Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services

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.

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.

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.

We're going to start with issue one, an overview of the department, and then LAO and Department of Finance.

Would you like me to start?

Please sir, go ahead.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

So I will stop there unless you'd like me to continue to number two.

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?

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.

Thank you. Members, any other questions? Senator Grove?

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?

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.

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.

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.

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.

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.

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.

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.

Director, currently, is it accurate that we have approximately 2000-4000 people only in sub-minimum wages?

Yes, I believe that is the number that is reported, yes.

Okay.

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.

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?

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.

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.

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.

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.

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?

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.

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.

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.

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.

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.

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.

And I'm really worried about 15,000 people that lost their job because of these two pieces of legislation.

Director, any final comments on this? And then we're going to go back to the agenda.

I think I said what I could say on the topic.

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.

You're okay, Senator.

Thank you.

Senator Roth,

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.

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.

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.

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.

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.

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.

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.

Final thought?

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.

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.

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.

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.

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.

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.

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.

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.

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.

Director, how can one individual apply to obtain one of these equipments?

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.

Would they have to go to the Regional Center to request this?

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.

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.

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.

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?

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.

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.

Thank you.

Hello, Director, you may proceed with question number one.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Does Department of Finance or LAO have any additional comments to this?

Christopher O'Neill, Department of Finance. Nothing further to add, Madam Chair.

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.

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?

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?

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.

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.

Those are the three things that came to mind.

Okay, thank you.

LAO, do you have any comments on that? I mean, you're not LAO. Department of Finance, do you have any comments?

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.

Maybe that's where I got budget.

Yes, exactly. Just wanted to clarify. $20 figure not.

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.

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.

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.

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.

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.

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?

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.

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.

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?

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.

The complexities of being able to update that system is not the most intuitive and flexible. So we have more work to be done.

No system is apparently.

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.

Okay, Senator Roth.

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.

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.

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.

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.

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.

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.

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?

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.

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?

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?

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.

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.

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.

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.

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.

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.

And we do have an agenda that is 10 miles long, so I am going to zip my lips. Thank you.

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.

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.

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.

We certainly don't want to get there, but we want to be able to work through and meet the requirements.

Is that within a six month period, one year period, we're talking in five years, maybe we come back to that provider or.

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.

Okay. And it's a standardized timeline for every provider if they don't meet a certain goal benchmark.

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.

Perfect. Thank you. We're going to hold that item. We're not holding, Senator Grove.

She has the habit of looking that way to her. Right.

It's because she doesn't always grace us with her presence in here.

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?

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.

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.

How many staff are at that warm shutdown?

I'd have to get back to you on that.

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.

Senator Grove, that's the next issue.

Okay.

Yeah.

Thank you.

We're going to have a whole panel on that.

Thank you.

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.

We might need one more. Oh, no, we're perfect.

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.

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?

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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?

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.

Would you feel comfortable in the stakeholders that have been announced, have expertise in other areas, not outside of DDS oversight?

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.

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.

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?

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?

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.

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.

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?

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.

Do we anticipate which programs this plan will impact, or are we looking to address every single service under that covers this population?

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.

Does the Department anticipate any funding requests to ensure that this plan is implemented to support it?

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.

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?

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.

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.

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.

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.

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.

Easily absorbable.

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.

Thank you, colleagues. Any other questions? We're going to move on to our second panelist from Disability Voices United.

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.

Madam Chair, I just want to say to the panelists, you're up on the TV, too, so you're okay.

When you talk, you're on TV so I can see.

Thank you.

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.

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.

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.

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.

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.

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?

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.

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.

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.

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.

Thank you so much for that energy. I appreciate it. Moving on to our third panelist from Integrated Community Collaborative.

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.

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.

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.

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.

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.

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.

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?

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.

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.

Director, is it correct that there is only one Latino individual?

I believe that's referring to a self advocate, and so of the self advocates? I believe that that is correct.

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?

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?

Right.

We have to make sure that all those voices are heard, and it has to be done in a very meaningful and purposeful way.

Helpful.

Okay.

Thank you so much. We're going to move on to our next panelist from San Diego Regional Center.

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.

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.

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.

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?

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.

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.

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.

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.

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.

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.

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.

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.

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,

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.

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.

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?

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.

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.

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.

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.

Thank you.

Thank you.

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.

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.

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.

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.

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?

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.

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.

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.

The system to us.

We are the disability community, and the system is what is supposed to be supporting us.

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?

Okay.

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.

Thank you.

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.

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.

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?

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.

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.

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?

The lucky number?

Like why 21?

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.

And so you have 21 Regional Centers. Our community populations have evolved and changed.

Right.

So you could see where Inland Regional Center, North LA Regional Center, other Regional Centers have grown.

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?

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.

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?

Yeah. Okay, thank you. Moving on to our next panelist from the California Community Living Network.

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.

I would consider this the first roundtable.

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.

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.

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.

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.

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.

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.

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.

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.

Before we turn over to LAO, our final panelist from Disability Rights California.

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.

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.

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.

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.

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?

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.

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.

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.

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.

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.

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.

You're going to have to wrap up, will.

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.

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.

I appreciate the opportunity to testify.

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?

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.

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.

Thank you so much.

Thank you for the question.

Moving on to Lao.

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.

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.

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.

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.

Happy to engage in that conversation with you.

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.

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.

And then one of my final thoughts on this is this is neither. I think it's good. It holds us accountable, right.

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.

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.

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.

Thank you.

Senator Roth.

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.

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.

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.

Thank you, Madam Chair.

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.

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.

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.

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.

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.

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.

Thank you so much, Senator Eggman.

I just want to ask, Deputy Director, is this your only job now, Victor? Another duties as assigned.

This is my top priority.

Crafty way of answering that. Got it. Okay. Make it a priority.

Department of Finance, anything you'd like to add?

Thank you, Madam Chair. I think everything that's going to be said was said on this panel.

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.

We're not even before yet.

Can. It's.

Are we all here? Believe we're all here. Okay, we're going to get kicked off by LAO.

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?

Yes, please.

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.

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.

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.

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.

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.

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.

Thank you so much. Moving on to our Department representative.

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.

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.

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.

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.

Sorry. You're going to be collecting data on SOGI data?

Currently, in our system, we only ask, do you consider yourself to be male or female?

Oh, okay.

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.

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.

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.

Could you actually answer the questions in the agenda?

Yeah, absolutely.

The first one is, how are you collaborating with stakeholders, including individuals and families served?

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.

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.

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?

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.

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.

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.

Thank you so much. We're going to move on to our next panelists from our Association of Regional Center Agencies. Welcome back, Amy.

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.

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.

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?

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Can you start wrapping up?

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.

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.

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.

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.

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?

So when I say controlling for those costs, what I'm really getting at is comparing apples to apples.

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.

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.

We know that age and residential setting play a tremendous role in some of those additional costs.

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?

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.

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?

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.

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.

And does the Association play a part in preventing TA there?

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.

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.

Is it more reactive, though, or does Association help police your own?

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.

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.

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.

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.

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?

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.

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.

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.

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?

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.

Okay, we're going to move on to our next panelist. Joining us from Integrated Community Collaborative Alianza de Hombres.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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?

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.

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.

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.

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

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?

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.

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.

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.

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.

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.

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.

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.

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%.

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.

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.

Mr. Gomez, just final thoughts?

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.

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?

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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?

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.

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.

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.

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.

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.

Ms. Westling, I know you asked that question, but do you have a definition of your own?

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.

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.

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.

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?

I'm going to allow some final thoughts from any panelists.

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?

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.

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.

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.

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.

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?

Anyone else? If not, we're going to turn to Department of Finance for final. Ms. Westling?

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.

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.

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.

It doesn't fix it for you, but know that those things then do shape public policy.

Department of Finance, do you have anything to add?

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.

Great. Thank you so much for this conversation.

Thank you.

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.

We're going to start first with Department of Finance, who will then tag team the Department.

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.

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.

From here, I'll pass to Chief Deputy Castañeda.

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.

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.

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.

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.

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.

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.

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.

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?

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.

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.

I apologize. Chief Deputy I guess I'm not really thinking, I'm getting, not that I'm looking for a specific answer.

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.

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.

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?

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.

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?

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?

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.

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.

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.

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.

Senator, can you clarify the HCBS spending plan funding?

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.

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?

Are you speaking to unspent dollars like in other-

I just meant career pathways

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.

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.

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.

Thank you, Senator.

Let's move on to our next panelist from the California Disability Services Association.

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.

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.

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.

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.

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.

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.

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?

Or what we've had to do in the last few years is actually ration staff hours.

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.

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.

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.

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-

You'll have to start wrapping up.

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.

We are not going to be able to hire staff, we're not going to be able to retain them, and

We're going to close out there.

Sorry. Thank you. We're going to move on to our next panelists from the Association of Regional Center agencies.

Thank you.

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.

Welcome to the fun.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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?

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.

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.

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.

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.

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.

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.

To your final point

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.

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.

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.

Thank you.

The scenario I gave you shows isolation.

Thank you. Thank you so much.

So we need to get past that.

Thank you. Our next panelist from Disability Rights California.

Thanks for your help.

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.

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.

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.

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.

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.

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?

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.

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.

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.

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.

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.

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.

Vivian, you're always a joy to listen to, but you're going to have to start wrapping up. Please.

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.

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.

Thank you so much. Thank you. Our next panelist is from the California Community Living Network and Director of public policy.

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.

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?

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.

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?

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.

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.

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.

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.

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?

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%.

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.

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.

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.

Thank you so much for your remarks. Now, finally, LAO for your remarks on this proposed delay.

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.

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.

We are working on it.

There we go.

Okay.

Your wish is my command.

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.

And we can also provide technical assistance on evaluating trade-offs.

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.

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.

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.