on the board of directors for Orange County Regional Center. My son has a person-centered plan and he's served very well by the regional center. His plan includes respite and job coaching. Unfortunately, the respite goes uncommitted because the local vendors don't have people. Worse, when they do come, they ask if we will pay them on the side.
- Sandy Martin
Person
So because they're desperate, not because these people are not being paid. Additionally, my son has been working for seven years in a restaurant near our home. It's been life-changing. It's exactly what we're trying to do for our community. He works alongside everybody. He has so much pride. He's got structure. It's fabulous. He also is paid more than his job coach of seven years. His job coach is wonderful. He's a member of the family.
- Sandy Martin
Person
But he informed me that he may leave to work at In-N-Out because he will make more money there. Thank you for your time, and I hope that we get the vendor increase.
- Caroline Menjivar
Legislator
Thank you.
- Unidentified Speaker
Person
Hello, my name is Paulina. I come from Marin County, and I am here to speak up to continue to support my services. I go to Marin Ventures day program, and I do want to continue to support because I have a very good staff and good supporting. And I also have a job too, but I just wanted to continue and I am very happy to support and defend myself that I am here to speak up. Thank you very much.
- Caroline Menjivar
Legislator
Thanks so much for coming.
- Alex Mountford
Person
Hello. Thank you guys very much for your time. My name is Alex Mountford. I'm the president of the California Respite Association. So I'm speaking on behalf of the respite services.
- Caroline Menjivar
Legislator
You can raise the mic.
- Alex Mountford
Person
I didn't want it. The noise was bothering me as well, too. So there we go. Perfect. So close. So I want to echo all of the sentiments, too, about continuing to implement the rate study. This is critical, especially for the workforce. Respite is a core service that often links people, and it's one of the first touch points with people getting connected with the regional center service systems and a critical service that helps transition to adult services as well. Specifically for respite, one of the core problems in the rate study is that additionally, for about a third of the regional centers, the assumed pay rate for respite workers is $15.33. That's $0.67 below the prescribed California minimum wage. And so respite providers are having to make that up with the rest of their rate. It is a critical aspect of continuing to implement the rate study on the current timeline and address these disparities. Thank you very much for your time.
- Caroline Menjivar
Legislator
Thank you so much.
- Edgar Esquivez
Person
Hello. My name is Eddie Esquivez, and I represent Manos Home Care. And this proposed budget delay would destabilize Californians with IDD, their families, and the service system that supports them. It will decrease the access to the services that they need. Now, with even more staff turnovers and more vendors will be forced to ultimately close its doors. Currently, our organization has 150 individuals on our waitlist because we're unable to keep up with staffing demands. And with the proposed budget delay, the problems will obviously make matters significantly worse by now, receiving services that they currently need, it will require them to access more intensive and expensive services later in life.
- Edgar Esquivez
Person
And we could all assure you it is less expensive to continue to invest now rather than adding additional funding later to rebuild the system after it erodes. Californians with disabilities accounting on the Legislature to deliver the promise on the Lanterman Act, please reject the rate delay.
- Caroline Menjivar
Legislator
Thank you so much.
- Robert Harris
Person
Good. I'm not either. Okay. Madam Chair, members, staff. Robert Harris, on behalf of SEIU California, and also on behalf of my two deceased cousins, who, if there wasn't a Lanternman system, they might still be alive, but they ended up in Montana. And what really bothers me is the system right now is dysfunctional. It's not working.
- Robert Harris
Person
And if the rate study doesn't happen, all the plans for going forward with the master plan are based on no foundation whatsoever, because the rates that people get paid now, they don't even know how many people are actually DSPs. They've gotten 53,000 signed up for the class to get the stipends. The data shows there should be 118,000 in California. So there's no way to even locate the people. Right? So our people who work in this system are mostly service coordinators at regional centers. We have a few hundred who work for provider agencies, and they do it for love, but they can't afford to live.
- Caroline Menjivar
Legislator
Thank you, sir. Thank you.
- Timothy Park
Person
Do you want to speak first? Go ahead. They can hear you. Go ahead, Marsha.
- Unidentified Speaker
Person
My name is Marsha. I live in Garden House. I go to school tomorrow morning, Friday, the weekend. Got a new TV in my room.
- Timothy Park
Person
Hi, I'm Tim, an associate director at Marin Ventures, and we have a few of our participants here, including Marsha. I just wanted to speak to the rate model implementation, and we had started to make inroads with the first phases in alleviating some of our staffing problems. And since the budget proposal was announced, we've already started to see some of those inroads eroded. We've already started to see people leaving after we'd seen people come back who'd left us before because they love to work.
- Timothy Park
Person
They love the work. They love the job. And they went to other positions where they could earn more. I'm one of the art staff there, the art creative arts director. Sorry. Now I've lost my train of thought. In any case, I'm here to ask you to refuse the delay. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Andrea Ball
Person
Thank you Madam Chair and members. Andrea Ball here on behalf of the California Speech Hearing Association. On behalf of speech-language pathologists who provide services to infants and toddlers as their vendorized or service providers through the early intervention program, we joined with the Lanterman Coalition and others to urge you to reject the delay in the rate increase. These service providers, many of them are small consultant small firms run by women, many of them more and more bilingual. And they provide services that are critical to infants and toddlers. And we know when we reach young children with these services just improves their opportunities throughout life. And I also want to thank your staff. We had the chance to share with her some of the more detailed information. Really appreciate it.
- Caroline Menjivar
Legislator
Thank you.
- Tamika Hill
Person
Hello, Madam Chair and committee. Madam Chair, I just want to let you know that I really appreciate your tough questions that you asked today, as well as your comment about making the IDD community a priority. So thank you for that. My name is Tamika Hill. I am the executive director for the Arc of Fresno and Madera counties. I'm here to speak about the delaying the rate study implementation. It would be devastating to our industry. It would hurt the most vulnerable citizens that rely on these vital services and staff. We understand that our staff are the key. There was a promise that was made, and that promise should be kept. We understand that the pass-through, a majority of that would go to the direct service professionals. Without the workforce, Californians with developmental and intellectual disabilities will face the raw reality of their services not being met. So this is an entitlement through the Lanterman Act, and our folks deserve it. I am asking for the promise to be kept. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Jordan Lindsey
Person
Good afternoon, Madam Chair, Senator Roth, staff. My name is Jordan Lindsey. I'm executive director of the Arc of California, as well as the ARC and United Cerebral Palsy California Collaboration, as well as co-chair of the Lanterman Coalition. As you know, there have been hundreds of people here today and thousands more watching across the state. And the reason is because there is shock and dismay that Governor Newsom wants to cut $1 billion from Californians with developmental disabilities, their families, and their workforce. There are already thousands of people on waitlists and not receiving the services they need. This cut would cause immediate and direct pain to people with developmental disabilities.
- Jordan Lindsey
Person
So why would Governor Newsom and his administration aim their largest single cut in his entire budget, largest single cut in his entire budget at Californians with disabilities in this community? Especially while wages are going to increase for workers in healthcare settings and workers in fast food settings. Madam Chair, we have heard strong comments coming from the committee already today about the rate model delay. As we just heard from a speaker, a lot of damage is already being done just from the proposal itself. I've heard the administration say this is a starting point. Damage has already started. What we need from the Legislature is a strong response, rejecting this immediately.
- Caroline Menjivar
Legislator
Thank you so much. Thank you.
- Jordan Lindsey
Person
Thank you.
- Barry Giardini
Person
Good afternoon, Madam Chair, Senator Roth. My name is Barry Giardini with the California Disability Services Association and yet another co-chair of the Lanterman coalition. There are a lot of us. I'm not going to be able to tell you anything you haven't heard today.
- Barry Giardini
Person
We are opposed to the delay. We know that it will be harmful. When I hear the Department talk about making these tough budget decisions, I'm not sure they want to do it either. Right? But this is more than math. I get paid to be here. Most of the people here are fighting for their lives. This is what matters. So thank you for listening to them. Thank you for partnering with us on this. I know that we're going to try to find a solution together. Thank you.
- Caroline Menjivar
Legislator
Thank you. You did say something I hadn't heard yet.
- Rand Martin
Person
Hard act to follow. Madam Chair, Senator Roth, Rand Martin here on behalf of Aveanna Healthcare. Aveanna is one of the leaders in providing direct services to about 25,000 regional center clients across the state. We are on the front lines. We know what's happening because of the proposed budget cut on the rate delay. I'm really concerned about being able to retain people.
- Rand Martin
Person
The rates that we've received so far have been helpful, but we're seeing the workforce across the state, across the country, doing much better in other fields than they're doing in the developmental services field. And we need to equalize that in some way in order to keep our folks. One last thought I want to leave you with for those of us who are around during the dark budget days of the recession. We know what happens when something gets delayed a year. It doesn't get delayed a year. It gets delayed a second year, a third year, and we may never see that money come where it needs to be. Thank you very much.
- Caroline Menjivar
Legislator
Thank you.
- Alicia Schott
Person
Good afternoon. My name is Alicia Schott. I am a parent of a regional center consumer. I echo other parents who've already been up here saying it's hard to get DSPs to come in and do work. But also, I am a board member for a regional center, and I've been able to go into several facilities vendors that we work with and heard their complaints that they are having high turnover rates because they can't keep staff when Taco Bell pays more. So I just wanted to echo everybody else saying that they're struggling and we're trying to be a listen for them, but please consider. So thank you.
- Caroline Menjivar
Legislator
I hear you. Thank you.
- Aaron Carruthers
Person
Thank you, Madam Chair, members. Aaron Carruthers, executive director of California's State Council on Developmental Disabilities. The State Council is a body of governors, appointees of people with developmental disabilities, family members and agencies here to advise the administration, Legislature on issues impacting them. They met this week, took a number of votes and letters, will be forthcoming on everything I'm talking about. First item is supporting your bill, SB 1281, on self-determination. Thank you for writing legislation based off the evaluation that the State Council issued. Next is urging flexibility for IPP meetings.
- Aaron Carruthers
Person
Third is, while we've heard a lot about the rate study and its impacts on providers, I brought my own timer so you don't have to watch. The council is concerned about its impact on people and from their own experiences themselves. We have, on one hand, Council Member Julie Gallona, who needs somebody to help her get up in the morning, get out of bed, get bathed, get going for the day.
- Aaron Carruthers
Person
And on the other hand, we have Council Member Nicole Adler, who is hosting a radio show for people called a No-No show of all the issues people with development disabilities shouldn't be talking about, and she's talking about them. So on that whole continuum of experience, these experiences will be impacted. Thank you.
- Caroline Menjivar
Legislator
Thank you. Last but not least.
- Unidentified Speaker
Person
Madam Chair, I wish I was serving with you right now in this time, so we could do this together. Senator Roth, you and I fought many battles together. I'm asking you, I'm imploring you to reject the delay. This is something that we worked on in this Legislature to promote the quality of life for these individuals, and we cannot renege on that promise. We have an ability to improve services. We have an ability and a responsibility to this population that is unsurpassed. It sits on your hands of how we now can continue that promise. You are an amazing chair. I've sat here all day and watched you, and I loved your knowledge.
- Unidentified Speaker
Person
I know that Elizabeth is a big part of it, and I commend her also for all of the background that she's done. But we do need you, Chair, today to announce that you will reject the governor's proposal as the chair of this committee, we needed it publicly, as did Assemblymember Corey Jackson when he did his hearing. When you do that, there's 35 signatures in the Assembly right now circulating a letter rejecting the governor's proposal. We hope that you can do the same in the Senate also, but we're hoping that you come through this after seeing all of these folks understanding the impacts of what the rate will do. And I appreciate your support. Thank you.
- Unidentified Speaker
Person
[Foreign Language]
- Caroline Menjivar
Legislator
Seeing no other further comment, I know I was asked by the Assemblymember on my stance. I think I said it earlier, that I've chosen 3, 4 issues in HHS that I really want to put most of my energy in in prioritizing, rejecting the delay or cuts and the DDS rate reform is within my top four priorities of it.
- Caroline Menjivar
Legislator
We all know and you know, Assemblymember, all of this is a three-party deal, and this item is still open and will come back in May with whatever the department is going to come back with us, hopefully with a better plan and to see how we can address, but also with the mind that hopefully with a better plan. I'll leave it at that. We're going to now move on to issue number six on the preschool inclusion grants delay.
- Caroline Menjivar
Legislator
Welcome back, Chief Deputy. You may begin.
- Carla Castañeda
Person
Thank you, Madam Chair. Carla Castaneda with Department of Developmental Services. Issue six is the proposal to delay the Preschool Inclusion Grants. These were authorized in the 2022 budget. They were intended to support the inclusion in preschool for children with disabilities, as well as to integrate into programs with children without disabilities. Happy to answer any questions.
- Caroline Menjivar
Legislator
LAO, do you have any comment on this?
- Karina Hendren
Person
Karina Hendren, LAO. We just wanted to note that given the Governor's Budget projects multi-year deficits, the proposed delay until 2026-27 is best considered to be a reduction in effect. The Legislature may wish to consider eliminating this program, and we say that because the program has not yet been implemented, and so eliminating it would not disrupt any existing services.
- Caroline Menjivar
Legislator
Department of Finance, anything else to add?
- Christopher Odneal
Person
Just to dovetail off that, Madam Chair. It is an ongoing program that would pick it back up in 2627. And so thank you.
- Caroline Menjivar
Legislator
Okay, no further questions on my end, we're going to hold the item open. Move on to issue number seven, Self-Determination Program Participant Choice Specialists.
- Unidentified Speaker
Person
We know how to clear a room.
- Caroline Menjivar
Legislator
You may proceed.
- Brian Winfield
Person
Good afternoon, Madam Chair. Brian Winfield with the Department of Developmental Services. I was asked to answer the three questions that are on the agenda regarding the Participant Choice Specialists. So, first of all, the Department has had funding of $7.2 million annually for Regional Centers to hire Participant Choice Specialists. These specialists were really aimed at assisting Regional Centers with the Self-Determination Program going statewide and to really help with that ramp-up of the program.
- Brian Winfield
Person
We have heard from some Regional Centers and advocates concerns about the funding ending at the end of this fiscal year. However, the Department is committed to continuing to work with and collaborate with our system partners to continue to prioritize Self-Determination and to continue the current efforts.
- Caroline Menjivar
Legislator
What does that look like?
- Brian Winfield
Person
And I'll get there. Yes. Thank you. The second question was, does DDS anticipate the expiration of this funding to have an impact on participants and new enrollments? As I said before, DDS has really prioritized Self-Determination, as have Regional Centers, and we will continue to prioritize this work. We've received lots of input from system partners as we have developed the program since it went statewide.
- Brian Winfield
Person
And as it notes in the agenda, DDS will add incentive funding through the regional center performance measure to support the Self-Determination efforts to include the ability to hire Participant Choice Specialists. So there is a mechanism whereby we can incentivize regional centers with that funding so that they can continue the current efforts.
- Caroline Menjivar
Legislator
Can you, what was your name? Mr. Winfield? Where are we getting that funding to be able to incentivize.
- Brian Winfield
Person
Yes.
- Caroline Menjivar
Legislator
Or how are we incentivized?
- Brian Winfield
Person
Yeah. And this is through our system reform. People spoke earlier about there being sort of two pieces to it. One is the regional center piece, and the other side is the quality incentive program for service providers. And so we have mapped out with community engagement the priorities within our system, and those are goals that we're working on to really streamline and standardize and.
- Caroline Menjivar
Legislator
Make the 90/10 rule, right?
- Brian Winfield
Person
Right, exactly.
- Caroline Menjivar
Legislator
Okay.
- Brian Winfield
Person
So through that funding, we've been able to incentivize things, for example, like employment, increasing employment outcomes for people, and other items like that. So we would use some of that funding to incentivize the progress and Self-Determination as well.
- Caroline Menjivar
Legislator
Thank you. LAO, any comment on this? Chris, would you like to add something to that?
- Christopher Odneal
Person
Thanks, Madam Chair. I think, just to clarify, I think it's the performance measure funding with the regional centers, not the 90/10 quality.
- Brian Winfield
Person
Oh, sorry.
- Caroline Menjivar
Legislator
Okay.
- Christopher Odneal
Person
That's helping with this effort.
- Caroline Menjivar
Legislator
Okay, thank you. We're going to. No further questions. We're going to hold the item open and move on to issue number eight, Regional Center Family Fees.
- Brian Winfield
Person
Okay, thank you.
- Steven Pavlov
Person
Good afternoon, Madam Chair, Senator Roth. Steven Pavlov, Deputy Director for the Department. So the agenda provides a great overview of the proposal. Specifically, the Department proposes to repeal the Family Cost Participation Program and the Annual Family Program Fee. A little background on the program. So they're income-based and Medi-Cal eligible-based. So with the Family Cost Participation, the program requires regional centers to assess the cost participation for parents of any child through 17 years of age authorized to receive respite, daycare, and camping services.
- Steven Pavlov
Person
And then the Annual Family Program Fee requires Regional Centers to assess an annual fee to parents of children through 17 years of age that meet specified criteria. So both programs currently are suspended through June 30, 2024, in response to the pandemic. These programs are complex to administer, hard to explain to families, and because of the complexities, result in cost offsets and revenue that's largely indeterminate.
- Steven Pavlov
Person
So the aim of the appeal is to allow Regional Centers to focus on the core functions of conducting assessments, of doing service coordination, and providing services. Thank you.
- Caroline Menjivar
Legislator
LAO, any comment?
- Karina Hendren
Person
Just one comment. Karina, Hendren, LAO. Although the proposal would remove a small revenue source, we just wanted to note that keeping the revenue source should be weighed against the administrative burden on regional centers, as well as any potential access issues for families that it could create.
- Caroline Menjivar
Legislator
And that's approximately like up to 1.3 million.
- Steven Pavlov
Person
So the pre-COVID levels for the Annual Family Program Fee was approximately 1 million. Right now, the estimate is closer to 300,000 for the budget year. It's still kind of indeterminate on what the new normal would look like if this was to be restarted.
- Caroline Menjivar
Legislator
I think this is one of the only, if not the only positive issue we're talking about today. Department of Finance? Chris?
- Christopher Odneal
Person
Chris Odneal, Department of Finance. Nothing further to add, Madam Chair.
- Caroline Menjivar
Legislator
Okay, we're going to hold the item open. Mr. Winfield, I had another question for you, sir, if you could come back up. Now is okay. I want to go back to SDP. I know we talked about the incentives and so forth. Have the case workers, have they open trained on SDP now? Since we utilize the specialist case.
- Caroline Menjivar
Legislator
What's the actual term? Since we utilize the choice specialists as the core individual to help. With them leaving, have we started or will we start training everybody else that's left to know about SDP very well?
- Brian Winfield
Person
Yeah. Regional Centers have had a practice of training the service coordinators about Self-Determination prior to the Participant Choice Specialists, and that will continue. Yes.
- Caroline Menjivar
Legislator
Okay, so we. Okay, so I was making sure we didn't lose everybody that knew a new issue. Okay, that was it. Thank you so much, sir. I appreciate it. So, issue eight will remain. We're going to hold the item open and move on to issue number nine on DDS items in Home and Community-Based Services Spending Plan, HCBS.
- Steven Pavlov
Person
So again, Steven Pavlov with the Department, the agenda does a good job providing overview of the key changes. Overall, the Department estimates no change to the HCBS ARPA funding level. So that's approximately 1 billion over the multi-year appropriation. There is a change of 36.9 million in reimbursement authority, and this is due to increased actual federal financial participation in past years. With regards to social, recreation, and camping services.
- Steven Pavlov
Person
So in the current year, given the actual costs and utilization trends, the Governor's Budget updates the fiscal for this initiative, so it retains the $19.7 million, of which $12.8 million is General Fund. This is from the enacted budget, while shifting $22.9 million in ARPA and ARPA-related reimbursement funding to the service provider rate reform. And the intent is to maximize eligible claims, given the limited time and availability of the HCBS funding.
- Steven Pavlov
Person
Just to give you a sense of actual expenditures, so as of September 30, 2023, approximately 1.4 of the $1.9 billion has been expended. And with the rate study being the key driver of the expenditures, DDS projects that all of the HCBS and reimbursement funding will be expended by the end of the current year of the fiscal year 23-24 with the liquidation continuing through December 2024. Thank you.
- Caroline Menjivar
Legislator
Do we know where that is going to be spent? On which of those programs? The remaining 500 million.
- Steven Pavlov
Person
So you have the rate study. You have our coordinated family support program. You have language access. You have a number of initiatives at headquarters for our UFis modernization. It spread out. Multiple initiatives.
- Caroline Menjivar
Legislator
Oh it's spread out, okay. Thank you so much. We're going to move on to our last issue. Issue number 10, probability sampling and statistical extrapolation. Welcome back.
- Pete Cervinka
Person
Thank you, Madam Chair Members. Pete Cervinka again with the Department. Appreciate the opportunity. I appreciate as well that you and staff have saved your most exciting issue for the end. My goal today is to associate this issue with the comment you made earlier about positive things in the budget. Appreciate that. This issue, very simply, thorough write up with information on page 43 puts another tool in the toolkit of our auditors. Historically, the departments produce somewhere between 10 and 18 audits for a number of years.
- Pete Cervinka
Person
We have literally thousands of providers in the system, much in the way that you and I could go to lunch, walk into a restaurant, and know fairly quickly whether it's a good place to eat. There should be an audit equivalent to that. We have begun to do those this year. We're on track to pass over 60 audits this year, so really proud of that, especially given the investments that we've made in the rate structure.
- Pete Cervinka
Person
There are two common audit findings that we find when we audit vendors. One of them is that they've been paid at the incorrect rate. That works in both directions. So I would add that to the description on page 43, and that's really what we're after here when we go in and we audit two different months across the year, and we identify something. The other thing that we would find commonly in an audit is something like billing for authorized hours instead of actually worked hours.
- Pete Cervinka
Person
And when we find a business practice that occurs in two different months during a year, this extrapolation would basically allow us to fill that gap. So it's one more tool for auditors to identify the amount of state money at risk, state and federal money at risk. Nothing about this proposal changes anybody's due process from the provider side. Again, we can identify overpayments or underpayments, and they would still have all the due process they normally would. So this is just one more toolkit.
- Pete Cervinka
Person
But it's a government efficiency measure, in my mind, because it minimizes the paperwork burden on the providers to document what they've been doing and it makes our audit team faster at what they're able to do so we can cover more ground to protect state investments. Thanks. Happy to answer questions.
- Caroline Menjivar
Legislator
Maybe I should have led with the two positive things so everybody could have heard, right? LAO, any additional comment on this matter?
- Karina Hendren
Person
Just noting that we reviewed and have no concerns.
- Caroline Menjivar
Legislator
Chris.
- Christopher O'Neill
Person
Department of Finance, nothing further to add, Madam Chair.
- Caroline Menjivar
Legislator
We're going to hold the item open and close out with public comment on issues six through 10. Public comment on only issues six through 10. Respectfully asking that you stick to those issues at hand. And after the people doing public comment in person, we're going to turn to our phones. You may proceed.
- Jordan Lindsey
Person
Thank you. Much Shorter line this time. Madam Chair, members. Jordan Lindsey with the Arc of California. The Arc is a movement of parents and always has been. And so that is why we were so supportive and so thankful for the proposal to eliminate all Regional Center family fees. Been advocating for it for years. Essentially, what it turns, it turns the Regional Centers into tax collectors, and they have to go out to families. The families hate it.
- Jordan Lindsey
Person
There's this animosity that happens then between families and Regional Centers. So we're very supportive of that. We thank the Department for bringing that forward, and we thank you for hearing that today.
- Caroline Menjivar
Legislator
Thank you so much.
- Barry Jardini
Person
Good afternoon again, Madam Chair. Members of the Committee. Barry Jardini, California Disability Services Association. Similarly, in support of the proposal to eliminate the Regional Center family fees, very much appreciate the administration's efforts to do so. Thank you.
- Caroline Menjivar
Legislator
Thank you so much. No one else in person. Moderator, if you can, queue the people on the phone.
- Committee Moderator
Person
Thank you. Madam Chair, if you would like to provide public comment for issues six through 10, you may do so by pressing one, then zero. Right now. That command again. One, then zero. And we have a comment. Line 12, please press 1 0 again. And we have a comment from line 12. Your mic is open. Please go ahead.
- Stephen Hinkle
Person
Am I line 12?
- Caroline Menjivar
Legislator
Yes, you are.
- Stephen Hinkle
Person
Okay. This is Stephen Hinkel, and I'm a self-advocate who is now in the self determination program. And I'd like to say that it's been great so far, but you need to fix the flaws and support the bill that is going to do that. In terms of the FMS issues, I also support keeping the funding for the participant choice specialists, because people, when they go into that, it's more complicated, but it is far better than the current system.
- Stephen Hinkle
Person
When I was on the old system, I got zero budgets many years in a row, and now I'm on self determination. I get to pick what I want for what the direction I'm going, and that can benefit everyone out there.
- Caroline Menjivar
Legislator
Thank you so much, sir. Next caller. Thank you, sir.
- Committee Moderator
Person
And Madam Chair, there are no more comments at this time.
- Caroline Menjivar
Legislator
Really? I was not expecting that. We went through so many hurdles just to set this up. Moderator, can you just check one more time?
- Committee Moderator
Person
Sure. If you would like to provide public comments today, you can do so by pressing one, then zero that command again. One, then zero. Line 12 queued up again. Would you like me to open their line?
- Caroline Menjivar
Legislator
No, they already spoke.
- Committee Moderator
Person
Okay. Yes. And then we have no further comments at this time.
- Caroline Menjivar
Legislator
Okay. Wasn't ready to leave so early. No, just kidding. Well, that concludes our public comments section. I want to thank everybody. Everybody already left. So I want to thank everybody who are no longer here for coming in the Department again, for joining us and all this, and collaborating and finding a way that come May, we are both realistic in what we're dealing with, but also very strategic and mind full of what we are cutting and delaying and how much that's really going to impact our people.
- Caroline Menjivar
Legislator
If not, you can join me in my office and get all the constituent calls about these issues. I welcome that. With that, Senator Roth, thank you for holding down the fort with me. Budget Subcommittee number three on health and human services is now adjourned.
Bill BUD 5160