Assembly Budget Subcommittee No. 2 on Human Services

Good afternoon and welcome. This is the Assembly Budget Subcommitee 2 on Human Services. Today we'll be discussing critical issues regarding Developmental Services for individuals with intellectual and developmental disabilities and rehabilitation services for those with occupational challenges, including blindness, traumatic brain injury and other disabilities. Before we invite our first panel, let me just make a few remarks.

I'd like to first pause for a minute and reflect on all the progress we've actually made together. It has been through your work, those of you who are in this room, advocates and through education, both of others and Members of this Committee, those who have sat on this Committee past and present, that California is leading in many areas of providing services to our most vulnerable populations.

While we know what it means to have progress in this space, we must be active participants to show up and to also hold the line. We have to make sure that we continue to support those who continue to travel here to tell their stories, to talk about the challenges that they face.

They have been invaluable to this Committee, and we continue to look forward to hearing all those affected in these subject areas in the future. Also, I want to make sure that we understand that we still have a long ways to go to. We still have much to do.

And when we feel like we're about to make progress, sometimes we just can't catch a break and some other disaster happens in California and all those things. But it's important for this Committee to know, no matter what happens in this state, things that we can't control, we will not forget you.

We will not forget the work that we still need to do. And we will not forget the dedication, the discipline and the courage we may have to press forward even when it seems that it may be impossible to do in one year or the other.

I want to also make sure that we understand that these issues continue to be complicated, but through collaboration, through great communication and some downright grit, we will continue to make progress in years, both large and small. So I want to thank everyone for being here.

I want to make sure that everyone knows that public comment will be at the conclusion of all the issues and each person will have two minutes and there will be an audible beep at the two minute mark. There will be no votes taken in today's hearing.

And so I'm going to ask the first panel to take their seats and you may introduce yourself. We are going to do this a little bit out of order on issue number one, but we were going to we're going to start off with the Department of Rehabilitation and then we are going to do the Department Developmental Services.

And then we are going to do the LAO and then we will do the our advocates after that. Okay. And Chief Deputy Director, you may begin when you're ready.

Thank you so much. Assemblymember Jackson. So again, my name is Victor Dur0n. I'm the Chief Deputy Director for the Department of Rehabilitation. But today I'm here on behalf of the California Health and Human Services Agency, where for the last year I had the great privilege of serving as the Project Director for the Master Plan for Developmental Services.

So I'm going to to get us started, do a little bit of level setting about what the Master Plan was and the process we undertook over the past year and really spend some time talking about how this has been truly a community driven and community centered effort.

We began this effort last March, so it's been just over a year. And while the Department of Health and Human Services or while the Health and Human Services Agency with the Department of Developmental Services, the Department of Rehab and others provided resources and created space, this truly was an effort driven with and by community.

The recommendations in the Master Plan are a reflection of the diverse voices of community and their vision for a future for Californians with developmental disabilities.

This Master plan was rooted in several key principles including consistency and accessibility to services for all people, equity, recognizing that different communities experience different outcomes and different access to services, and most of all, community engagement. The community engagement really was central to this effort and it showed up in a variety of different ways.

We established a steering Committee with 38 Members that represented a diverse range of perspectives, principally people who benefit from services. We engaged in 45 different community engagement sessions up and down the state with diverse ranges of communities, cultural disability specific, issue specific communities.

We held two public comment sessions at every Committee meeting and a public comment meeting at every work group. We established five work groups with nearly 100 Members collectively from the community, representing a diverse range of ethnic, racial, socioeconomic, geographic and disability type to make sure that we had a wide range of perspectives.

And we also ensured that we used the stakeholder engagement and the public comment to lift up any issues that arose. That despite these really diverse communities that we pulled together may not have come up through that collective wisdom as well. So all of this truly was centered in how do we ensure that voices of community are heard.

To further ensure that this was led by voices of community, we had five workgroups that each had two co chairs. And in each of those work groups, the co chair was a family Member of a person with a developmental disability and very importantly, a person with a developmental Disability.

Truly a leader with a developmental disability who knows firsthand what is best for them, what they need, and how their life can be the most self determined and autonomous as possible. On Friday we will publish the final draft of the master plan.

There was an initial draft published on the 12th and the final will come out this Friday. And in that you will see a number of things. You will see about 170 recommendations across a wide range of topics and I'll very quickly go over the five main topic areas covered.

We open with equity, how we center this system, inequity, supporting choices of people with developmental disabilities, ensuring access to essential services, building up that workforce that supports the system, enhancing accountability and transparency in the system and looking to the future of the Developmental Services system. You will also see in the report a commitment to plain language.

I think it's perhaps, I would venture to say it might be the most readable government report you will have an opportunity to read and hopefully will set a new precedent for how we can communicate in plain language moving forward.

And you will see a really clear vision for the future of the Developmental Services system driven by the diverse voices of communities that stand to benefit from it.

Thank you, Mr. Chair. Pete Chervinka. I'm the Director at the Department of Developmental Services and just ditto to everything he said. Really appreciative to the people in the community that lent their time and expertise and then also to Victor himself and the cast of many people that contributed to that work.

Bringing it to a conclusion in name on Friday. The obvious question then is what happens next here to tell you today that the master plan is going to be embedded in all of the work that we do going forward. It's going to be a key part of the information.

And precisely because government is supposed to implement what people want. And that master plan is a reflection of what the community wants for the future of development disability services in California. There are some questions in your agenda and I'm going to explain why I'm not going to answer it quite the way the question was asked.

There was a question about roadmap for its implementation. And you know, really, I think the answer lies in what I said before. We're not prioritizing services for people with autism over employment opportunities, for people who want employment opportunities, as we do work on those topics. The master plan is of course going to inform that work.

And those are just two of of course, many examples. So there isn't perhaps a roadmap and a timetable for that. Mr. Chair, you alluded in your opening remarks to some difficult times ahead. And we'll talk about some of those things in future panels.

But it's, I think, an important point in time for us to recognize that the voice of the community here has been heard, has been document is going to be retained, but it's not just a plan on a shelf, but actively referred to in terms of all of the work that we're doing across the spectrum of services and supports.

I would also extend appreciation to Secretary Johnson of the Health and Human Services Agency and her team. They have an ongoing expressed commitment to ensuring that other departments within the agency and entities in state government beyond our Department and agency will also be included as they are needed there.

You know, Victor alluded to a number of the themes in the Master plan and I think it's important to always remember that while dds, Department of Developmental Services is often first thought of when it comes to developmental disabilities, the people's experience with government goes well beyond what a single Department provides.

So whether we talk about transportation, housing, healthcare services, education, there's lots of work to be done and we'll talk about employment in another panel again today. So there's lots of work to be done beyond the confines, if you will, of the Department and Regional Centers as well.

There are a few themes that I took away from the master plan and I would share them here with you today in the vein of talking a little bit about things in the short term and longer term, longer term perhaps first is a little harder to predict.

We have an entire panel on federal happenings later today in the agenda, but it's a good example. Between that and you mentioned La Wildfire Response and another panel again later today, there are things that come up that sometimes create competing priorities for time, attention and resources. So it's really difficult, difficult in the face of some uncertainties to prepare a long term plan.

What I will say is that themes from the master plan, things that we commonly think about equity has been a long running conversation, kind of basic fairness, access to programs, timely transition to services, more understandable processes for people, more understandable information to people.

There is a boatload of work already underway that can still be informed by the Master Plan before it's concluded. Things for example, like standardizing the intake process across Regional Centers. So there's some really important work to be done that can, I'm sorry, work underway that can be informed by the master plan.

And there may be new work that we want to start and future work that we couldn't today yet envision. And obviously there's gradations of simplicity to complexity, resource availability and other concerns that need to factor into that. So I can't promise you a plan for implementation of the Master Plan from the Administration.

What I can tell you is that we take very seriously the voice of the community and the effort people put into it. We plan to make use of it on an ongoing basis.

There's a list I brought, but I won't read to you, of 15 different efforts we have underway where the voice of the community is involved in the public process, but also more importantly and your agenda references this.

And I appreciate that twice a year we're going to invite the Committee from the Master Plan back together to go through the recommendations and not just for the Department to say what's being done on them, but also to hear what's being being done. The Administration and the Legislature without offense, doesn't have a monopoly on the ability to take action on these things.

So using that twice a year convening of the Committee holds us all accountable for making sure there is progress to report on something and existing statute requires in March every year starting next year a report to the Legislature on the Master Plan and its implementation. So there's a variety of commitments there that I've outlined to you.

But I just want to close again with gratitude to the Committee community and the effort they put into development of the plan itself. Happy to answer questions or hear from other panel.

Thanks. Thank you very much LAO.

Karina Hendren with the Legislative Analyst Office Just wanted to start by noting that on March 5th the LAO published our analysis that addresses the Master Plan's development and implementation process. The hearing for today's agenda does include excerpts from that analysis and then the full text is also available on our website.

And we wrote the analysis in the anticipation that the Legislature would receive the Master Plan in late March. Again, it came out on March 5th and so the Master Plan draft hadn't actually been published at that time.

But we are talking about the overall process and implementation and the analysis is intended to give the Legislature some guiding questions that it could ask, for example, in the hearing today in thinking about the Master Plan.

So we want to start our comments by noting that this Subcommitee adopted budget related legislation last year regarding legislative intent for the development of the Master plan and that legislative intent was that the Master Plan be developed as a cross departmental and multi agency effort.

And today we recommend that the Subcommitee ask the Administration to explain the extent to which the development of the plan over the course of the past year has aligned with the legislative intent outlined in that legislation and these recommended questions are included at the top of page 10 of today's hearing agenda.

Next, we want to note that the master plan includes recommendations for some significant policy changes, including changes to the Lanterman Act. For example, one recommendation would call for amending the Lanterman act so that people with IDD can choose to leave the school system at age 8 rather than at age 22.

The master plan also includes recommendations that would require significant budget changes, for example, increasing SSP payments or updating provider rates. There are also several recommendations that call for changes in departments other than dds. As the Director noted, this is a system where individuals are served by multiple departments.

Some of those are even outside of the Cal HHS agency. And if implemented, several of these recommendations would represent fundamental changes to the existing Developmental Services system. And finally, as the Administration noted, the master plan reflects recommendations developed by the community. This is following a process that was established in statute.

The recommendations do provide valuable information about opportunities to improve the experiences of individuals and their families who received Developmental Services in accordance with statute. The Administration didn't filter any of the recommendations for feasibility in terms of legal or budget constraints. And the Administration also did not comment on any of the policy merits of the proposed recommendation.

And as a result, the plan is not necessarily ready to implement in its current stage. For example, there are some recommendations that could potentially overlap with each other or overlap with efforts that are already underway by the Administration. There are some recommendations that could potentially be constrained by existing laws and regulations.

And so to address this, what we're recommending is more information from the Administration on how these recommendations could be translated into a more feasible or actionable set of budget and policy proposals for the Legislature to consider.

And so we think that the Legislature really needs the administration's expertise when it comes to addressing maybe some of those legal constraints or changes to. To statute that might be needed, or thinking about staffing changes, for example, issues directives to Regional Centers.

Kind of just more that nitty gritty detail of what is needed to actually put this in place. And again, the Administration holds that expertise.

And so we're recommending that the Legislature work with the Administration to provide that technical expertise on what it would take to take these recommendations from the community and actually translate them into implementable policy and budget proposals. Thank you. oh, sorry. My colleague also had a quick comment.

Yes, good afternoon, Dr. Jackson and Committee staff. Mark Newton with the Legislative Analyst Office.

Just wanted to speak just very briefly in response to the Department directors DDS Department director's comments about priorities and Maybe difficulties in having a roadmap going forward, given the difficulty perhaps of judging across various priorities for the system, of not being able to say one priority is more important than the other.

Maybe I'd like to comment on that because I think our view is that the community has done really excellent work here in providing information that really can inform the Legislature and the Administration sort of going forward and you don't want to sort of lose momentum with that.

The recommendations are very, very wide ranging, as was mentioned, 170 recommendations covering a whole slew of different sort of policy priorities. Many involving, you know, could potentially involve, you know, major, major funding requests, major changes to policy that is in current law.

And I think going forward, what we would view as being very helpful, I think, to the advancement of all the work that's been done is to have perhaps some focus and I guess a plan for going forward.

And in terms of priorities, we do think it is important for the Administration to take a first look at being informed by what the community has presented, but provide the Legislature with its long term vision of changes within the Developmental Services system based on all the recommendations that the community has brought forward and letting the Legislature know, you know, what types of activities would it like to effectuate first and the changes that are necessary and you think to sort of to continue the momentum.

But you need to have some focus in a plan because it's quite unwieldy what's been presented, but it's, it's very valuable information. But you need to have sort of focus and sort of a plan of what you're working towards.

And I think the trailer Bill legislation that the agenda sort of mentions I think could be a good step forward or so. But just wanted to add those additional comments and really happy to respond to any questions of the Committee.

LAO, you have got to stop telling us to focus and you've got to stop telling us to be responsible. This is not going to work. This is not going to work. Thank you all very much. Organization representatives, please come on up for issue number one. I have integrated Community Collaborative. I have Association of Regional Center Agencies. I have Disability Rights California, come on up.

And we will start with Integrated Community Collaborative.

Good afternoon, Chairman, Dr. Jackson and Members of the Assembly. My name is Oscar Mercado and I am honored to speak today. As a self advocate, Director of Community Programs for the Integrated Community Collaborative and a Committee Member for the Master Plan for Developmental Services, I want to begin by thanking this Subcommitee for the chance to speak today.

We've heard from the department that there will be two stakeholder meetings moving forward. While that is the step in the right direction, this is not the way to really move forward.

I want to be sure that there is a legitimate concern that despite the tremendous effort and engagement that went into developing this plan, that there's a potential risk that it could be sitting on a shelf, forgotten, underutilized or selectively implemented in ways that do not reflect the needs of our community.

We have to ensure that this does not happen and I believe in order to fulfill that promise of the Master Plan, we should take immediate and concrete steps to avoid that. Categorize and prioritize all 170 recommendations covering everything from service accessibility to equity and funding.

But without a structured process to prioritize and classify these recommendations, progress will be slow, unfocused and fragmented. Establish a Stakeholder Implementation Committee. Just as the Master Plan on Aging has dedicated stakeholder group overseeing its execution, we must create a similar committee for the Master Plan on Developmental Disabilities.

This committee should include self advocates, families and community leaders who will monitor and ensure transparency, hold agencies accountable for ongoing commitments, and identify challenges and solutions to prevent delays in execution. Improve accessibility and community engagement. This Master Plan provides a pivotal opportunity to shift from a compliance driven system to one that is truly person centered.

Equity is only possible if we listen to the community. The individuals and families directly impacted by these systems, Regional Centers and organizations profiting from serving the developmental disability community cannot dictate the priorities. The Master Plan must prioritize the impact it will have on individuals with developmental disabilities.

The community implores that their comments and input must be included in this process, not just written down on paper. Some recommendations that the community and I feel very passionate about are improving the Self Determination Program to ensure it fulfills its promise of providing a person centered choices.

As a participant in the program, I can attest that SDP person provides more freedom of choice and helps me become more independent, thus being a tremendous game changer in my life. Number two, providing compensatory services to people and families whose Regional Centers have wrongfully denied or delayed the services they need.

I went on without services during the toughest moments of my life. Had I been provided support at the time of my greatest needs, my life in progress would be very different.

Expanding Choices for Service Coordinators Enabling families and clients to have control over who manages their care Choosing our own service coordinators expands the potential for quality service coordination. Honoring the individual dignity of the human person Implementing robust accountability performance measures to ensure accurate, high quality service delivery.

Right now the system operates without meaningful consequences for poor performance, leaving families vulnerable and having to face constant barriers just to attain services for their child. The submission of the Master Plan is not the finish line. It is a starting point.

The responsibility now lies with all of us to ensure that this plan leads to real, measurable change in the lives of individuals with disabilities and their families. As a self advocate, I feel that this plan is about creating meaningful change.

For too long there has been an outcry from the community highlighting the cracks in the system that that cause people to fall through them. This is our chance to make things right, to create a system that prioritizes people over policies and paperwork.

I urge everyone here present policymakers, agencies and community advocates to seize this moment and fix the system which requires a great need of repairing. People's lives are at stake and we must ensure we do everything in our power to make this right with community engagement and collaboration.

Thank you for giving me this time to speak and may God bless you.

Good afternoon, My name is Amy Westling. I'm the Executive Director of the Association of Regional Center Agencies and I'm here today speaking on behalf of the state's 21 Regional Centers, but also as one of the Co Chairs of the Lanterman Coalition.

First off, thank you to the Chair Members and staff staff for the opportunity to speak today and particularly to Nicole for the thoughtful and comprehensive agenda and we know these things don't right themselves and really appreciate it. Shout Out.

I've had the honor over the last year of being a Member of the Master Plan Committee and want to share with you some of the thoughts and reflections that I've had as a part of that process.

First and foremost, what I will leave with is the appreciation for the work throughout the process that went into prioritizing and supporting the authentic voices of our self advocates. For too long we have relied upon others to speak for and on their behalf, including professionals.

And really shout out to Victor and his team for reminding us all this needs to be a priority and for doing an artful job in ensuring that their voices were heard and were central to the process.

What we heard from our self advocates was that people value California's service system and want to lead its continued evolution, including making services easier to navigate.

Many expressed appreciation for their service coordinator, but the sense that too much time is spent on administrative functions and these are all things that as professionals we know from an objective perspective, but hearing it from the people we're here to support is really impactful.

ARCA supports many of the elements of the plan and wanted to call out a couple that stood out as foundational for future work. First, the recommendation to clearly define equity. Everything we do in this system is supposed to be based in equity, and this entire plan was written through the lens of equity.

But when we say equity in our system, we don't have a clear definition of what we mean by that and how we measure it and relatedly identifying outcomes. So what is it that this system system is supposed to be doing for people and how do we know when it's doing what it sets out to do?

So identifying the outcomes, establishing the data elements to measure them, developing an IT system to collect information about that systematically, and funding a structure to support them, including not leaving people with high support needs behind, which we can often inadvertently do.

As Director Chervenka said, many current initiatives are underway to enhance consistency and predictability in the service system, and we feel that the Committee meeting a couple of times a year would be a good opportunity to make sure that those initiatives are taking hold and also to reflect on their progress.

We know that change is important, but that it can take time. One of the things that Mr. Duran said throughout the process is that at times this process felt that it was moving too quickly and at other times it felt it was moving too slowly.

And so a good balance needs to be found to not change too many things at once, but really to be thoughtful in our progress and then to reflect on is it doing what we hoped it would do. Additionally, thought needs to be given into how best to balance consistency with person centeredness.

This was another theme that resonated throughout the Master Plan Document. Additionally, as Ms.

Hendren said, some of the recommendations, such as changes to eligibility standards would require statutory and or regulatory changes and that that would provide us all an opportunity to partner with the Legislature, but also to get additional public comment about what those things should look like.

There was a lot of public comment in this process, but as discrete elements move forward, there are certain things where the public will want to weigh in in a more targeted way and so those statutory or regulatory changes may provide that opportunity quickly.

Funding sufficiency is required to ensure access as a robust workforce is needed to meet people's needs as they define them. We heard from people frustration about service delays resulting from insufficient providers and challenges that result from that.

There was thought about the expansion of the role of Regional Centers to include working with their communities to enhance disability awareness and accommodation, which we're in strong support of.

But we recognize that would mean either the work that's currently being done would need to pivot or that there would need to be a way to prioritize that in a different way. Ongoing work should include engagement with other Systems. I believe Ms. Hendren mentioned that as well as Director Trevenka.

And we're glad to hear that this is an area where there'll be additional focus because it really is one of the foundational things that will help improve people's experience with not just the Developmental Services system, but with state government as a whole. Overall.

Appreciate the opportunity to continue to work together to strengthen the service delivery system and to use the robust community feedback that we've received and will continue to receive to inform our work. Thank you so much.

Thank you and good afternoon. My name is Vivian Haun. I'm a senior policy attorney at Disability Rights California and I also have a sibling who has autism and is served by the Regional Center system. As we've heard, the master plan covers a lot of ground.

I'd like to focus on two key themes that have recurred throughout the plan and then offer a suggestion for what to prioritize next. First, many of the recommendations focused on our system's capacity to carry out essential case management duties.

When people with IDD and their family Members ask for more navigators, for service coordinators to have more authority or more administrative support, or to have more choices about whom they can get service coordination from, what they're really saying is we aren't able to get this kind of service coordination we need from the service coordinator staff that we currently have.

When people ask for more transparency around how to get an exception to a purchase of service policy that sets a 30 hour cap on respite, or when they call for there to be more consistent understanding across Regional Centers as to what constitutes a generic service, what they're really saying is we aren't able to get the service coordination we need under the policies and procedures we currently have.

Ultimately, what all these recommendations highlight is the considerable gap between the level of service coordination that people need and deserve from the system and the level of service coordination that they're currently able to get. Years of underinvestment and a laissez faire approach to capacity building have left Regional Centers without some of these essential case management elements.

Elements like staffing that meets clients needs, modern IT and data collection capabilities, standardized protocols for the most critical decision points and workflows, and most of all, elements like strong direction and a compelling vision from the Department on how to do this all in ways that are consistent not just consistent across Regional Centers, but consistent with people's goals for their own lives and consistent with the policy priorities and guiding principles of California's health and human services system.

Without sufficient infrastructure or expectations for service coordinators, it has become increasingly difficult and sometimes it can feel nearly impossible for people to get the kind of high quality service coordination that they not only need and deserve, but are entitled to. Service coordination is the first service. It's the first service that people in our system ever get.

As the gateway to all the other services a person might need, it is foundational to everything we do. If we want people with idd, their families and our entire system to thrive, not just survive, then high quality, racially equitable and truly person centered service coordination is not a nice to have. It's a must have.

Another key thread running throughout the Master Plan is our system's long standing culture of only focusing on the developmental disability and failing to see a single with other support needs that fall outside of the system as part of its responsibility too.

For too long our regional center system has operated like an island, an inward looking system that historically has placed little priority on coordinating or co planning with other systems or on helping other systems better understand how to work with regional centers and with the people they serve.

As a result, our system's capacity to collaborate effectively with other systems that also serve people with IDD is minimal at best.

And this showed up in master plan recommendations that called out things like the shortage of health care, behavioral health and dental providers who know how to serve people with idd, the inability of people with IDD with housing issues to get the help they need from either our IDD or housing systems, and the gaps between the Regional Center, child welfare and criminal justice systems that allow too many of our most vulnerable people slip through the cracks.

Our needs and our systems are interdependent. There are too many big problems to solve. We can't do it alone. No system can. We have to move away from the island mentality of the past and prioritize what I would call language and cultural exchange with other service systems.

We'll never be good at solving shared problems together without more people who are bilingual or know how to translate or how to bridge those cultural differences. Where does this lead in terms of what would I suggest that the Department focus on next? My money is on fixing generic resources. It kills a lot of birds with one stone.

It's an opportunity to collaborate with other systems and build more of that cross system familiarity. It builds capacity for better service coordination since linking to services and other systems is such a core component of what service coordination is supposed to be.

While some changes in statute might be necessary, there's a lot that can be accomplished administratively without changes to statute through directives and guidance to Regional Centers. Getting generic services right gets to the core of what we do as a system and it also meets the current moment.

I've often heard it said that the Regional Center system is a gap filling system. It was designed to step in and step up when other systems have failed or cannot cover certain needs.

In today's world, in light of all the federal uncertainty and potential threats to other public benefits and services like Medi, Cal, Calfresh, Social Security, special education, housing vouchers, the list goes on and on.

I don't know how we can truly be a gap filling system if we don't have an accurate and clear understanding up to date, timely understanding of the shape and the depth of the gaps that must be filled. And that's something that I would recommend as a one way to move forward.

Thank you so much for your time and consideration.

Thank you very much. Department of Finance.

Omar Sanchez, Department of Finance we have nothing further to add. However, we'll note that any recommendations originating from the Master Plan would need to follow the normal budget process.

Thank you.

Thank you very much for that. First, I want to thank you all for the tremendous work that you've done. It seems to me that future departmental endeavors, not just within the Health and Human Services Agency, but across the government of California, can really learn from the type of community driven input that has been done.

So I want to commend you for that and commend all of those who've participated in this process. Certainly a lot of hard work has been done and even harder work still remains to be done.

And one of the things that I have that I think is also essential is number one, Director Savinka, congratulations on your role and I've thoroughly enjoyed our conversations. I thoroughly enjoy your clarity and frankness as well. That's how I like it and your commitment to this work.

One thing that I think is the challenge though, and I agree with the LAO, but I would just add one caveat and that is we are going, we need to prepare for a transition Administration.

And with that means that we have to create a sense of consistency and predictability, which means that as a Legislature, we're going to need to take some steps to ensure that not only the Legislature but the IDD community as well as the broader community knows what direction we're trying to head in.

And while I have full confidence in your work, I believe that if we don't chart a path forward with a roadmap led by the Legislature until we know who the next administration is going to be and give them time to be consumers of the document and those type of things and have our own interactions, whoever they may be, that we do need to make sure that we start to codify some of these things similar to what we've done in the Department of Aging with the Master Plan of Aging.

And so all that to say is that I look forward to continued conversations on this. Tell me though, administration, what do you believe or how do you believe that the master plan went? I look forward to seeing it and consuming it on my own. You know, that's what I do during the holidays. I read your reports.

But how do you believe the Master Plan is going to help with what I think has been in every report I've ever seen, no matter what the subject is, no matter what the population is, and that is the huge barriers of departments operating in silos. What do you believe?

How do you believe the Master Plan is going to help with cross developmental collaboration? Either one of you? Depends on whoever wants to give it a shot.

Absolutely. Thanks again for the comments. You know, this question of government silos goes a very long way. People come to government seeking help. They don't come to government because they actually enjoy going to six different departments to get the help that they need. This concept of horizontal integration modeled after concept of social determinants of health.

I mean, this is a long running conversation in California government. The fact is we appropriate money for specific programs in specific departments. We also as government don't tend to have broad based metrics for knowing whether we're doing what we're doing makes a difference for people.

It's easy for me to tell you I serve X hundreds of thousands of people, but it's much harder to come to an agreement on the metrics that we use to decide whether to their lives are better off as a result of having received those services or some of those services, what have you.

You understand the point with the master plan? I think first and foremost it's an affirmation that the lives of people with Developmental disabilities go well beyond just the two departments that you have here. Right. So this is really a cross system conversation. We've been asked already. I mentioned Secretary Johnson.

She invited us later in April to once the report is out to brief the agency wide on the contents of the master plan with this particular focus on what it means for them and their implementation. And I suspect similar engagements will happen at another level of government following that.

So I think if anything it's reaffirmed that need to have that conversation. But I think it's also focused. You know, frankly the experience of individuals and families is really driven here. You heard disability rights, our colleague talk about some of these concepts.

The need for more community navigators, more assistance figuring out where to go to get what you need. Government shouldn't be that complicated for people seeking help. And so the creation of no wrong doors, our Department of Aging is chasing that one with us in strong support behind them.

I think it's a conversation that I think only got re energized by the master plan. I can't tell you recommendation 30 is going to lead us there. But what I can tell you is that it's certainly going to inform what it is that people want from us.

And it's on us then to figure out how do we better integrate behavioral health into it. We'll talk later today about the lowest project life outcome improvement system. We don't have fundamental data or the ability to track fundamental data in our system across case management and fiscal. And that's kind of a prerequisite for metrics.

And so there's a conversation to be had around our rate structure and the quality Incentive improvement program and its 10% role in the 90:10 rate structure and what measures we select there for provider quality of what people get. So I think the conversation is long running, better informed certainly by the master plan.

But I think it's a long running government conversation about how best to deliver services to people in a kind of no wrong door, one stop shop. Pick the right term for that aspect.

Absolutely. Advocates, do you have anything that you would like to add in terms of.

I think one thing that struck me as I have looked over the last few years at some of the large initiatives as Director Trevenko was just mentioning this concept of whole person care that we need to break down the silos as you said, and get past our turfiness to really put people at the center.

There have been a lot of statewide initiatives lately that have aimed to do just that. Things like system of care reform from the child welfare system The California Youth Behavioral Health Initiative. Sorry, too many acronyms. But these are all examples, along with the Master Plan for Aging, of big initiatives that try to get at big problems.

Lots of different components with lots of different people contributing from across deployment. And they tried to do it together. When I look at their materials, what I've often seen in the past is DDS's name on the materials. But I see very, very little evidence of DDS really playing or regional centers playing a huge role.

And I see very little evidence of people with IDD being considered very much in those initiatives. So it feels to me like in the past we historically as a system have not prioritized showing up for those other systems.

And one of the things that I constantly heard in the Master Plan process from many different committee and work group members is where are the other departments? Where are the other departments? Can we hear from them? Can they be part of this plan planning process too?

And I think one way to get people to show up for us is to show up for them. A good way of getting a, having a helpful neighbor neighbor is to be a helpful neighbor.

So I think that there is, there's been some historical priorities or maybe lack of priorities that I hope the master plan has very clearly called out. We have to prioritize things differently. We have to move away from the way things did before. And now is the time to start.

Thank you. Did you.

Yeah. I would just add that on a state level, like at the top, in terms of program administration, there are a lot of silos. But what we've seen is that at the local levels there have been ways to work through some of those things.

And so you see in some communities, some really great work that we could draw upon to perhaps spread more widely. Unfortunately, what that tends to mean at the local level is that there is a regional center Executive Director or member of their executive team and a like minded person who oversees another local department.

So it may be child welfare, it may be a local health plan, and they come together and build strong systems locally. But those systems, in all honesty, have tended to be very based on that relationship between those two people or those two organizations that align at a moment in time.

So all too often when somebody retires or somebody gets promoted or changes positions, those systems that are too fragile to sustain. So really some intentional work at the state level. And encouraged to hear Director Trevanka say that there is going to be an upcoming briefing for other Department directors on the Master Plan.

And have heard Secretary Johnson talk about her interest in greater systems integration. And so we're really encouraged to see that work going forward.

Thank you for that. A couple of things that I want to do as we wrap this up is, number one, LAO, I really want us to continue to talk about and see if we can get some recommendations on what are some things the Legislature can do to continue to chip away at this. No, wrong door. Right.

What are some legislative things we might need to do to allow for this type of information sharing? Right. I have learned the hard way that a lot of times there might be different laws that are currently in place or different practices that have prevented programs from talking to each other in one way or another.

And so I would like for you to work with me and my staff on that. Secondly, I really want to use this year's budget process to begin to chart the course of how we move forward here as a Legislature with a Master Plan.

And so I would like for like to see if LAO is willing to help us draft some trailer Bill Language that will first come to my Committee staff that really seeks to say, well, what could be next to at least pave the way and set the foundation for what I believe will probably be, well, what I know will be this Committee.

It's my intention that this Committee has more concrete priorities within the master plan in the next budget cycle. But until then, how do we be able to have a roadmap or a foundation set for as we go into next year when we have time to really digest the Master Plan?

That could include providing requirements for the administration to provide additional analysis and reporting on the Master Plan. It could also include providing cost and benefits for near term priorities in the Master Plan. But I really want to make sure that we again, how do we get from 2025 to 2027, 2028? Right.

I think that's going to be a key transition point that the Legislature is going to have to fill in that gap. And so I want to make sure that we are prepared for that and we're starting with that in this budget process. Does that sound amenable to LAO?

Karina Hendren, LAO. Yes, definitely sounds amenable.

Okay. Thank you very much. I really want to thank this panel. I'm so excited about the future, so excited to digest it myself. I wasn't playing.

I do read these things during holidays and looking forward to continuing to listen from you all, listen from the stakeholders who participated in this master plan process so that I can continue to be as helpful as possible. Thank you all very much for your time.

We'll now move on to Issue number two, the Employment First Office and Competitive Integrated Employment. Please come on up. All of those who are supposed to participate in this issue. That includes our administration partners, State Council on Developmental Disabilities, Progressive employment concepts. And Ms. Cooper. You may begin when you're ready.

All right. Good afternoon, Chair Jackson. My name is Deborah Cooper. I'm an Assistant Secretary with the California Health and Human Services Agency. Thank you for the opportunity to speak with you today about the efforts that the State is coordinating to help individuals achieve competitive integrated employment.

The Administration applauds the passage of SB639drazo from 2021 and supported the phasing out of subminimum wage. As of January 1st of this year, there are no longer any individuals in California receiving sub minimum wage under a 14C certificate.

While a momentous achievement, this is only one step in the long standing work that the Administration is doing to support individuals with intellectual and developmental disabilities who want to work to help them find, attain and maintain competitive integrated employment opportunities.

These efforts for supporting competitive integrated employment are reflected in the current and ongoing efforts led by DOR and DDS in partnership with other state entities and stakeholders to provide a variety of employment services for Californians with the most significant disabilities.

The budget act of 2023 established the Office of Employment first to be housed in the California Health and Human Services Agency agency effective July 1, 2024. The 2023 Budget act also included $1 million beginning in 2024 for the establishment of this office the following year in order to solve a $47 billion deficit.

The enacted 2024 budget included a permanent reduction of $1.5 billion in vacant positions and a 7.95% reduction in operational budgets to state agencies and departments in 2024. 25 as part of the government efficiency drills, Cal HHS reduced our budget by $1 million for establishing the Office of Employment First.

The difficult decision to include this office as part of the operations efficiencies was twofold.

One, the Office had not yet been set up and staffed and 2 we knew that aligning with the objectives of the office, Cal HHS would continue to work in concert with DDS and DOR to assist individuals with IDD to find and maintain competitive integrated employment.

Cal HHS will advance the goals of the office by coordinating employment support services across all agencies and departments and developing strategies to partner with other entities committed to creating integrated employment opportunities.

We will work with DDS and DOR to evaluate data collection systems to gauge how we measure success and to monitor our progress as subminimum wage was phasing out DOR and dds.

Each designated an existing executive level staff Member to serve as dedicated leadership to advance the ending of subminimum wage and successfully transition and expand employment and other opportunities for adults with IDD. Working together along with Cal HHS, the Department successfully tracked and transitioned individuals out of subminimum wage.

Going forward, Cal HHS, DDS and DOR have several ongoing and new projects aimed at assisting individuals to attain employment and incentivizing employers to hire individuals with IDD. For instance, DDS Coordinated Career Pathways Pilot provides person centered career planning by a career pathway Navigator and customized employment specialists.

Additionally, their paid internship program increases the vocational skills and abilities of individuals who choose through their individual program plan to participate in a paid internship. DOR's existing employment services already only support competitive integrated employment outcomes.

Further, DOR is conducting a five year research project on the topic of subminimum wage to competitive integrated Employment designed to offer a range of services to test new service delivery practices and establish evidence based approaches to vocational service delivery that addresses future needs.

These are just a few of many initiatives aimed at enhancing and expanding employment opportunities for individuals with with IDD. Victor Duran and Ernie Cruz from DOR and DDS can provide additional details on specific initiatives within their respective departments. I want to assure you that improving access to competitive integrated employment is an Administration priority.

This coordinated approach amongst the departments in CALHHS right sizes the use of state resources for the task at hand. Rather than committing ongoing resources to establish an additional governmental structure, the Administration's approach leverages existing expertise, coordination, collaboration and partnership between both departments.

Each organization plays a unique role in expanding statewide capacity, providing education and information and assisting with the development or refinement of services.

The Administration, through the Executive leadership assigned to this effort from DDS and DOR will continue to engage with partners like State Council and other stakeholders on the needed efforts to support competitive integrated employment and to fully realize employment first in California. Thank you.

Good afternoon, Dr. Jackson, committee members, and staff. I'm Ernie Cruz, Deputy Director, Department of Developmental Services. During the last year, DDS has been focused on closely monitoring the transition of individuals from sub-minimum wage, with sub-minimum wage ending on January 1, 2025.

We worked closely with Regional Centers and initiated the monthly reporting process to track the transition of individuals. Not all 2,000 plus individuals we were tracking achieved competitive integrated employment. To those that did, credit must be given to service providers working closely with Regional Centers and for advocating and working with employers to transition individuals from sub-minimum wage to minimum wage or above.

Moving forward, the department aims to continue working closely with advocates and the community, other departments, Regional Centers, and service providers to increase opportunities and avenues for competitive integrated employment outcomes for individuals we serve.

The new standardized Individual Program Plan that went into effect on January 1, 2025 will provide the department insight into the number of individuals who have employment identified as an objective or life area in their IPP. The department will continue to promote and track utilization and outcomes of the new Coordinated Career Pathways Service.

This person-centered approach to Coordinated Career Pathways and the level of expertise and experience needed to offer this service provides an opportunity to achieve successful CIE outcomes. The department is evaluating these outcomes ongoing.

As part of rate reform implementation, a new job development service and corresponding rate has been added to the Supported Employment Individual Service to go along with a job coaching rate. This is a higher rate with enhanced staff qualification and requirements. This service provides individualized staff time to assist an individual with all activities involved in preparing for and securing competitive integrated employment.

Fiscal year 23-24 saw the largest utilization of the paid internship program, with over 3,100 paid internships and expenditures of over $20 million, surpassing the previous year of close to 2,600 internships and $16 million. Each paid internship offers an opportunity for our system to make inroads with a business.

The department will be working closely with Department of Rehab and looking for opportunities for both departments to engage these businesses and provide additional information about the benefits of employing the individuals we serve and the supports that are available to individuals to help them succeed in their job.

Information, education, and training is another important area of focus for the department and offers an opportunity to work closely with our partner agencies. Benefits counseling continues to be an area where continuous ongoing training is required.

Getting this information to service coordinators at Regional Centers and to individuals and families is very important in overcoming fears and hesitancy in losing benefits. The department will continue to put together different employment-related trainings for Regional Centers and team up with partner departments based on the topic.

One of the next training topics that the department is working to schedule is on CalABLE accounts. CalABLE accounts have provisions for individuals who are employed that allow for contributions above the annual limit without affecting eligibility for benefits. Efforts to improve employment outcomes will also be informed by the Master Plan for Developmental Services being released this Friday.

The recommendations in the Master Plan, along with other concepts to improve communication, the range of employment services, and monitoring and oversight will be important moving forward. Engagement with individuals served and learning about their experiences in employment will inform these concepts, including concepts such as developing an employment roadmap, having a no wrong door approach to support from departments, exposure to apprenticeships, project search, and other programs. Thank you.

Thank you, Dr. Jackson. Victor Duron, again, for--this time with my Department of Rehabilitation hat, Chief Deputy Director. So I'll be brief. My colleagues have shared much about--

Are you the mailman and the custodian too? What's going on here?

I've talked to my boss about that other duties assigned--

Something's going on. Something's wrong.

So I'll be brief. My colleagues here have shared much about DOR's role, but I'll begin by just reiterating that the Department of Rehabilitation, we serve people of all disability types and we only pursue competitive integrated employment outcomes. However, our focus and our attention to the IDD community and particularly individuals in sub-minimum wage goes back years long before the law phasing out sub-minimum wage.

We've been partnering with HHS, the State Council on Developmental Disabilities, and of course our colleagues at DDS for years to carry out this work and move towards that vision of competitive integrated employment for all individuals. Since 2016, we have been offering what is known as Career Counseling Information and Referral, or CCINR, which is a targeted information and referral service specifically for people in sub-minimum wage.

Every single person that we are--that is known to us to be in sub-minimum wage has received this service, and since we launched that, 1,801 individuals who have received the service have chosen to enroll in DOR services, and so far, 792 of those individuals have achieved a competitive integrated employment outcome, and of course we continue to serve the others and continue striving towards that goal of achieving CIE for everyone who pursues our services.

And as has been alluded to, our partnerships have only been strengthened by this endeavor. We are working with DDS and with our local partners to share data, develop local planning agreements, cross-refer between our programs, explore new ways of developing strategies to support individuals who would have otherwise gone into sub-minimum wage. As Dr. Cooper pointed out, we have regular convening of our executives from the two departments to meet and strategize about the work that we're doing.

And we also have two pilot projects currently about the midway point, one in Orange County and one in San Diego, that are specifically looking at and researching new models that serve people with developmental disabilities who would have otherwise gone into sub-minimum wage settings so that we can test new strategies moving into the future. And I appreciate the time and look forward to your questions.

Thank you, Chair, Dr. Jackson. I'm Aaron Carruthers. I'm the Executive Director of California State Council on Developmental Disabilities. The State Council is an independent entity that exists to really disrupt systems to make it more effective, more efficient, more agile, and more accountable to people with developmental disabilities and their families.

In one area where people with developmental disabilities want to see better results is in employment, and when we at the State Council ask the public, ask adults with developmental disabilities, what do you want us working on? For the past ten years, the number one answer among adults with developmental disabilities is employment. I want a job.

I want to work, I want to contribute. And about ten years ago, California became an employment-first state, which means regardless of severity, the highest priority is competitive integrated employment. Now we've used that word, but what does it mean?

It means real work for real pay in the community, in the real world. Despite people's desire and despite a vision in the law stating this is what the outcome, the ten-year employment rate stays about the same for adults with developmental disabilities, right around 15%. Sometimes it goes up to 17, sometimes down to 13.

Let's just hover around 15. So when California is in good times, is in bad times: right around 15. Hundreds of millions of dollars invested into supports and services, still right around 15, so we need to do something different if we want a different outcome. Part of the lack of the results is the systems itself.

No fault of anybody here at the table; just we humans can make things very complicated. So I want to show you a chart, a visual, and I'm happy to give the sergeant examples to share. You don't have to see the details on the chart to get the message. What this is is this is the user's experience.

So if I'm a person with developmental disability and I want to get a job, this is how I navigate the system. The blue dots on here are DDS. The green dots are Department of Rehabilitation. And so the takeaways are one: the complexity, the complexity of the system. It's hard for anybody to get a job.

Clearly, getting a job and job supports for a person with developmental disabilities is sort of like chutes and ladders or maybe like stops and dead ends because the second thing I'd like to point out is that there's really only one route here that leads to a job, and that's the one over here.

The rest are stop signs and dead ends and people either getting frustrated and leaving the process or getting stuck in some place that doesn't result in them getting employment. You're just stuck in a training program forever. You don't get out. So the third thing to notice is really these two boxes over here; this is what people typically do when looking for a job.

So we're looking for job, we apply, it's captured here in these two boxes. Everything else is what somebody with developmental disability needs to go through. It's all complexity. So getting better outcomes is not the responsibility of one entity or one department.

Better outcomes come from looking across departments for better coordination and possibly, possibly simplicity. The number one recommendation in the State Council's 2023 report on how to phase out sub-minimum wage was to create an Employment First office. We've ended sub-minimum wage. No one's paid sub-minimum wage in California. This is a huge policy win.

We pause, we take them and we get them, this matters. Additionally, there's now 1,117 adults with developmental disabilities who are earning minimum wage who were earning sub-minimum wage before. Again, huge outcome. As Assistant Secretary Dr. Cooper pointed out, that's step one, though. We're only in phase one. Phase two is getting people into competitive integrative employment, and to do that, we need to do something different because we're not getting any different results.

An Employment First office outside of any single implementing department would have the ability to coordinate among departments for efficiency, have the ability to reach across state functions, to say, Labor Agency, Department of Education. I know my colleagues here work with them closely. Very good people. They are deeply committed to this outcome, but the ability to get the right outcome is bigger than any one person.

It's simply beyond their control. So--and we know evidence of this. Despite best efforts, there's no consensus on state level goals or ways to achieve alignment. We hear a lot of activities. These are really good efforts, but are they coordinated and are they aligned toward competitive integrated employment across departments? Instead, DDS, Department of Rehab, Education launch their own initiatives and oftentimes with mental coordination. I believe the next speaker will give her experience on those multiple efforts.

So despite these efforts, there are still systemic structure--barriers that are bigger than, again, any one initiative. The biggest barrier is that the payment system itself is inverted. It doesn't pay the best for the best practices that we know about. We heard good amplification of two important initiatives of Coordinated Career Pathways and the paid internship program.

Both of those are paid the lowest. So we can see this because when people left sub-minimum wage, where do they go? They went largely into day and look-alike programs and they went into community integrated training programs. Those have the higher reimbursement and payment rates. So things are inverted and things are flipped.

So good people trying to get--are still doing good things but getting the same results, 15%, and it's time to do something different. An Employment First office would have the ability to analyze the barriers like the rate structures, see how efforts in different departments can be coordinated, reach out to Labor Agency, Education, as I mentioned before, get consensus on goals. There's a lot they can do, but one more opportunity want to make sure that we pay attention to, which is the Master Plans, plural, need coordination.

So the Master Plan in Developmental Services and the Master Plan in Career Education both both give nods to each other. The Department of Developmental Services gives a nod to employment. Career Education touches on disability. These are major efforts that need focus and attention to make sure their goals and initiatives maximize employment outcomes for adults with developmental disabilities. So thank you very much. State Council stands ready to be a partner to achieve people with developmental disabilities' number one priority: employment.

Hi, Dr. Jackson and members of the committee. Thank you for letting me be here today. I appreciate your comments, Dr. Jackson, on the need for a roadmap and to break down the silos, and that's what I'd like to talk about.

My name is Carole Watilo, and I'm the Executive Director of a small nonprofit here in Sacramento, Progressive Employment Concepts, which my husband and I founded 30 years ago this year. I am also a member of the board of California APSE, and I come to this work having grown up with five nieces and nephews, now adults in their late 30s and 40s, who use all of the services we're talking about here today.

What I have experienced as a family member and a service provider, I feel, is a result of the lack of a comprehensive statewide vision for employment services for individuals with intellectual and developmental disabilities. As we have heard, our system is very large and the number of--in it--the number of people served in it continues to grow.

As a result, our system is overly cumbersome for individuals and families to navigate, especially in the areas of employment. It is also difficult for providers to navigate. Having served on a fair number of work groups, committees, task force, member organizations, subcommittees, group, group, groups, with a great number of wonderful people who are working on important issues and really want to see changes happen.

However, when one thing that many of us have found is there's a lack of coordination of all of these efforts. I have literally been in a work group meeting with representatives from the different state departments talking about employment and gone into another work group meeting later that day with different members of the same state agencies who don't know about the other work group.

And I don't say this to be disrespectful--DDS, DOR, Department of Ed, these are big departments with many roles to play, and I understand how this happens, but it also demonstrates the need for a focused office to oversee employment if we are to see changes in the outcomes.

While many of the outcomes of these work groups are good things like Coordinated Career Pathways Navigation Services--it's a good step--however, if we lack services to navigate to, then we will still not see the outcomes we want and that people deserve.

To note, the LAO in their March 5th Budget summary referenced that 600 people transitioned from sub-minimum wage to community integration training programs. This service came to being over the last couple decades as a need for services for individuals that we're not succeeding in other employment or community-focused services.

However, this service is not even in the new rate study service descriptions. Tailored Day Services were also designed to meet a need for individual services focused on employment, postsecondary ED options, and to help people gain skills in the context of inclusive communities, but the hours restrictions and the low rate of reimbursement, not commensurate with what it takes to provide the service well to all individuals, has led to low utilization.

So where will these individuals get support to find and maintain employment? The Employment First Office. We were all very eager to work toward the creation of an Employment First office housed in CalHHS where the efforts of multiple state agencies and their respective committees and initiatives could be viewed through the lens of Employment First.

As envisioned and described, the Employment First Office would track, analyze, and publicize utilization and outcomes, establish and improve mechanisms for measuring success and drive quality improvement, identify and disseminate best practice, make recommendations for legislative, regulatory, and policy changes consistent with Employment First and based on the collection of data and known best practice. The E1O office gives us the opportunity to really streamline a lot of these individual siloed processes.

The times we're living in, it's imperative that we are using our resources effectively and efficiently. We currently, and in the new rate study, pay more for services that have no intended outcome of employment. That is not to say that they are not good and beneficial services. However, California has said it's an employment-first state.

If this is true, then our output of resources should reflect this. And I do understand that there's a cost associated with the Employment First office and with adjusting rates to be commensurate with skills needed to provide employment services well. There is also a return on that investment.

In my small agency, the people we support last year made $719,000 in income, paid around $92,000 in taxes, and lessened their dependence on Social Security, and they felt like contributing members of their society. Their self-esteem improved, they made friends, were less isolated, they bought things and participated in our economy.

This is the return on investment we want from our tax dollars. In closing, we need to do things differently if we want the outcomes to change. All of the lovely areas that were mentioned and all of the things that we are working on in the different departments and in the different Regional Centers across the state are wonderful, but they're still siloed, which leaves individuals and providers still struggling to keep up. We know what it takes to help people get and maintain employment.

There are models to follow. However, we all have to be moving in the same direction and we need resources allocated intentionally on the outcomes we want to see. An Employment First office gets us all moving collectively in the right direction. Services such as CCP coupled with Tailored Day Services or a new community inclusion employment service will advance employment for Californians with intellectual and developmental disabilities. Thanks for your time.

Thank you very much. Department of Finance.

Omar Sanchez, Department of Finance. Nothing further to add.

LAO?

Thank you, Dr. Jackson. Karina Hendren with the LAO. First, we don't have any comments on the Office of Employment First, but we do have comments on the phase out of sub-minimum wage. So SB 639 of 2021, this has already been referenced. Just as a reminder, what SB 639 did is it established legislative intent that employees working under sub-minimum wage should transition into competitive integrated employment.

And to this end, we recommend that the Legislature ask DDS to provide regular updates on the status of individuals who recently transitioned out of sub-minimum wage and whether they've been placed into competitive integrated employment.

We've heard that the Administration is committed to finding placements for these individuals and we think that a particular focus is warranted for the approximately 13% of individuals identified by the department who have not yet started new services, and the Legislature could use its oversight authority to track whether these individuals have found alternative services and ideally placements in competitive integrated employment.

This will help ensure that the implementation of SB 639 aligns with legislative intent, and as noted in the agenda, the LAO would be happy to assist with SRL or any language to effectuate that oversight. We also had a comment on Coordinated Career Pathways. This is a new service that's been mentioned a few times. As the Administration noted, this is a new service that requires a higher level of skill among the DSPs who provide it.

We've heard from stakeholders that there is some interest among both Regional Centers and providers in receiving technical assistance so that they can provide this new service effectively, and so we're recommending that the Legislature could ask the Administration whether there's capacity to provide this technical assistance so that this new service can reach its intended potential in helping individuals secure competitive integrated employment.

Thank you very much. Dr. Sharp-Collins.

Thank you guys so much for bringing forth this, this information. I've learned a lot, so thank you so much. I think it was Aaron, when you were talking about the new model and the pilot programs. I'm out of San Diego, so I just wanted to know if you can give me just a little bit more insight in regards to who you're working with. Is it the Regional Centers or who are you working with down there in regards to the pilot and how long has it been going on and what is it?

I did speak to pilot programs in San Diego or specific ones.

Correct. Okay.

Thank you.

Okay, so it was--it's the person that does everything. All right, it's Victor.

Thank you so much for the question. So one of our two pilots is in collaboration with the San Diego Community College District, and so we are enrolling individuals with developmental disabilities who are identified as individuals who might have otherwise gone into sub-minimum wage settings to provide a variety of different supports.

So the regular employment services, trying out other individualized supports, going through training, vocational training programs, and then we are working with San Diego State University's research foundation--sorry--San Diego State University's Research Foundation Interworks Institute to provide program evaluation and technical assistance, and we'll also be working with UCLA's Tarjan Center for additional technical assistance on employer engagement.

And if your office would like additional information on the work that we're doing in San Diego and that particular pilot, my team would be happy to pull some additional data together for you. Absolutely.

Let me just make a few comments and then I have some requests from the Administration. We are very concerned with the actions that have been taken with the Employment First Office, and this committee really finds it extremely disrespectful to virtually kill an office that was negotiated by two co-equal branches of government.

It is not acceptable for us to find out without any communication, any collaboration on this item. It is clear that we cannot continue on with the status quo when it comes to this. And we find it very difficult to continue to engage in agreements on budgets only to find that the Administration seeks to do something different.

It damages the future trust of the budget process and it needs to stop. And so we remain committed to ensuring that the Employment First Office finally gets implemented and we're not going to stop until this gets done.

This is definitely not a budget issue because we're only talking about $1 million when we have seen the Administration propose additional funding for what I would argue less important things in the hundreds of millions of dollars at the same time. It is wrong and we will not remain silent on this issue. We expect this office to get done.

So I am asking the Administration a detailed timeline and the process to implement the statutory mandates for the Employment First Office. We're simply asking to follow the law, and we ask that we get this information by May 14th.

Additionally, we are requesting a quarterly update on the individuals per each department involved previously in sub-minimum wage positions and where they are transitioning to starting at a date certain. And we suggest that this reporting starts July 1, 2025 and then occur every quarter thereafter.

For DDS, we are also requesting information on how technical assistance to Regional Centers--we also request information on how technical assistance to Regional Centers for the Coordination Career Pathways is occurring. It's important that we get this right. When we make a budget agreement, people are making plans, stakeholders and members of the IDD community are given expectations, and so we will maintain a priority of consistency and predictability.

And most importantly, when we say we're going to do something, we are going to get it done. And if we believe that it cannot be done, then we are going to re-engage in the communication and collaboration process in order to make this happen. So with that, thank you very much for this panel.

Let's bring up issue number three. Respite services utilization trends and issues. We're also looking for the San Diego Regional Center.

Right here.

Oh, right there. Department of Developmental Services. Right there. Somebody's missing. No. Okay, we got everyone. Okay. Alright. DDS, you may begin when you're ready.

Thank you. Good afternoon and thank you for the opportunity to participate in this discussion on respite. I'm Michi Gates, the Chief Deputy Program Director. Chief Deputy Director of Program Services at DDS. My title is too long and I still don't have it down.

At least you only have one title because before.

I know. Yeah, I haven't started custodial duties yet. Respite is a commonly used service for individuals served by the Regional Center and their families. Many families whose children live in the family home utilize respite for temporary care and supervision for their son or daughter. And this allows the family to take a break from the constant supervision and care.

For today, I will focus on in home respite, which is used far more than out of home respite. The majority. There are different ways in which in home respite can be provided. The majority by far are provided through an option called agency respite.

But it is also provided through participant directed options employer of record, which is done through agencies. And for those in the self determination program, respite is also available. These different options do offer flexibilities for families to recruit and select respite providers that fit their particular family needs.

For example, families may want to choose relatives or close friends, people who understand their culture, speak their language, and who have an existing trusting relationship. On page 19 in the agenda, you will see there is a graph at the top of the page regarding in home respite.

And you can see that over time from fiscal year 16-17 through fiscal year 23-24, that the overall number of individuals who used in home respite has increased, as have the total expenditures. So the money spent on respite over that same time period, the caseload of those receiving respite steadily increased from 85,000 to 150,000.

And that's a reasonable increase given overall caseload growth. But you'll see that total expenditures had a much more dramatic increase from 310 million to 1 billion per fiscal year over that time period.

In fiscal year 23-24, 34% of the individuals, so that's 150,000 individuals out of a total of 440,000 individuals served, receive services from the Regional Center system through respite services.

And the demographics of that 34% by race are 46% Hispanic, 21% white, 11% Asian, 14% in the other category, and 8% black. By language, 75% spoke English, 21% Spanish, and 4% consisted of Chinese, Vietnamese and other combined.

Overall, based on the expenditures, the amount of in home respite services being provided is greater for individuals who are Hispanic, followed by Asian and black. Individuals who are white appear to be using slightly less respite on average.

Access to respite services begins with knowing about the service that it exists and discussing the need with their Regional Center service coordinator. Regional Centers have a primary role in informing individuals and families in the community about respite services.

The Department is also actively working to improve information available to individuals and families, such as the new guide to California's Regional Center services system, which is now available on our website in seven languages.

Relatively new services and supports such as enhanced Regional Center service coordination, the 1 to 40 caseload ratio and coordinated family support services can increase opportunities to identify specific needs and provide support with accessing those services. There are workforce shortages in the system.

I think that's well known in particular, rural areas may lack a sufficient worker pool to hire from. There may be a lack of workers who speak the family's language and understand their culture. Respite agencies who hire family identified workers expand the range of options for families to be able to hire someone they know and trust.

The department's development of a standardized vendorization process may also lead to greater ease with bringing on new vendors and agencies. The standardized respite support tool and procedures will also offer consistency. Regional Centers will be trained and begin to use these in January of 26.

Uniform process across the Regional Centers offers transparency and the ability to compare data on authorizations and utilization to better identify trends and access issues. Thank you.

Good afternoon. Chair Dr. Jackson and Committee Member Dr. Colin Sharp from San Diego. My name is Mark Klaus. I'm the Executive Director of the San Diego Regional Center. San Diego Regional Center serves two counties, San Diego and Imperial counties, two neighboring counties that are distinctly different in demographics and opportunities. And Dr.

Gates mentioned a number of the items, but I wanted to provide a little insight, I guess into San Diego. Looking at our numbers the last quarter we had approximately 11,150 individuals or about 27% of the families that we support in San Diego County with authorizations for respite.

The utilization in San Diego is actually almost mirrors the statewide averages just in terms of utilization authorizations, you know. But we are also seeing slight increases in utilization, which is good. You know, getting the authorization to receive those services is wonderful.

But actually receiving those services is even more important in Imperial, where 86% of the county identifies as Hispanic, many of those families being monolingual Spanish speakers. We support about 4,500 individuals in Imperial County. Half. Over half of the families that we support, individuals are receiving respite services.

You know, the average growth in Imperial to our caseloads reaching out to families is over 8.5% this year. We're trending a 13% increase. And families served. Dr. Gates mentioned a number of the different options that are available to families.

One that is kind of a combination of family directed and agency, or participant directed and agency is utilized by one of our largest vendors in Imperial County. They support just over 900 families year to date. 95% of the families in Imperial county are. They're using, excuse me, 87% utilize this combination of agency and family directed.

So the families reach out to the agency, the providers, and say, you know, here's a staff person we would like you to hire. We don't want to go through the paperwork. We don't want to go through everything that we need to do.

If would you hire them and would you be our, you know, essentially the employer of record, so to speak. So 87% of the families in Imperial County have chosen that model. The utilization of respite hours for those 87% of the families is 95%.

They're getting services, which is much different than many of the other communities where there's a labor shortage. So it's reaching out to our communities, trying to find out what they want, what they prefer. And Dr. Gates also mentioned, you know, access, you know, in staffing from a staffing agency perspective is difficult.

The other challenges with respite are two other types of respite. Not just standard respite, but also behavioral respite and medical respite services are very challenging to get providers. And the other for many of our families is transportation. You know, those in rural communities that have limited access to providers if they're not family specific.

I'll use Imperial again as an example. If you live in the north part of Imperial county in Nyland, there's not a lot of providers out there, not a lot of vendors, so that transportation and I know DDS and others are looking at how that rate can support families to get the services they need.

One of the idea is to improve services. As Dr. Gates mentioned, the Senate Bill 138, the standardized assessment tool, I think will be helpful.

To me, it's also outreach, Regional Centers, community based partners, organizations working together, not just educating families in terms of the services that are available, but also marketing to potential providers, potential service providers, you know, and to me, you know, it's community engagement.

It's meeting people where they are, when they're there, and being a part of the community to continue to spread this information. So appreciate the opportunity.

Thank you very much. Department of Finance.

Omar Sanchez, Department of Finance. Nothing further to add.

LAO.

Karina Hendren LAO, no comments at this time.

Any questions for or comments from committee members on this item.

Doctor Sharp-Collins.

Yeah. When it comes to, comes down to respite, one of my questions now considering, you know, issues with ICE and other things happening. So when a child is no longer, I guess is now moving to temporary custody, I just want to make sure.

How is that outreach being done to the family or someone else who's taken in that child? Is that the eligibility is, is it being transferred over? I'm just wondering, curious about how that process is, especially coming out of Imperial Valley. That's, you know, it's different and their needs are a little bit more different.

So I'm just wondering how are we dealing with those families that are being displaced?

We're. We're providing at this point. Dr. You know, we're providing information to families. We have not had any families put in that situation at this point. But I. Imperial is a very close knit community. It's a very small community. And I think that speaks a lot to the respite services, the utilization of that respite.

There's trust in hiring your own staff from your own community that looks like you, that has, that speaks your language versus calling up an agency and saying, send me somebody tomorrow.

I don't, you know, I wouldn't feel comfortable having somebody that I've never met before caring for my child or grandchild, but calling my neighbor or, you know, a friend that I work with, you know, that that circle of trust is a lot.

And that's why we see the successes, you know, in many of our communities in San Diego. But it's easier to identify in Imperial because it's separate, so to speak. Yep.

We set this panel to emphasize just how important we need to continue to focus on respite services. This is hard, stressful ruling work in the name of love. And we have got to continue to find. I'm glad we have an increase in respite services.

I know it also puts other pressures, but it's a good problem to have because people taking care of their loved ones is essential. And without respite services, it's hard for them to do it in a healthy way. Bad things happen when you don't get enough sleep or no sleep or no sleep.

I'm thinking about my own mother when it comes to this and then my own breaks in the legislature. I'm finding ways to go to give some respite for my own mother who's taking care of her mother with dementia. Right.

And a difference that it makes to be able to get regular sleep, to be able to eat properly, to be able to get Some fresh air and exercise makes a world of difference in the care of the people that they care about. We're going to continue to bring this issue up.

We're going to continue to find ways for us to continue to give people the respite care that they need because they're doing all of society a great benefit. Thank you very much to this panel.

Thank you.

Can I just add one thing too?

Oh please, please.

I forgot to mention that the standardized family support tool that the department is developing, which will be done very soon, also contains standardized assessment for personal assistance and daycare as well.

So the tool will not only help with consistency and transparency about respite and how much respite, but also with those two other rather related, though very different services as we know that sometimes, you know, things can get lumped in under respite that aren't necessarily respite.

And I think it's helpful to really, you know, very specifically identify the needs and and make sure the individual and family is getting services specific to those needs. So. But yes, respite is absolutely vital to maintaining families, keeping them together. And that is huge, hugely important.

See, that's the problem with making more comments. Now, I have a question.

I took that risk.

They should teach you a lesson. Actually, my question is for the Regional Center. What are we doing? See what happens. That's what happens. Guilty by association. That's what that is.

Do we have targeted questions that we ask clients to identify whether they are in need of respite services because they may not even know it exists or is possible? What are we doing to ask them, you know, how are you. Are we asking them? Are you getting regular sleep or do you need additional assistance?

You know, those are individual discussions with each family, you know, with the service coordinator. What are your needs? You know, we go through those basic questions. What kind of supports do you need? What's your.

The standard IPP process, which is also a new process that all Regional Centers are utilizing, ask some very specific questions in terms of immediate needs as well as future needs and future planning for families as well.

Do they incorporate simple questions like, how is your sleep patterns?

I don't know if that one's in there. Honestly.

That's, yeah.

So, I mean, when I'm having a bad day, I ask myself, did you eat, Corey? Because you might be a danger to other people if you haven't eaten. Right? I mean, sometimes I think we get. So I'm not saying this is you, but I'm just

So clinical

Correct that sometimes we just don't ask the human questions, right?

Because sometimes people may not. If you ask my mom, are you getting enough sleep? She might say, oh, I'm fine. Right. And in my mind I'm like, you lying. Right. Sorry, mom, sorry. I would encourage us to think just on the human level. Right.

And by the way, you may already be asking these, but I would encourage you to check and all of members of ARCA to check to make sure that we're just asking the basic questions about what it means to be healthy.

Because sometimes when you have a open ended question, which is the proper way to do so, most of your questions should be open ended. Right. And so that you give them time and you're not trying to guide the conversation in a certain direction. No doubt about that.

But on certain questions, some questions just need to be asked that I would just encourage us to make sure that we're doing. Because those who are taking care of loved ones, they're superheroes. And many of them will not complain and won't tell you when they may need help. Right. They're just dedicated to getting it done.

And so I would just like to provide that feedback.

And I think that's the efforts that we're trying to make that is at the core is asking those kinds of questions. When the service coordinator meets with the individual and family.

And so that's behind the standardized IPP that the Department created that all the Regional Centers are using that is very person centered and outcome oriented, it will get to those questions.

All of the training that service coordinators receive that help them to know how to ask those kinds of probing questions, if it's not volunteered, how they can continue to ask those questions to get to those issues.

Also the person centered thinking training, which is now something that all Regional Centers participate in that really focuses on identifying the those needs and doing a better analysis and having that better conversation and developing that.

That trusted relationship between the service coordinator and the individual and family so that they won't withhold information or say, zero yeah, everything's fine. Yeah.

How's your day? It's a great day. And some days aren't so great, but the answer is, I'm having a good. It's a good day.

Absolutely. And is this the process? Do you have additional question?

Okay.

Absolutely.

Yeah.

Yes.

Absolutely.

That's absolutely. The Regional Center is also participating in the cultural sensitivity training to, you know, help with identifying what are those cultural issues that may be part of that.

Conversation and what part of your process assesses for the most complex behavioral medical needs.

Besides the individual program plan and the planning team meeting.

Right. I mean, what part of that process helps too? Is it just through your, you know, I'm sure that sometimes there may be a new issue that arises. Yes. And how are we assessing in the times when there's follow up. Right. When there might be an emergence of a more complex behavioral health need or things like that?

What's that process look like?

Yeah, there's, I mean, there's formal assessments. If you know, for example, there's a new mental health issue or a new behavioral issue, there are formal assessments and providers that can be used to assess for that.

But also, just within the person centered thinking process, there are tools that are provided to just assist with the conversation, how to focus on that individual and putting that individual and their needs at the center of the conversation and also giving them and the family that voice to lead and drive the conversation, services and supports and the goals and dreams that they have for their life.

So there anything from the informal just again, establishing that relationship, building that trust, knowing how to have that conversation and that probing conversation when needed to formal assessments that can be provided by Clinicians.

And I think a lot of that is that building those relationships. Some of those are longer term behavioral or family needs. Some of them are short term. In working with a family this morning, single mom, two children served by San Diego Regional Center is expecting her third child. You know, do you need anything else? No, I'm fine.

We're like, are you sure you don't need anything else? Well, it'd be nice to get a little more respite so I can get, you know, my, my medical appointments done. Great.

You know, that's, I don't know, short.

Nine months is short term, but that's a shorter term fix that helps. That helps support that, that family, that mother and those children.

Well, sometimes it's that extra day that determines. Yeah. Whether, you know, it's under those extreme long term pressures. There's too many possibilities of the caregiver even going into a state of crisis. Right. And we want to prevent that, prevent that from happening. Thank you so much for this panel. Unless you have another call. Thank you.

Thank you, Doctor.

Talk later.

Was I supposed to read this? Oh, okay.

I was like, oh, did I miss some?

Did I miss your. What you were saying? Okay, now we'll bring up issue number four, aging individuals in the Developmental Services system. We'll bring up the director as well as Disability Voices United.

You may begin when you're ready.

Mr. Chair and Members, I'd actually like to defer the beginning of this based on the questions in the agenda to my co-panelist next to me, if that's okay with the Chair.

Yes, I hear an icon is in the house.

Well, and so what that means is that he's going to have a chance to answer every criticism I have of the Regional Center system.

I'm stunned she would have criticism, sir.

Well, Honorable Chair, Members, it's really a pleasure to be here. Nicole, I want to particularly applaud your staff work on the preparation for this because I know what that takes. My daughter is 33 years old and I had her when I was working right over there across the hall from 447, which was our hearing room for the Assembly Human Services Committee, which I worked for through two Member, two chairmanships.

It was in the days of quick turnaround of Members. My daughter was born with a congenital very unusual syndrome that includes both developmental and physical disabilities. So we've lived through this. She's now 33. I will tell you, I am now 72. Kind of shocking, but I think we fit the description of what I'm supposed to do in this panel. And I think I might be the age of your mother's mother.

I plead the fifth.

You know, where I would start is that we need to remember that when a person ages, what their life is now directly affects what it will be when they age. If a person with IDD has never learned to participate in the community, make friends, hasn't ever had a position or job that makes them feel a sense of belonging, if they lived in a community that was not accepting, if they were totally unintegrated into the community, if they've had to rely primarily on their parents for their primary emotional and personal support, all of that predicts a bad outcome for when they age.

As we engage in person centered planning, we have to remember that what we're doing today when our children are young adults creates the foundation for their future as well. So for instance, to the question of conservatorships. There are about 50,000 Regional Center clients who are conserved in California.

Over half of them are conserved by strangers who are not in their family. These are public guardians, professional conservators, service providers, DDS, and in some cases the Regional Centers themselves. Conservatorship is a legal mechanism that significantly limits individual rights and choices.

The person with IDD loses the right to make their own choices even when... Now they may have a good conservator who consults with them, but they don't have the right to that, right. So even when they have been able to make decisions in the past with support.

So I was very pleased to see that supported decision making was highlighted in the master plan recommendations because it's a mechanism in current statute, and we're starting to see it in other states as well, that recognizes that individuals can choose support to teams that will help them make their decisions. And these teams are legally built in to a relationship that clarifies the roles and responsibilities.

You know, as much as we fear that our kids will end up with a conservatorship or in a situation where someone has control over their lives who doesn't know them, who doesn't respect them, who doesn't really know that this is a person who does a lot of things and cares about a lot of things, we still often as parents turn to conservatorship because we just don't know what else exists.

I think most families... Now this I hope is changing and I think this is something that I think the Regional Center is taking very seriously. But most families, you know, when parents are getting old, I'm not that old yet, in 15 or 20 years, I might say this. But when parents are getting old, they really feel desperate and so they just want to make sure their kids are safe. Right. So if they haven't had that ongoing support to build community, to build relationships, to ensure that their child feels connected, they're likely to make a decision that they would rather not.

So that comes back to the major point that what we're doing now with our kids in integrating them into the community matters a lot. To the question, I'm trying to address the questions. To the question about what happens when our children's needs become too difficult to address on a daily basis.

I think we tend to think of this as being kids living at home. But I want to remind us that that is not necessarily the case. It's, you know, as parents, we think about and worry about our kids no matter where they are, whether they've got a developmental disability or not.

I know for those of us in the room with kids, but when we're in a situation where we are the glue between all the silos. We are not even, the glue we provide isn't even always recognized by the service providers working with our kids, but we are in fact the glue. We have to really look at that role as we're planning for our kids futures and the systems that work with our kids have to look at that role also. Because I think they forget that there's somebody in the background gluing things together.

The one last point I would make is, you know, I laud the developmental DDS for their new webpage. I hadn't seen it until recently about aging and disabilities. And you know, there are a lot of resources on that page and there are a lot of generic services mentioned on that page. And that is great.

And it makes me very nervous because what we're doing is expanding the number of silos and generic services that have to be weaved together to make this work for our kids. I tracked the master plan process closely. I think it was a great process in many ways.

DVU was involved. But I never really saw many of the other agencies that I would have liked to see there participating. And some of them, of course, aren't even under Health and Human Services. Right. So all of that just adds up to the need to really think cross system and recognize that we've not done a good job of managing those processes.

Thank you, Mr. Chair and Members. And to my colleague on the panel, I would simply say ditto. I mean, there's no substitute for lived experience in describing what the solutions or options are for people. Whether or not you have a child with developmental or intellectual disabilities, I think the question is always, what happens to them when I'm no longer able to take care of them?

It's a logical question. I would add family supports. We know once mom and dad can't do it anymore, a sibling may step in and take care of somebody. It may be hired strangers. So family supports, community supports, inclusion in the community. Critically important. An understanding of health and other health, behavioral health, other needs that somebody might have may dictate the care that they need once the parents are no longer able to do it. So it's obviously a very individualized decision making process.

And it has to do both with the socioeconomic status of the family as well as all of those other factors. I appreciate the agenda, page 22. We didn't provide a sum to that, but it's 76,000 people over the age of 40 receiving services through Regional Centers in California. That's the sum of the colored graphs at the top.

So this is a fairly significant portion of the population. What I will additionally share are a couple of things. One, the new statewide... Sorry, try not to use too many acronyms. The new statewide individual program plan includes, at age 18, questions about future planning. Kind of, who are the people closest to you to ensure...

You know, obviously it's an optional section, but it's there in that it's forced to be asked, but can be skipped if necessary. But it's forced at certain points in the process to be asked so that it's actively considered. It also includes a section about emergency notifications.

Very often in a number of other state programs, including one of our larger generic services, the In Home Supportive Services Program, this is kind of a mandatory piece where you're identifying what happens in an emergency. The people on that page are often the people that you end up relying on as well.

They're the closest, most important people to you in your life. So all of that's true. I would also add we will be coming to the community and some work has already been done on this led by members of our staff at the Department. Alternatives to conservatorship are really important. Supported decision making is obviously there. Guardianship, limited conservatorships, conservatorships.

Conservatorship is not the only option available to people. And I think it's important that we educate people about what those available options are. That document is being developed. We expect to get community input on it. After all, they're the audience for it and should have input. So I think those things are there. And something, frankly, to the cross system nature of it. Once we have that available, I think it's also going to be taken on the road with school districts.

We often hear at age 18 or 22, school districts encouraging parents, particularly as they get older, to consider a conservative for their soon to be graduate. That's not necessarily the most appropriate thing. And I think there's room to educate cross system as well. So it's a big deal. It's a very individualized decision.

The trigger points in the conversation are there through the individual program plan. Sorry, I keep trying to say IPP. And you know, I think, you know, there's a lot there. I'll also acknowledge in your agenda on page 23, there's a discussion as well about coordinated family supports.

And that program and future planning is service number four within that program as well. So there are some options to get support there. But that clearly doesn't reach everybody, given the scope of that service particularly. So thanks for your attention to this. It's something we hear quite a bit about, including in the master plan development process.

Absolutely. Department of Finance.

Omar Sanchez, Department of Finance. Nothing further to add.

LAO.

Karina Hendren, LAO. Nothing from us either.

Director, do we, when the master plan comes out, will it include this specific population in terms of members of the IDD community who are aging or becoming in the aging community?

I fully expect there to be recommendations that both touch on this directly and indirectly.

I wonder if I could add one more point because the Director is right that these are very individualized decisions, plans, and that's what person centered planning is about. But what can't be individualized is our assurance that there will be equity across.

So, you know, the question of data and ability to actually know what the outcomes are, you know, amongst our population came up earlier and it's really important. It's going to be so easy to sort of shuffle these old people to the side. It happens to old people already in our society. Right.

So it's really going to be important to see are the Regional Centers across the system, are the outcomes the same? Are families taking the various options at the same rate? How does it vary? Because it's not just, it's very individual planning and it's also individual to the relationship with that Regional Center. So I think it'll be extremely important to monitor what's happening to this population over time with real data.

Absolutely. I want to be clear. There's going to be, there's two, this hearing specifically, this panel is specifically for the IDD individual who is aging. Right. And then next month we'll be talking about the caregiver who's aging and what services and supports we can begin to provide.

Again, one of the main priorities of this Committee is really, as we know, our aging population is going to continue to grow. How are we making sure that our systems are going to be adjusting to that growing need? And based upon that population shift, what services should we be starting to plan on expanding? Because it'll be a growing percentage of that service than it may be today. Right.

So we want to continue to think about these things and continue to make sure that we're not waiting until we're facing a crisis in a certain situation where maybe now we don't have enough providers for a specific service or now we don't have the proper amount of funding to be able to make sure that that service had.

It might be a growing number of medical type services. Right. In most cases. And certainly more respite services as well, when you're thinking about it. So again, we want to continue to make sure that we're focused on this area intentionally on those that are aging, both on the client side and the caregiver side as well. Any additional questions or comments from Committee Members? Seeing none. Thank you so very much. Thank you. Next we'll move to issue number five, rate reform implementation and quality incentive payments updates and issues.

And Mr. Director, your begin when you are ready.

All right, thank you. Just for the record on the last item, coordinated family supports is on page 24, not 23. So apologies to the committee on Rate Reform, Quality Incentive Program and Provider Directory. There is a definitely a lot that we can talk about here. So I appreciate the discussion in the agenda.

My high level recap of this rate reform has been a long time coming. Legislature requested a report in 2016 and 2019. It was delivered and the first investment came in the budget in 2022 with subsequent steps January of 24 and about 10-12-13 weeks ago. They go by fast now.

In January of 25 was the third and final implementation step of rate reform in California. Obviously in the intervening time there have been changes in cost factors, inflation of course being a big one. We had a single year of almost 9%.

I don't need to lecture this committee about the cost of insurance in California, but that's a big deal for transportation providers and others in our system. So what I will say is that and the statute for implementation of rate reform gives the department the authority to continue to review and update rate models.

And we already know that there are a number of issues with rate models that may require subsequent adjustment. We've made some, we've done some tweaks to the employment program, for example.

And so there's a trailer bill statutory proposal to align both the methodology for rate model implementation to be written directives from the department versus specific numbers in the statute, but also an adjustment for employment support services to also include a one to two ratio and to clean up the use of service codes, which was another goal of rate reform so that both profit and nonprofit providers of those services can both be in the same service code.

So there's, you know, some boring technical nuance to it all backing up for just a moment. This is an incredible multi billion dollar investment in California's service provider network not only to maintain it but to expand it in the face of rising caseload. And of course, the service providers employ people to actually provide the service.

So we're talking about a major workforce investment as well. Both of these are really unprecedented in our system. For a long time we were operating under rate freezes and doing funny machinations to make sure that services are getting to people.

The conversation that we had about respite services and barriers to it was actually the subject of a state auditor report a couple years ago. And the number one barrier was not having enough people willing to provide it for the wage that was offered.

So, you know, rate reform absolutely helps with that, but it needs to also be maintained investment with the cost of living. And so last year the legislature passed and the governor signed legislation that requires every two year revisiting of the rate models and an update on what they should be.

Note I didn't say that it promises the appropriation for the higher cost, but at least we know what we need to do in order to maintain both the service provider network and the workforce that it works for. The rate models include what we call a 9010 structure.

There's a 90% of the model base rate, and the remaining 10% is known as the quality incentive increment for the rate that has to be earned based on the quality of the service being provided by the service provider.

There's a long conversation that can be had about the history and development of the quality incentive program that determines that 10%. Needless to say, there's some basic fundamental investments that need to be made in our system, primarily in data collection, but also baselining what's actually happening in our system.

So for the last couple of years, the quality incentive program has been standalone outside the rate payments based on, for example, completing a workforce, a direct support professional workforce survey to find out how many people are employed, how much they're making, what languages they speak, basically surveying their capacity to serve people across California.

For this year, the quality incentive piece is 100% determined by provider's validation of basic information about them in California's first ever provider directory.

Up to this point, vendorizations of service providers by Regional Centers were done in a centralized database at each Regional Center, and we didn't have a single statewide view of how many providers there are in our system. So there's another long, complicated conversation to be had about that.

We are learning through this experience that we think we have around 3,400 or 3,500 providers in the sense of an agency with about 16,500 vendorizations in the provider directory as of last Friday, it looks like roughly 60% of providers have validated their information.

And given that we've spent a year outreaching to the provider community to get them involved in that provider directory, we're going to be increasingly looking at other options, including pausing their ability to submit bills to us until they call the help desk to get it squared away. So we are working on it.

What you heard from me one. Historic, massively important investment. Two, there's a lot of bumps that still need to be ironed out and we're working on it. Three, we appreciate that when folks raise concerns about that they get directed to us so that we know we're working on the right stuff to get it fixed.

And four, December 31st is the magic date coming up, December 31st, nine months from now, the magic date for services providers and Regional Centers to align their rates with the rate models based on the individuals being served and the service acknowledgement form that agrees that the services being provided by a particular provider are aligned with particular service codes and the rates for them.

There are additional features in the rate model implementation. The rates across California, one of the goals was to standardize them or as I say, squash the bell curve together on both ends a little bit. There are providers who are making more than the rate models would call for.

They have a hold harmless in current law that ends at the end of the day on June 30, 2026 the end of budget year. So there are some features in there. We think about 13% of our providers qualify for that hold harmless.

That number is growing as we get more providers between the 90% and 100% of the four rate models. And now you're just going to be glad that I'm stopping talking because it got really technical.

So thank you, Mr. Chair, Director Cervinka, I was nerding out with you, so it's all. It's all good for me. Good afternoon. I'm Barry Jardini. I'm the Executive Director at the California Disability Services Association. We represent 120 providers who serve individuals with intellectual and developmental disabilities throughout the state.

I'm here today in that capacity, but also as one of the three co chairs of the Lanterman Coalition, which is a coalition of statewide and regional organizations that come together really, to protect the fundamentals of the Lanterman act in California. Appreciate all the work that went into building the agenda today.

I know you've already been called out once, Ms. Vasquez, but thank you again for a very comprehensive agenda that really lays out the issues particularly well. I've been here, asked here today to speak about some of the key issues and findings as we deal with rate model implementation and the quality incentive program.

Director Trevinka did a really nice job, I think, of quickly summarizing kind of the history of how we got here. And I just want to reinforce a couple of key points, especially in light of some of the challenges that we're potentially going to experience at the federal level with federal funds, et cetera.

It's really important to recognize what happens when funding is cut from our system. Back in 2008, when we had rate cuts and rate freezes. It has taken us 17 years to January 1st of this year before we get back to a point where rates are meant to be sustainable and paid at a sustainable rate.

It takes a long time and time doesn't just tick over and we're waiting. People's lives are impacted every day when that happens. People with intellectual and developmental disabilities don't get the services that they need. They go on wait lists for services because providers can't hire staff.

Workforce gets paid less than they should to do vital and important work to support people with intellectual and developmental disabilities. So these are things that have tangible, meaningful impacts on people's lives that are destabilizing. To steal your kind of framing for a lot of this, Dr. Jackson, these are things that matter a lot.

And we are very excited that the legislature took this up, calling for a rate study, ultimately putting in place a five year plan, then a four year plan, then ultimately a four and a half year plan to get us to full funding. Director Cervinka correctly notes that we are finally there on January 1st, 2025.

I would just say that in stages 1 and 2, which we needed to do, you know, an iterative process, we still weren't fully funded. Right. And we are still now just in the process of trying to shake all this out. 16,000 vendorizations three and a half thousand provider agencies.

There has been a tremendous amount of work that has gone into trying to right size everyone's rates and get everyone to where they should be. That work is ongoing. I want to commend the department and the Regional Centers who have done kind of herculean efforts to try to get us there.

It has been bumpy without question, but I will say that there's been a lot of responsiveness and openness to feedback from the department and it has been very much appreciated by the provider community flexibility as we try to make sure everyone gets what they deserve in terms of rates so that not.

Not so that they can fill their coffers so that they can serve individuals with intellectual and developmental disabilities is the key.

And again, appreciate that the Department has taken on a few services that we've already recognized, have some mistakes in the rate models and also an openness to discuss issues that still need to be addressed on an ongoing basis. I mentioned it's a.

It's been a big task and the other component that Director Cervinka spoke to was this 9010 structure. And I just want to make sure everyone is on the same page. We have a couple of new members of the subcommittee and welcome by the way, welcome to our world.

I don't want to presume one way or the other, but the 9010 structure, I don't want any misunderstanding. 100% of the rates was what was determined to be sustainable.

The structure for the 9010 was a component of the acceleration plan that ultimately has a perfectly laudable and commendable intent, which is to make sure that as we're increasing rates, we're pushing for quality, that we're not just paying for any service, that we are paying to make sure people are not, are getting quality services that meaningfully impact and relate to their needs and wants in their lives.

But 100% is again meant to be the sustainable level. And a 10% quality incentive payment, if not achieved is a very draconian sort of drop off. And it is a penalty structure the way that we've done this in California. And it is a bit out of line with some of the best practices for value based payments.

So I would, I would urge us all to consider long term whether that's the structure we're looking for for the 9010 and whether there want to be any revisions so that we make sure that we're not destabilizing services as we pursue quality in our services.

The provider directory as a foundational measure has been broadly available to providers, as Director Cervinka indicated.

While we are continuing to try to make sure everyone updates that information, which is a critical component, it seems basic, but frankly to be able to know where services are, what people are offering, and then ultimately to be able to grow that into something meaningful for individuals so that they can see what services are available, so that we can not only use it for data on our, on the administration's end and from the back end, but really make it community focused and community friendly forward so that people can choose the services and they're not relying necessarily on someone else telling them what might be available, they can do some of that research themselves.

It's going to be a really important tool and we're excited that it's, you know, going to be the qualifying measure for the 18, 18 months. Beyond that the question about what becomes that 10% qualifying metric is super important.

We need to make sure it is broadly available because if we, as we work towards individualized outcomes measures, which is the goal, it's complicated stuff. No state in this, in the nation has figured out exactly how to measure outcomes in our system.

We know that investment in workforce and investment in rates is a great quality metric when people have stable and consistent services with direct support professionals who are well trained and adequately supported. We see great outcomes. We know that to be true. But that's not alone enough.

I'm not suggesting we don't continue pushing for excellence in all ways, but we do know that full funding is foundational to making sure that happens. I want to touch on I mentioned I'm here on behalf of Lanterman Coalition.

We have put forward a stakeholder proposal that was sponsored by Assemblymember- Assemblymember Nguyen to do some technical cleanup on the rate study, which is all about maximizing the investment that we have made as a state and the impact and stabilizing services.

So as Director Cervinka mentioned and I've mentioned, there are some services that, you know, we haven't gotten 100% right or need some fixes as we go forward. Some assurances about making sure billing. I mean this is some technical nerdy stuff.

I was nerding out with Director Cervinka earlier and I'm, I'm not going to go too far in the weeds here, but there are some things like maintaining billing units as we transition into new services, making sure that hold harmless doesn't destabilize the system.

As we approach that June 30, 2026 deadline, make sure that we have a process to build rates for innovative services. Ms. Swatila on the employment panel spoke to Community Integrated Training Program that doesn't have a rate model at this point.

There are other great programs that have been offered to individuals with IDD because that's what they need and what they want for their lives that don't currently have a rate model.

We want to make sure there's a process in place to build those rate models out and make sure that they are going to be available in the long run to them. And then I think Ms. Swatila also mentioned Taylor Day Services, which is an individualized service that also allows that making sure that that rate is right size.

So those are some of the components of that stakeholder proposal. These are things that we believe to be cost neutral at least in budget year and we would pursue to try to again maximize the impact and stabilize services. And happy to answer any more questions that the subcommittee has on that point.

I will finally note, just with a little bit of appreciation for this committee and for the partnership that has happened between the legislature, the department's partnership and the Regional Centers and really all the stakeholders, ultimately the families and family members who work together to make this happen. Our system only works if everyone's pushing in the same direction.

We're all here for the same purpose, which is to make sure people with intellectual and developmental disabilities live full, inclusive lives as any Californian will. And so it's often, I mean, this hearing in some ways is about trying to figure out where the cracks are. But there are life changing and life affirming services happening every day.

And some of that has happened because of the partnerships between the legislature, the leadership, the administration, and everyone else in the system who's so committed to it. So just a moment to acknowledge. A lot of great work and a lot of the strength and support of the legislature has facilitated meaningful things in people's lives.

So I just want to close with that. Thank you.

Well, my co presenters up here really teed up the workforce, the importance of the workforce for me, didn't they? Good afternoon Dr. Jackson, committee members and committee staff. My name is Teresa Anderson. I'm the Executive Director for the California Policy Center for Intellectual and Developmental Disabilities. Thank you for the opportunity to share findings from our recent report.

Over the last year, we undertook an extensive look at the impact of the DSP workforce shortage on individuals with IDD and their families. We conducted surveys, focus groups and interviews across the state with individuals served by the Regional Center system, their family members, direct support professionals, Regional Center vendors, and Regional Center service coordinators.

We also used existing state and national data sets, policy research, analysis of state and national workforce initiatives, initiatives, and some other, you know, state level data to really inform the report that we produced. I was asked to share key findings from our report and how they relate to sufficient rates and quality incentives.

There are many significant key findings in the report, but the findings I want to highlight today are that the DSP workforce shortage is severely limiting choices and opportunities for people with IDD, where they live, who they live with, what services they can access, where they work, if they get to go to work at all, as well as many other life choices.

64% of the individuals reported staff turnover in the last 12 months. 20% reported six or more staff leaving. And it was also reported that staff turnover, especially high levels of staff turnover and frequent turnover, increased feelings of sadness, fear, anxiety and overall disruption in people's lives. Low pay is the number one reason DSPs leave their job.

Focus group and interview participants all reported that there's a serious disconnect between there's a serious disconnect between what they get paid and the level of skill required for the job. Nearly half of the DSPs reported working two or more jobs just to make a living.

And this is another really important theme that continually came up in the focus groups and the interviews, the new sector set minimum wages. In fact, food and healthcare are really having a ripple effect on the DSP workforce shortage because DSPs are feeling very, very devalued.

Providers are concerned that they will lose DSPs or that the DSP job will become the second job. Individuals, families and service coordinators all shared the same concern of losing the DSPs.

And as we think about provider rates and sufficient rates in the context of workforce development and workforce stability, we have to think about a rate structure that provides enough flexibility to account for DSP's experience and training.

Because a DSP who has been working for many years and has a lot of experience shouldn't be making a dollar or two more an hour than someone who's brand new to the field. And this is very common, which is why it's likely why we see a significant drop in retention around the three year mark.

Provider rates in quality incentives are an equally important part of the discussion related to workforce because it's important to ensure that you're incentivizing the right things. For example, research shows that turnover and vacancy rates are a factor in quality.

However, it also shows that vacancy rates and turnover tend to increase, and sometimes significantly in tight labor markets or where there are workforce shortages. So we want to be very mindful about what we're incentivizing. We don't want to incentivize keeping DSPs that might not be a good fit for the job.

We also don't want to penalize providers for things that may be out of their control, like people seeking higher paying jobs. But we can incentivize other things and things that we should think about. Can we incentivize reductions in turnover, vacancy rates, or increase training opportunities or efforts that directly impact retention?

I don't claim to, and I definitely don't have the answers to all those questions. But I do know it's critical to make sure that we are incentivizing the right measures to avoid unintended consequences. Finally, I was also asked to discuss how the DSP workforce shortage relates to issues and concerns around equity.

And this is such an important part of the conversation as we think about equity. And I know we talked earlier that or you heard earlier that we don't have a definition, we don't really know what equity is.

But when we're looking at families and people served, some important findings were that 58% of the families reported that their family Members, Members with IDD, were not able to access all of the services authorized in their IPP.

Sorry, Individual Program Plan As a result of the DSP workforce shortage, there's a growing concern that aging caregivers are disproportionately impacted by the DSP workforce shortage as they're increasingly providing substantial support and care for their sons or daughters, and many of whom have very complex needs. You talked about sleep and you talked about food.

And so many of these aging caregivers are, you know, running really low on both because they're providing so much care. In terms of issues and concerns of equity, we cannot overlook the reality that the greater the workforce shortage, the greater the inequity, especially for individuals that need higher levels of support.

And one indicator of this is that the alarming number of there's an alarming number of service providers that reported they're no longer able to accept individuals that require one to one because they simply just do not have the staff.

So I'll just close by saying that there are so many incredible quotes from people who shared their experiences with us. But I would like to share this quote from a father that I interviewed, and he said, think about what it costs not to invest in this workforce. Parents can't work, so you lose there.

People have to seek higher levels of care when it becomes a crisis, so you lose there. And people with disabilities lose their Independence, which is the greatest loss of all. Thank you for your time.

Thank you very much. Department of Finance.

Omar Sanchez, Department of. Finance Nothing further to add.

LAO.

Thank you, Dr. Jackson. Karina Hendren, LAO. We have a couple of comments on the quality incentive payments. So first, the Director and Mr. Giardini mentioned the new provider directory. This is the first time that DDS is going to have a statewide view of all the providers across the state. Thank you, Dr. Jackson. Karina Hendren, LAO we have a couple of comments on the quality incentive payments. So first, the Director and Mr. Jardini mentioned the new provider directory. This is the first time that DDS is going to have a statewide view of all the providers across the state.

And we think this could provide really valuable information about areas where there might be gaps in access to services in different parts of the state. Currently, there is no requirement for the Department to publish any kind of analysis or report on what it finds from the provider directory.

So what we're recommending is that the legislature could consider directing DDS to produce this type of report so that the legislature has clear and transparent findings on what is shown in the provider directory. And that way the legislature can better consider where it might want to invest resources to address any gaps in service availability.

Second, we wanted to talk about beyond the provider directory and kind of thinking more about quality incentives in the long term.

So there is chapter legislation that establishes legislative intent that the quality incentive program should be a tool to provide individual outcomes and the quality of services to this end we've identified some questions that the subcommittee could ask the administration on its progress towards moving towards these individual outcome measures. This is not an easy process. As Mr.

Jardini noted, there is not currently any state that has individual level outcome measures in its Developmental Services system. But the questions that we've identified could help the legislature provide oversight to ensure that individual level outcome measures are in place with the in accordance with the date established in statute.

And this will help ensure that the quality incentives program is implementing, or rather implemented according to legislative intent.

Thank you very much. Questions, comments from committee members Dr. Sharp-Collins.

One of the questions that it could have been answered, but I didn't catch it, is how would the administration keep the legislature informed about decisions on the quality incentive payments leading up to July 1, 2026? That's. That's one question.

Thanks for the question. I was going to back cleanup and you're helping me do it. We since since the enactment of the statute, we have had a quality incentive work group established. Initially, they met monthly. They're now on a quarterly cadence. All of those meetings and their materials are archived on our website. Archived

sounds like it's hard to find. It's on our Stakeholder Events page under past. It's not that archived, including our most recent one in March. Additionally, we as a Department brief legislative staff every quarter and we talk about QIP in that forum. Not every single time, but when we have things that we think may be material.

Additionally, we will own as a Department, we don't necessarily always follow statute as closely as we should, but proposed measures are actually supposed to be published and released for public comment in April 1st of every year. We're going to miss that date again this year. But we are transparent about those measures.

I will also share that we're not as far along with these measures as we would like to be. You've heard me say earlier the measure this year was validate your corporate ownership information in a statewide provider directory. I don't think there's anybody in the room that would say that's a wonderful quality measure. Let's do that again.

But if you don't know who you're paying, the rest of it's kind of not meaningful. Right. So yes, it's a foundational investment in the system. Appreciate the comment from our colleagues at the lao. You know, if this was easy, some other state would have done it first.

We're, we're getting to get there, but nobody else has done it because it's not an easy thing to do. And you run Quickly into things like you're a supported employment provider and you're supporting five people in employment. What's the individual level outcome measure you're going to use to set their rate for the entire year?

Is it based on an 80% satisfaction rate? Somebody's survey on a bad day? Is it the tenure of four of the five people in the placement you've supported them in? There's a lot to think about. And so what's in control of the provider has obviously got to be part of the equation. We call that a attribution.

But the rates also have to be valid and reliable if CMS is going to approve our rate structure for rate setting purposes. Meaning we need to get the same answer from the same person in the same situation on different days. Right. Survey has to be reliable, it has to be accurate.

So the answers, people, you know, the questions we ask need to result in valid answers. Like are we asking questions about the thing we're actually trying to measure or are we capturing proxies for it? It. So there's a lot to think through on that in four steps of quality measure development.

The first is data collection and we find ourselves there mostly. Then goal setting. Once we have the data, where are most people? What's reasonable? What's a decent expectation? Is it 70% of the bell curve? Not to pick on bell curves. They're one measure. And then, you know, is Everybody over that 70% mark?

You know, is that a quality measure? And do we, is it year two? Is it 72%? Like, how do we move that over time and then to get to individual level outcomes. Good grief. Tie that with what I said about rate setting. This is not simple. So just in that one explanation.

Hopefully you're still nerding out with me. Thanks.

I, I had one more if you didn't mind, because I, I missed the very first panel that talked about the master plan and. But I continue to hear the, the conversation that we don't have definition for equity.

So equity is not already infused in the creation of the master plan or the revision of the master plan or what is there, has there been any, any form of definition presented that maybe we just haven't agreed upon? I'm just trying to get to that point because I have a definition for equity.

But I'm just wondering, has there been anything at all?

I'll take that as the Administration Member up here. The master plan talked about equity. It's one of the big frames. Achieving equity, I think has a lot of different definitions.

We would intend to follow Our agency's definition, equity, and that's not quite yet finalized, but I think at its core, people who are similarly situated with similar needs, receive similar services, is a pretty straightforward simplistic answer. And equity is not just based on a race. It can be based on age.

It can be based on disability, diagnosis, medical condition. And the other one that we find ourselves talking a lot about is where somebody lives, kind of the residence type. Right? So if you're in assisted living, it costs presumably a lot more than if you're still at home in mom and dad's bedroom. Right.

And so we see those kinds of things, then we can also talk about it in terms of equity and expenditures. We can talk about it in equity of outcomes. You may have a better Doctor than I do, so your outcome is going to be better, even though it costs the same.

And we can also talk about it in terms of things like timeliness of access to services. So how long was your intake process versus my intake process when we're similarly situated, but maybe in different geographies across California?

So there's lots of ways to talk about that, or access to services, meaning now that we know you're eligible and we've approved you for this, how long does it take to find somebody to give that service? So there's lots of ways we could measure equity.

In my mind, I think about it really, that simplistically, two identical people with identical needs getting roughly the same thing and resulting in the same outcome. More importantly.

Thank you. Thank you. I'm heading up a Bill on behalf of our Black Caucus priorities as well, which is AB766, which is diversity, equity, inclusion, and access us. And so this is why I'm asking even more. So is there a formal definition or are we just throwing things around?

Or whichever, because I appreciate you indicating that DEIA for me, is not just about race. And that's typically too often where the conversation goes. It's just about race, and it's not.

And so what I wrote down, too, as a definition is that it's to ensuring that everyone, regardless of the disability, has a fair and just opportunity to access resources, services, and opportunities to achieve their full potential and live a fulfilling life. And looking at that is focused on everything you just said.

And you and I are in full agreeance of focusing on needs, addressing the disparities, and promoting inclusion and et cetera. That's how I see diversity, equity, inclusion, and access.

And I'm hoping that we can, you know, can continue to work to finalize that formal definition, because as you do any type of financial analysis, are you doing program services analysis and all of that, all these components should be through that work.

And everything that I do, even as an educator in other avenues, come from an equitable lens. And we know that there's no one size fit all model approach to anything that we do. We have to keep that in mind as we move forward. And you hit it right on the nail.

So I appreciate your own response from the top of your head in regards to how you see that, and I'm hoping that other colleagues that you have can start to see it that way as well. This work, it is essential to us. It's important to our quality of life.

And I hope that we can get this done so we can make sure as we continue on in this process that everything that we're talking about is going to reflect that moving forward. So thank you.

Can I add one comment to that? I really appreciate that. And I think when we're looking at that, we also carry that into workforce development. Right. Do we reach into the community, do we develop, you know, where we're seeing the inequities, where we're seeing challenges in the workforce?

How are we connecting with those communities to really build that workforce and develop that workforce in those communities? I think that's a really important piece to consider and looking at equity, looking through that lens as we think about workforce and workforce development and stability. So thank you very much.

Wow, that was a sexy equity discussion. Have mercy. All right. Got me all excited. All right. All right. Okay. So a couple of things, Elio. Again, as we begin to try to chart the course so that we can continue across administrations, we want to rely on your expertise.

So we're going to ask you for some assistance sense to work with our Subcommitee before we share it with Administration and our Senate partners to think about trailer Bill Language on two subjects.

Number one, as we were talking about language on information from the provider directory being reported to provide insight into system gaps and these, and then number two, reporting and codification of the pending quality incentive payment details. And so if that is possible, we would love to get that. Is that possible?

Karina, Hendra and Lao.

Yes, thank you very much.

I mean, obviously, as we are engaging in this new frontier, that we are not only trying to reach our goals and create, ensure that we have some stability as we implement it, not trying to make a lot of changes along the way, but at the same time, how do we make sure that possible unintended consequences that we may see coming?

How can we begin to Address those now before it actually becomes right. Well, I know we're already talking about a fragile system here, and the last thing we want to do is making sure that we are not losing service providers and that we're not losing these services.

And so I would like us to continue to think about as we go through this budget process this year. How. Do we make sure that we keep the system stable as we're going through this unchartered territory at the same time. Right. And so looking forward, further discussions along the way. Thank you all very much for being here.

Thank you.

Issue number six. And it's not even five o'clock. You all are welcome. Issue number six, Life Outcomes Improvement System Automation funding issues and timeline for completion. Director, this. That's right. At this point, the Director is not going anywhere until we adjourn. Director, please start us off.

All right. Thanks for the extended opportunity to hang with the rest of you IT projects. Everybody's favorite subject. I think I said this in my opening remarks about the master plan.

And if I didn't say it here, one of the major themes coming out of the master plan is we need more better information and we need more, better access to information and we need more ways to access that information. So essentially the ugly story and appreciate again, Nicole Vasquez's agenda for laying it out.

So I don't have to read it back to you. Essentially what we're after here is to replace two legacy systems in California, our 1984 case management system. You laugh. It ain't funny. I was a baby.

I wasn't born yet. Mr. Jackson, out of order, out of order.

In that case. I was a toddler.

Anyway, it's all protected, but you chose to say it yourself, so you've waived her protection. And then our 1985, that year. I'm making it up, but it's pretty darn close. Fiscal system. They are two systems that have served California well, that were designed when we've served way fewer people than we do today. Yeah.

Black font, black screen, green font. I mean, this should help for those of you that at least have seen that much. Apologies if you haven't. I have. But, you know, you're too old when. Anyway, you know, everything that we do is about the lives of people.

And the information we have about those people is kind of the fundamental first for what it is we're able to do either for them or to improve what they're getting. So case management system of record, vitally important. It's so Darnold that among the Regional Centers. There are actually now several other case management systems in use.

None of them have the full functionality that you would want if you were designing a system from scratch today, knowing what you need to do to get the job done. And all of them still have to do transfers of data into the state system of record. I call it the state System of record.