Assembly Budget Subcommittee No. 2 on Human Services

Good afternoon, and welcome. This is the Assembly Budget Subcommittee on Human Services. Today, we'll be discussing issues and programs principally related to the Department of Developmental Services. We have asked the Department of Social Services, Department of Rehabilitation, and the State Council on Developmental Disabilities to also be here given the crossover impacts for people served through these programs. Before we invite our first panel to begin, I'll just make a few introductory comments and then open up to any colleagues who wish to do the same.

We've worked hard over many years to strengthen the system that serves individuals with intellectual and developmental disabilities. One third of the regional center served caseload receives In-Home Supportive Services, and over two thirds are Medi-Cal enrollees. We'll ask today about the number of people in the DDS caseload who rely on CalFresh for food assistance. When we see reductions and cuts in areas that impact the IDD community, we need to be attentive and ready to preserve those services and supports some other way.

There is inherent risk in a faltering safety net, especially for individuals and families who have less income, may be foreign born and unable to speak English, and who may have less education and ability to access and navigate these complex programs.

Our goal is to not lose ground. We must hold the line. We have made progress, and we should make sure that we continue to do so. We need to do everything that we can as a state to preserve the vital safety net that we have stitched with blood, sweat, and tears back together since the Great Recession. We also have a long list of trailer bill proposals from the Governor as part of his January budget.

I won't be guarded on this. Today, we will be assessing the level of concern and issues with these mostly policy-oriented pieces. In one month, we will have the May revision, and then precious little time to meet our constitutional and moral responsibilities to achieve a balanced and compassionate budget. Today, we will be asking, can this trailer bill be landed? We'll ask ourselves, is this trailer bill in the best interest of the IDD community and the principles of the Lanterman Act?

Number two, has the trailer bill been properly vetted with stakeholders, and does it include edits that they are seeking? And then number three, is the trailer bill compatible with the overall budget, and do the members of the Legislature support it? Finally, as chair of the subcommittee, you've heard me say this very often: if you can't see me, you can't serve me. So today and this year and this season is not time to be shy.

Your input is not only a request, but an imperative part of this process. In other words, we see you. With that, I'll open it up for any colleagues. Any colleagues have anything? Okay.

Seeing none, we will start listening to the panel speakers for the issues on the agenda, and then we'll take public comment after all of the panels have been concluded. Each panelist has three minutes to speak, and each person providing public comment will have one minute each to make your remarks. There will be no votes taken in today's hearing.

So I'm going to ask for the first panel to come forward, take your positions at the witness table, please, and then please introduce yourself before you speak, and let's try in the order listed in the agenda. Our first issue will be impacts of HR 1 for the IDD community in California.

And with that, Department of Developmental Services, Mr. Director, you may begin when you are ready.

Thank you, Dr. Jackson. I appreciate that you read my opening remarks already, so thank you for doing that. My name is Pete Cervinka. I'm the Director of the Department of Developmental Services. Appreciate the opportunity to be here today.

Very quick opening remarks. 2025 and now 2026 are absolutely incredible years in our system. We have been busy, busy, busy, and I want to take a moment to thank the community for coming along with us on the ride, our regional center partners for helping with us, the many colleagues that I have with me today from the department, the community writ large, advocate groups, service providers, the individuals and families without whom nothing would actually happen.

I'd like to thank the Legislature for its support with everything we've had under way. I also appreciate the committee staff for the agenda, as always comprehensive, thorough, somewhat abbreviated, no offense.

But there's lots of detail and nuance here as well. And I want to also appreciate colleagues from Department of Social Services on the first couple panels with me today. Very quick overview of the budget. I'm not going to tell you a whole bunch. The bottom of page seven really sums it up.

We have a current year budget of $18,700,000,000, and it grows in our proposal to $21,100,000,000 in the budget year. That's an increase of $2,400,000,000 year over year. We're also expecting to see nearly 38,000 individuals join our caseload, and we were pretty close last year, when we estimated we'd add about 30,000 this year, we added about 28,000 this year. So just phenomenal growth in our system. That's the equivalent of adding a single regional center every single year the last couple years.

And we still, yes, have 21 of them. I'm really proud of the work that it represents. You know, there are many things here. I know you noted a variety of trailer bill proposals. We do consider them budget proposals, although, of course, policy is made in the budget as well.

The objections we have heard across all the issues from stakeholders, have not heard a single thing that's insurmountable with perhaps one exception at the end that we can talk about when we get there. If the Legislature is interested in consensus language, we would appreciate as an administration and Department of Finance being clear on that expectation so that we bring back a revised version, but always happy to pursue what we've historically done, which is work through legislative staff to achieve that consensus.

So a direction there is helpful. Obviously, lots to be proud of. The bottom of page six in the agenda lists four basic budget adjustments for the department: ongoing commitment to IT, implementation of a federal mandate, redirection of existing resources, recognizing we don't have a lot of money to throw around.

We've taken a really hard look at our state operations and redirected some funding. And I also want to take a moment and acknowledge both the individuals and families, but also the staff from the department who for years took care of people while they lived at Fairview Developmental Center in Southern California. We have shut down that property now. The last residents moved out several years ago, but it's a major milestone in California history.

Only Porterville Developmental Center remains, and people go there because they're forensically committed, not because there are no other places for them.

So just want to mark that point in history, but no longer staffing that, running the diesel boiler for the facilities. There's some savings achieved to the state as a result of that proposal. Beyond that, obviously, we have state chronic fiscal situations, structural deficit to address, and we also have a variety of federal activities both past and feared upcoming based on the President's proposed budget. So we continue to watch federal happenings and I'll make that my transition then into HR 1 conversations. We are continuing, sorry.

Flip to the right page for those questions. The first question asked in the agenda, foreseeable impacts of HR 1 on the DDS system and the IDD community. So there are a number of things here. The first thing that I would say, the numbers that I presented to you in the overall budget, we also include their 37% of our total funding coming from federal Medicaid match. So things that happen in Medicaid are of significant interest to us as we operate the HCBS program.

We serve roughly, give or take, the year you're looking at, half a million people in California in the IDD system. As you said in your opening remarks, two thirds of them receive Medi-Cal. The Medi-Cal work requirement changes and the redetermination of eligibility will clearly impose barriers on individuals and families trying to maintain their medical coverage. Having said that, the federal law does exempt people with disabilities and their caregivers from the work requirements in HR 1.

And we continue to work diligently with both Department of Social Services and Department of Health Care Services on the best way to automatically exempt folks by transferring data into the county-operated SAWS system.

We are confident that those activities will be successful. We are, of course, still planning for failure, if you will. If it doesn't work, the community still needs to know what they need to know and what they need to say and be prepared for and potentially bring with them if it doesn't work. However, you know, we are planning for that but expecting success with our data automation efforts.

We are also working on a cross-programmatic data matching effort that will elucidate more information about the number of people served by regional centers who receive CalFresh benefits.

So we ourselves are seeking that information, but I would also like to point out if we transfer our file up into SAWS, then we've captured 100% of our population whether they have CalFresh or not. So it is of interest to us, but not an obstacle or a barrier into our auto-exemption policy.

I think I answered the first two here. The Medi-Cal changes, clearly, if people are losing Medi-Cal, either because of the six-month redetermination policy or because of some failure in our auto-exemption effort, that is an impact to people in terms of their available health care coverage. Some of them may need to turn to the health benefit exchange to maintain that.

There are certain services that regional centers can cover, but it's not health insurance writ large. So it is definitely an impact on regional center families, but somewhat outside of our control. The bigger impact for regional centers will likely be seen in the fund source pay more for the services delivered through regional centers.

In other words, if that two-thirds number getting Medi-Cal goes to sixty percent, that's six percent of the caseload that we would no longer be able to claim the federal match for, and they would become state-only cost. So there's that impact as well.

We don't anticipate in either case much, if anything, in the way of eligibility. People who need regional center services generally have already come to a regional center and said they want services. They're already eligible. Losing Medi-Cal is not going to drive a flood of people for eligibility processing at regional centers as we understand it. There's a question in the sub of the fourth bullet about potential codification of the exemption process.

We don't believe that it's necessary, but we are, of course, happy to receive language if the legislature wants to ask for technical assistance with that. I don't see any harm in doing so either as an administration. Impacts expected for the UIS community who are regional center served. Within the regional center system, we are blind to immigration status.

If you are a resident of the State of California and you are eligible and you have a substantial disability, then we provide services regardless of your immigration status, with the caveat, of course, of all the Medi-Cal impacts that that community may experience based on changes in other programs. The budget does not assume a significant transfer from the loss of generic services.

I will, this will be covered in the next panel when we talk about In-Home Supportive Services, but it's my understanding that those proposals don't reduce hours for individuals, but rather limit the number of hours that providers can work. We don't envision that the assessment will drop for an individual such that there would need to be a replacement of some of the services.

For example, personal assistance. Generic services and the work required by SB 138: this is another opportunity to express appreciation. We asked and received within the last month input from Department of Social Services, Health Care Services, Department of Education, State Council on Developmental Disabilities, the County Welfare Directors Association, and the Association of Regional Center Agencies, input on a preliminary list of generic services.

We're looking both, did we miss something, but also ask them in their own words to define what those programs are and also to do that in plain language for the public. So we believe in the last month, we've made significant progress in defining those generic services, pursuant to that bill.

It was a 2023 trailer bill. The final question in the agenda is what product is expected from Manatt, Phelps and Phillips, pursuant to the contract we executed with them regarding HR 1 impacts. And they're doing more for us with that $3,770,000 than just this analysis. The analysis that they prepared, they did as much as they could given what we had.

And the additional that we had originally asked them for is dependent on the results of some of the data matching that I just talked about earlier.

The product that they did provide to us was an eight to ten page report, and it was provided to legislative staff in our quarterly leg briefing in September, I believe, was the month. So at the moment, that's the only work product from Manatt, again, because we haven't been able to give them more data than that. So I believe everything's been shared. I think we could probably benefit from providing a little more information to you about CalFresh impacts.

And for that, I'm going to turn to my colleague from Department of Social Services.

Thank you.

Alright. Good afternoon. My name is Alexis Fernández Garcia, Deputy Director with the Department of Social Services. Thank you for the opportunity to discuss the impacts of HR 1, particularly for people with intellectual and developmental disabilities. CalFresh provides an essential safety net to millions of Californians, and our priority continues to be to protect benefits for those who are eligible.

Via my remarks, I will outline the CalFresh time limit rules for able-bodied adults without dependents, or ABAWDs, that is the federal term, and how we are approaching implementation of HR 1. The federal time limit rules have existed since 1996 welfare reform and generally restrict CalFresh eligibility to three months in any thirty-six month period unless an individual is exempt, is meeting the work or community engagement requirements, or is living in an area that is eligible for a waiver of the rules.

HR 1 keeps the basic structure of these rules, but significantly expands who is subject to them by narrowing exemptions. For example, it raises the age of an ABAWD from 54 to 64 and lowers the dependent child threshold from 18 to age 14. Exemptions remain for people who live with a disability, are pregnant, have a child under 14, are unfit to work, and that is a federal term, or are American Indian.

All individuals served under the Lanterman Act would qualify for an exemption based on the federal definition of a disability that is used for this purpose. HR 1 also changes the criteria for statewide or regional waivers, limiting them to areas with unemployment above 10%. Taken together, the results are more Californians subject to the time limit sooner than under pre-HR 1 rules. Today, we've provided a handout that should be in front of you to help us walk through some of the estimates that we've shared prior.

So roughly 2.7 million adults age 18 to 64 receive CalFresh.

We estimate that about two-thirds, or 1,800,000 of those people, are already exempt from the ABAWD time limit based on administrative data that exists within our eligibility system. That leaves roughly 950,000 adults whose exemption status is not yet known, and who may be newly subject to the time limit because of HR 1. Of these, we anticipate about 110,000 would be found exempt once counties collect additional information about them. And about 179,000 will meet the work or community engagement requirements through a qualifying activity.

That leaves us with approximately 665,000 individuals who may lose eligibility, either because they're not exempt, are not meeting the work requirement, or because of administrative burden.

California will begin implementation on 06/01/2026, allowing time to align policy, update our eligibility system, and train county staff. For ongoing households, screening for exemptions will occur at application or recertification, which spreads implementation and the related workload over roughly twelve months. To mitigate harm, we are maximizing the use of existing data to identify exemptions, pursuing additional automation opportunities, including the use of data sources such as those from DDS, and strengthening county training and engagement. We are also expanding employment and training opportunities and additional workforce development opportunities.

Even with these efforts, many Californians may face increased food insecurity if they lose benefits.

And we remain committed to implementing HR 1 accurately, transparently, and with a focus on minimizing harm whenever possible. Thank you.

Whoever's next on the agenda. Joe. Joe. Hello? You're up.

How are you doing? Good afternoon. My name is Joe Meadows. Today, I received services from our regional center. That is Arthur Regional Center in Sacramento.

For the last twenty years, Arthur has helped me to have a quality of life that I'm proud of. And and if we make any cuts, who knows what will happen to me and my friends out in the community? Yes. I am scared that cut any cuts to services system would send me back to an assisted living home or in the state hospital. We believe that that is not a quality of life that we will want.

Many many are very scared. We are thankful for the Lanterman Act. Without that, we probably will not be here or would be on the waiting list to get services. For example, anyone else will be on the waiting list for services or hope that the number will be caught soon. I want to work hard to keep my services.

I I need. Also, I'm also a voter and a taxpayer. It makes me feel good when I'm able to do that. Medi Cal has helped me to stay healthy since I since I have a lot I take a lot a number of medications. It helps me to pay for them.

CalFresh has helped me because I am someone who has diabetes and I need to eat things that are good for me. The Regional Center has helped me to get the support and the supplies I need to live in the community. Medicare helps me to work on my health needs. IHS helps me to be safe and clean and cleans my house. I I also receive independent living services.

Helps me by having someone take me to my medical appointments and explain things so I can understand them. With these services, I am able to do things I like. For example, I like to go to the farmer's market and baseball games. When I didn't have these services set up, this happened: my health was not so hard.

I have high blood pressure, and high blood sugar was out of control. I'm worried that cuts to any of these services will set me back. HR 1 and the state budget can mean I no longer live a quality life in the community. Today, I have people look at my ability and gifts, not just my disability. Today, I may be retired, but I still help my peers out by helping them to advocate to have a quality life.

Again, thank you for letting me share my story with you today.

Thank you very much, Joe. I'll tell you, I enjoy the farmer's market too, but I can't go because I buy too much kettle corn every time. And my blood sugar just goes, oh, Lord. So I've banned myself from the farmer's market. But thank you for being here.

Appreciate it.

Thank you.

Sabrina.

Good afternoon. My name is Sabrina Epstein, and I work as a policy analyst at Disability Rights California. I am also a disabled person, and I am deeply concerned about the impacts of HR 1 on the community that I love. You have already heard how HR 1 disastrously cuts $1,000,000,000,000 from health care. And now, as we speak, Congress is debating cutting even more funding for Medicaid to reappropriate to ICE and other violence towards immigrants.

California has two options: enable this violence or take action to protect our people. I hope you choose the latter, and here are my suggestions for how to do so. First, in line with SB 138, we need to address generic resources in a way that makes our system more equitable and efficient. Due to HR 1, we can no longer assume people will have access to generic resources, like CalFresh, Medi-Cal, and Covered California.

For example, a regional center client may lose their IHSS, not because anything changed about their daily needs, but because they are a refugee who no longer qualifies for Medi-Cal this October.

The generic resource, IHSS, no longer exists for them. The regional center must be ready to respond to quickly fill the needs for personal care and safety. Second, California can do more to mitigate the harms of HR 1 on regional center consumers. This can look like better resourcing regional centers to address medical questions in an increasingly complex system, or it can look like the diligent work already underway to automatically exempt 12,000 regional center consumers from HR 1's work requirements.

These tools to address navigation and administrative burden can only go so far.

We urge the state to avoid further cuts to services like IHSS and Medi-Cal, each of which only saves the state dollars by withholding needed care and by disenrolling people out of confusion and administrative error. Third, we must address gaps for disabled immigrants, particularly Latina immigrant families who are already experiencing the racial disparities that we have heard about in this committee.

As immigrant families lose health insurance due to cuts to Medi-Cal, they will increasingly turn to the regional center, and these families need to be met with language access and readily available culturally competent services. We have spent the last several years working to address the racial and ethnic disparities embedded in our system. Now we are at a fork in the road.

Do we accept the logic of racist, ableist federal leaders who think our lives are not worth living, or do we instead tackle these problems head on, embrace the promise of the Lanterman Act, and use public funds for what we all agree they should be used for, to help people live lives of their own design with the supports they need in the community surrounded by loved ones.

We have hard policy decisions to make, but these decisions will not be harder than a disabled person deciding between buying insulin or fixing their wheelchair, between paying an attendant to get them out of bed, or addressing a dental emergency. I urge you to find a solution so my friends and I don't have to make that choice. Thank you.

Thank you very much. LAO.

Good afternoon. Karina Hendren, LAO. As the director already noted, HR 1 requires that states exempt individuals with intellectual and developmental disabilities who are enrolled in Medi-Cal using the income eligibility pathway from the new community engagement requirements, and this affects about 15,000 individuals in DDS.

We just want to emphasize that these exemptions are key. And just to reiterate the reasons why, any errors or mistakes that might happen in the exemption process could have broader fiscal implications for the state. One implication is that any loss in Medi-Cal eligibility could affect the amount of federal funding that regional centers can claim for the services that they coordinate.

And the other reason, which has already been mentioned, is that loss of Medi-Cal coverage for health care services could create fiscal pressure for regional centers to pay for some health care services at 100% general fund cost. We do have some questions that the legislature could ask the administration about its exemption processes that it has planning and that it's putting into place right now.

And those questions are included on page nine of today's agenda.

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

Two main questions to start off with. Number one, obviously, we want to make sure that we have a very successful data transfer process to make sure everyone who is eligible for exemptions gets their exemptions. What is the quality control measure to ensure that once we say we have completed the process, we actually do another check just to make sure?

Like, what is the, can you walk me through the process besides clicking a button and it telling you we did it?

Sure.

You're using ChatGPT? What are you doing? Simpler.

So I think it's one exercise to identify who's potentially impacted. I think it's another to realize that people's lives are not static, but rather dynamic, and they come and go from these programs. So increasingly an approach that I'm leaning toward and would advocate through the department is to actually transfer 100% and just flag people as you are a regional center served individual in the system for the entire half million caseload that we have. Not providing additional lots of additional information. They have that already.

But if we can just flag everybody in the statewide automated welfare system, who's a regional center client, that would go a long way to making sure nobody is left out. So hopefully simpler than ChatGPT. Having said that, of course, when you do that, you're going to want to go back and spot check the results of that. But we also want to build our data capability to do that kind of matching. And if I can turn to Alexis, she can talk in more detail. Thank you.

So as the director mentioned, we'll do quite a bit of work between departments to ensure the lists are as complete as possible. Once they get into the eligibility system, we use standard processes which have built into them sort of backstops, if you will. So normally, when we run eligibility at scale because we're running a large list of people, we have what is called a fallout list. So if for any reason a case doesn't run as it was intended, staff can work those cases individually.

So that's the first kind of backstop that we have built into how we standardize these processes.

The second, and not the preferred, but another place where there's a backstop is because of the way we've outlined our guidance to counties, the exemption screening is going to happen at either a recertification or an application when there is a required interview. And so to the extent that is not showing up in the system, there is still another chance for the worker to engage with that individual and establish that exemption right then and there even if they haven't seen it prior in the system.

Of course, the goal is to run all those data matches, do that as automated as possible, but it's a second backstop from a policy perspective to ensure that everyone is captured.

When is your hope, what's your deadline of completion of this process?

So it's a little early for us to have a hard date for when the data will be in the system, but we are working toward a very clear goal to have that available before any case may reach the point of a discontinuance, of course. So June 1 is our implementation date. The first set of cases that could be subject to an exemption screening will happen in June. And then three months from then, July, August, September, is the potential for a discontinuance.

And our goal is to have this done well before that discontinuance can happen for this first group of people.

Obviously, this is a unique time that we've never faced before. Is there a way, because, you know, as a social worker, we're always taught that everything is connected. And just because the client is okay, doesn't mean the household is okay. And in order to make sure the client stays okay, we have to ensure that those homes stay stable.

What can we do to utilize our infrastructure including our regional centers to ensure that if instability starts to present in a household, we can still utilize the infrastructure to keep the household stable to protect the client.

Sure. So appreciate the recognition. It's not just about the individual, but their ongoing well-being based on the family. I think the answer to most questions like that is education and outreach. This is what people need to know.

This is what they need to know to protect themselves. This is the kind of stuff that they need to present to the county to document their exemption, for example. We need to reinforce the importance of making sure as eligibility, for example, in Medi-Cal goes from twelve months redetermination to six, the importance of being timely and prompt with that. We talk less about the fact that people will also have thirty days instead of sixty to cure any missing documentation.

So time is of the essence and families need to know that and its importance needs to be stressed to them. So that's just one example. And that's not just the department. That's not just regional centers. That's not just state government writ large, but that's also our service providers, our regional centers, our advocacy organizations, some of the nonprofits like family resource centers.

We all have to have a similar common message about this available to individuals and families, but also to proactively push it out. We've already, as a department, for example, run several newsletter articles in our monthly newsletter about this very topic and what families need to know about what's coming. And we have more on the way in the upcoming April and May editions as well.

I want to follow up on this subject just because I know it's very often that a constituent may call my office to complain about that pothole. And I'm like, I'm sorry. That's not me. That's your city council member or that's your mayor. Right?

And if regional centers are doing their jobs well, no matter what the issue is, they might be a trusted organization to go to when they need help of some kind, but they just don't know where. I'm wondering if it may be worth continuing to look at, at least for the initial year of this HR 1 implementation, whether we should be resourcing regional centers and others to have their own navigation teams for the household. I believe is inevitable for them to get some type of things.

And I'm sure the caseload is already daunting sometimes. And so they may not be able to have the time to do those things because they're still working with their individual clients.

But is there a way to resource these institutions in the regions to be able to handle those types of calls? Right, and to be able to give them the type of support they need to maintain support within their family. Because we have got to do everything we can to keep that household stable, and it may have nothing to do, it may not have anything to do with Medi-Cal. Right?

It may not have anything to do with some of the things that you all are responsible for, but there's something that created a ripple that affected that household. So you don't have to respond to it. I'm just thinking I want to kind of dig a little deeper. Obviously, we'll chat with our regional centers as well. But I think it may be warranted because we don't know what to expect.

So should we expect the unexpected, I guess, you can say. Okay. Any questions for committee members? LAO.

Thank you. Karina Hendren, LAO. Going back to the question about the household, HR 1 also includes an exemption that caregivers of individuals with disabilities can be exempt from the community engagement requirements. And our understanding is that the department has some information on caregiver relationships, particularly for individuals who are children. And so that could be another avenue to pursue as well and to better understand how the administration can collect and use that information for exemptions.

Yeah. Absolutely. I appreciate that. I mean, definitely, we want to make sure that, I think that's part of the education part of it, making sure that they understand everyone in that household who gets that exemption. But we also know that we're starting to have multiple people, multiple generations in a home.

Right? And maybe his cousin staying in that home, and that cousin now has some needs. But as we know, when one person becomes unstabilized, the whole household becomes unstabilized. And so I just want to make sure, and that information is great to know. But I think also we just need to be prepared that households are more complicated these days.

They're not, they all have all kinds of stuff. Right? And, you know, some people are in the household you may not want either. You know? You just have to deal with it.

So at the end of the day, want to make sure that we're highlighting that this could be an issue and worth some further conversations, especially as the May revise comes out. Okay? Additional questions or comments? Oh, this one here?

Just some housekeeping things.

I want to reiterate the request of a comprehensive update on the data matching activities that the administration is engaging in for CalFresh and Medi-Cal and the schedule for the implementation of this. I know you're still working on the dates and all those things, but as soon as you know, if you can let us know, that will be great. Our hope is that we know before May 1. Right? Even, yeah.

If we can know before May 1, that would be great. If the administration does not expect the data matching to be complete before 06/01/2026, we also want to know what this means for CalFresh impacts and the projected estimates on which DSS has been relying on. And we also want to know, won't more CalFresh participants potentially lose food benefits?

I know we have a lot of estimates right now, but as always, our goal is to make sure that we have the most up-to-date information as possible. So once you know deadlines, please pass that on to us.

Once you know you have more refined numbers, please pass that on to us as well. I also want to ask the administration for feedback on the blanket exemption concept, which we will seek to codify alongside the state's principles on implementing HR 1. Staff will be in contact on this, and we may ask DDS and DSS to attend our April 29 hearing and provide a response there as well.

We are looking to codify as much of this as possible so that we can make sure that not only do we have what is the requirements on the federal level right now, but we also make sure that we codify these things on the state level as well. And if you have any questions on any additional, or any clarification on any of these requests, just please feel free to reach out to us.

Oh, Dr. Sharp-Collins, you have the floor.

Yeah. It was just another thing to kind of follow back up on our last CalFresh hearing that we just did. We were discussing the variance as well, and just identifying how the rates are, the numbers are actually being calculated, and then they're looking at other states and trying to get our numbers. So that was brought up, and we did ask if that can be brought back to us in regards to the structure and being able to respond.

So I don't have the exact question here with me, but I just wanted to point out that we did discuss it. And it adds to this conversation that it would be nice if you can go back and look at the question that was asked and be able to share that at the next hearing.

Absolutely. Appreciate that. And we'll be in contact with your office to make sure we're, I know there's some folks that are still trying to get a lot of those answers for us. But let's just make sure that that is on the list. If you can check in with my office as well so that we can make sure we're setting everyone up for success. Okay. Yes sir.

If I could. Back to the point you made a minute ago. You requested we come April 29 to the hearing to provide feedback on the concept. I just want clarification: Are you asking the administration whether they're okay with the idea, which I said yes to in my opening remark, or should we be expecting draft language from the legislature that you'll want a reaction to? If you can just provide a little bit more on the process to get exactly what you might be expecting. Thanks.

We are looking at language so that you'll be able to respond to that. However, as you know, we will reach out for technical assistance. But also, usually the last meeting of the month is kind of like almost everyone coming back together to make sure that we get the answers that we are. So at the end of the day, if you don't want to come back, try to get us the answers as quick as possible so that we can make sure that this is really just about making sure that we're cleaning things up and ready for the May revise, and everyone has all the information they need to move forward after the May revise.

Alright. Appreciate that. We'll be on the lookout for language. Thank you.

Absolutely. Thank you for that question. Anything else? Seeing none, thank you very much to this panel. Thank you, Joe. Appreciate you.

You got a personal call.

Have some kettle corn for me.

Do what?

Have some kettle corn for me.

Issue number two, Mr. Director, you may begin when you are ready.

Thank you, Mr. Chair. So one of the large, so-called generic services for the regional center system is the In-Home Supportive Services system, or IHSS program. My colleague, Claire Ramsey from the department, will describe those proposals in a moment. If I can, I'll jump to number three as the question, which is what would occur if a person currently served under IHSS loses IHSS or experiences a reduction in hours. I talked about it very briefly in my opening remark.

It's my understanding there aren't particular proposals that would reduce somebody's individualized assessment, but may impact their ability to find a provider for those hours. And of course, IHSS being an optional Medi-Cal benefit, if somebody were to lose Medi-Cal, IHSS would go away as well. Both Medi-Cal and IHSS offer a variety of services, not all of those are things that are offered by regional centers. A good example of things that are would be personal assistance services. Think of assistance bathing with eating. Those kinds of things.

And under current law. And it's been this way for years. Once the generic services have been exhausted or is not available, regional centers have the obligation to pick that up, so to answer that question, regional centers would be picking that up and it would be funded out of purchase of service for personal assistance services in that example.

The next question asked about the master plan for developmental services. I'll take a minute on the record just to share that the administration recently released the first annual report on the implementation of the master plan. And so I want to flag that for folks. It's available on our website, and if you're subscribed to our newsletters, it's a brief read. The master plan itself and the implementation update is not, but the report is only about nine pages, give or take a page for formatting. So that's out there. Because we don't see a significant impact, again, not knowing what to expect exactly from In-Home Supportive Services on our system.

But again, people already have to be eligible, so there won't be a flood of new eligibility seekers. It's mostly a question about managing hours. But it very much, I think, aligns with one of the themes in the master plan, which was to view people as a whole person, and make sure that the way that we're providing services is person-centered in nature.

So that continues to be a theme in the master plan and how the regional centers, on the receiving end, would see that. I think I already touched on the next question in the first panel on how Medi-Cal state changes would affect regional center case load. Again, we don't for Medi-Cal expect an influx of people newly seeking eligibility for the regional center services. For us, it's mostly an impact on the fund split for the cost to the services and similarly, I think already answered for the unsatisfactory immigration status.

We don't in the regional center system, track immigration status. We track whether someone is a resident of the state or not. So we're already serving them, but there is a potential fund split impact there as well. And then the next question asks for the relationship of the proposals to our response to proposals for Medicare and Medicaid services. I think on that question I would simply say this: Department of Healthcare Services did a very thorough job. It's a 64 page letter to CMS.

I hope they read each and every page of it. I read the first half myself and didn't feel that I needed to go further because it was very compelling. There's been a long nationwide push to rebalance health care spending in favor of community living as opposed to institutional settings. And it was somewhat disturbing to see the federal government question why HCBS spending in states across the country was ballooning through the roof. The answer is obvious.

That's been the policy direction for all the states and nationally pushed by CMS itself. So, you know, yes, we continue to see rising caseloads. We continue to serve more and more people there. I mentioned in the opening, Fairview has now been closed. It was the last regional center.

We've moved people into the community, into community-based settings. We're very proud of the progress we've made. Yes, there are cost implications with that, but the cost of serving people in the community is vastly cheaper than serving them in institutions like nursing homes.

I don't know. I think I've gone as far as I probably should in my remarks about that. But just to say what we propose and what we continue to propose is very consistent. I'll stop there and ask my colleague from the Department of Social Services to pick up the first couple questions and correct anything that I screwed up. Thank you.

It happens to me very frequently.

Thank you for having me. My name is Claire Ramsey. I just flagged that I am in place of Liora Filicina. I'm one of the chief deputy directors at the Department of Social Services, and we'll speak on a number of your questions related to IHSS, including going over our three proposals in the governor's budget. Just for level setting, the In-Home Supportive Services program, known as IHSS, is a cornerstone of California's long-term services and support system.

IHSS supports more than 850,000 people with disabilities, children, adults, and older adults to remain safely in their homes by providing assistance with daily activities of living. These can include items such as bathing, dressing, meal preparation, mobility, and paramedical services. Counties administer the program. They conduct the assessments and authorize service hours based on each person's individualized needs. As noted in the agenda, about 150,000 people of a total of 850,000 IHSS recipients are also regional center clients are also eligible for those services.

The governor's budget does include three IHSS-related proposals. First, there is a proposal related to the assessed hours, which would require the state and counties to jointly establish a baseline for average authorized hours per case by May 2027. After that baseline is set, any non-federal cost for hours above it would shift to the counties proportionate to each county's share of the statewide caseload starting in fiscal year 2027-28.

Our goal with this proposal is to support accurate and consistent use of the assessment tools and to ensure that increases in hours are tied to verified changes in a person's condition. This proposal is not intended to impact any individual recipient services, including any recipient who's also eligible for regional center services.

And just will clarify one point which it it shouldn't reduce any provider eligibility either or availability. It really is a cost shifting between county a cost proposal between the county and the state. Second, the proposal proposes to align IHSS with medical eligibility processes. IHSS is a Medi-Cal service and individuals must remain Medi-Cal eligible to be eligible for IHSS. As such, there is a proposal to automate the disenrollment and the reinstatement.

If a recipient loses Medi-Cal because of failure to provide information to the counties to allow for reassessment, but would also automatically, once they've completed that process to regain Medi-Cal, they would also automatically regain IHSS, which would streamline the county workload and improve consistency statewide. Finally, we do have a proposal in the governor's budget to eliminate the IHSS backup provider system. After reviewing program data, we found that administrative costs exceed the cost of services delivered.

And so while the system was intended to meet urgent short-term needs, the growth that we thought would materialize has not yet materialized. Just quickly, I'll get to one of your other questions.

We do want to highlight that these proposals do not reduce IHSS services or hours to individuals, and hours will continue to be based on individualized assessed need. We were asked about protective supervision. Although protective supervision cases do often involve high hours, they represent only 11.5% of the caseload, about 98,000 recipients, and we do not see them as the primary driver of hours growth statewide.

More that we have observed overall authorized hours rising even as functional index rankings, which are used to assess need, have remained essentially unchanged for approximately a decade. Finally, we just want to reemphasize how important we know IHSS is to individuals with intellectual and developmental disabilities, including those who are eligible for regional center services.

As such, we will continue to coordinate and collaborate closely with DDS. And, of course, we defer to them for particular impacts, but I'm happy to answer any questions related to IHSS to be helpful to this panel. Thank you.

Good evening. Thank you for having me here. I hope you can see me through my story. My name is Anna Alonso from Bakersfield, California. I am a Disability Voices United ambassador.

My family is composed of my mother and my three sons, two of whom I adopted. Every single person in my house has a disability. We rely on Medi-Cal, In-Home Supportive Services, and regional center services to survive. So when you talk about cuts, please understand you're talking about our lives. I live with cardiomyopathy, complex PTSD, and myotonic dystrophy.

My mother has dementia, pulmonary hypertension, and arthritis. My 17 years old has a autism, epilepsy, and born with fetal alcohol syndrome. My 17 years old have three genetic conditions, cast multi organ damage, particularly to the brain, muscles, and liver. His heart depends in an ICD to work. He is autistic and use ASL to communicate.

And still, we give back by volunteering at the Ronald McDonald House and through my nonprofit, Padres Unidos De Kern. We help other families with disabled children navigate the system. They are so hard to access. We are doing everything we can, but we cannot do it alone. We rely on Medi-Cal.

My mother and two of my sons depend on In-Home Supportive Services. We have 12 caregivers coming into our home each week providing support twenty-four seven. They are the reason we are alive. We depend on them for basic needs and more when emergency hits. That's our reality.

If In-Home Supportive Services is cut, we lose our caregivers and our stability.

If MediCal is cut or cost more, the cuts is even more direct. We build that. One of my son's medications alone cost $5,300 a month, but the problem is he take 23 medications in total.

It is no way I can afford to give him a life my by myself. Every day, I see families like mine forced to beg for basic services. We are already, we are already exhausted. And for many of us, the fight is even harder because of the systemic races and anti immigration bias. So I need to ask you if medical and ecom super services are cut and regional centers don't receive more funding, who is going to support families like mine?

Someone has to. I want to be very clear. You are making decisions that will determine where people live or die. Please do not treat this like a light topic. These cuts put families like mine in dangers.

It means choosing to train you back on people who cannot survive without support. Protect our health, care, and services. Don't let these cuts going in effect. Do whatever you can to protect disabled people, and do the right thing for 15 millions of Californians. Thank you.

Thank you. LAO.

Karina Hendren, LAO. We have two sets of comments. The first is on IHSS and the second on MediCal. So first for IHSS, as the administration stated, its proposal to shift the cost of increased hours to counties is not intended to reduce hours of service. That being said, the way that the Governor's IHSS proposals will work in practice remains unclear at this time.

To the extent that the proposals could impact access to IHSS services, Regional Centers might be able to fill in any lost hours of services as the payer of last resort, but potentially at a higher per hour cost. The degree to which Regional Centers might provide personal assistance services as a substitute for IHSS could vary across Regional Centers. Second, the agenda asks how the proposed and enacted state budget solutions in MediCal could affect people served by Regional Centers.

So separate from HR1, these are just the state budget solutions. Many of the enacted and proposed state budget solutions in MediCal focus on enrollees with unsatisfactory immigration status.

As the director noted, Regional Centers have never considered immigration status as part of eligibility for services. And this means that state budget solutions affecting MediCal eligibility generally should not affect the directly eligibility for Regional Centers Services.

That being said, the state budget solutions in MediCal could affect individuals' access to health care services. For example, an individual with unsatisfactory immigration status who is served by a Regional Center could lose comprehensive health care coverage under MediCal due to state budget solutions enacted in 2025.

And as we noted previously, loss of MediCal coverage could create fiscal pressures for regional centers to pay for certain health care services. For consumers at full cost to the state if no other source of health care is available. We also wanted to note that our office has heard some concerns about individuals' experiences requesting that their Regional Centers Act as pair of last resort to provide a service not available through any other sources.

So similar to what we noted for IHSS, the degree to which Regional Centers might be able to fund health care services as a substitute for MediCal could vary across Regional Centers in practice.

Department of Finance?

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

Oh, I'll start off by just stating an obvious red flag to me. And that is almost in every hearing, no matter what the subject is, it seems as though the cost savings are coming from, is coming from a shift of fiscal responsibility to the counties.

And when you add all of that up, it makes me wonder what makes you all think that the counties can withstand a shift, whether they be CalFresh, whether they be in home supportive services, whether they be on IDD work and other things.

It seems to me that there's an assumption, but maybe it's not an assumption. So can you share with me, and this can be for the administration or Department of Finance, what gives you the confidence that they can be able to withstand that cost shift but still maintain hours, still maintain services at the same time.

Chair Jackson, I'll start. Claire Ramsey from CDSS with respect to IHSS. We do have one proposal that would increase cost to the county based on them going above a baseline that is jointly set. So there is a lot of discussion to the LAO's point about working out what the practice would look like, what the baseline would be set.

We do know that a lot of conversations would be happening. Counties are fully in control of hours assessments and that's why we are putting forth this proposal and think it is a proposal that is workable because the counties will have control of the assessments. But, you know, we are sensitive to the fact that this has been a extraordinarily hard year on the counties in terms of, particularly HR1 proposals that do involve increased costs.

I'll defer to my colleague at Department of Finance for the broader question you've asked.

Good afternoon. Lourdes Morales with the Department of Finance. The comment I'll add, to my colleague's comment related to the proposal for assessed hours is that our proposal also includes a resetting of baseline on an annual basis.

And so there is an acknowledgment from the administration that there might be sort of natural growth. And so as long as there is this baseline that sort of allows for that, counties would only incur cost to the extent that they are sort of over that changing baseline.

So I just wanted to make that point that it's not an inherent that counties would absorb additional cost as a result of this. It just really reflects on where they are relative to the baseline that we'll work with counties to establish. I'll also highlight for this proposal in particular, we're proposing a budget year plus one. So a '27-'28 implementation so we can continue to discuss the the particulars of these of the implementation as we realize that those are critical.

I seldom see the administration and counties agreeing on a number. And as a matter of fact, I think next week, we're gonna have another meeting about a disagreement on numbers. So I'm wondering, you know, I'm just worried about whenever you do a cost shift to counties and even if you are increasing the baseline funding to counties to be able to try to mitigate that.

There is a natural assumption to me that a way for them to stay within their funding levels is going to be a natural cutting of hours or something that's gonna end up hurting the client as opposed to ensuring that the client has everything that they need to be on a pathway to thrive.

And so which is why in many cases, this committee prefers that the State holds on to it so that we ensure that the county that that the client is getting what they need.

So if, so we're reluctant to support such a shift because this is not the only shift happening. And so if you can share with us what that baseline intends to be, or if you haven't because you're might be still talking with counties, which is still understandable. Just know this is that whenever we see that number, we are gonna be going to counties. I'm gonna be going to my county, or I won't be going home, in order to, ensure that they have what they need.

The realignment screwed over counties. And many counties and many programs are on life support because of it.

And I don't want to do another decision like that until we are confident that at the end of the day, it won't end up hurting the client. Right? So I appreciate that, but I'm a bit skeptical at this point. Questions, comments, committee members? Anyone?

Okay. Assembly member?

Thank you. I just wanna echo the sentiments of the Chair. You know, I think it's more than concerning or it's more than concerning the cuts and the cough shifts down to the county. Our Counties is experiencing monumental shifts right now due to the structural deficit that the State has, the federal cuts, and due to HR1.

Just in my county in Santa Clara County, we're the first to enact a Sales Tax Increase of over $300,000,000 to save our local county hospital system.

Many counties are now attempting to do the same, but it doesn't backfill the over $1,000,000,000 and cuts that Santa Clara County alone is facing.

And we are in a world of hurt in the county that has one of the largest concentration of millionaires and billionaires that also has some of the most extreme income inequality. Which is often not talked about and is burden on our county where we have had to take over and buy several hospitals in the last few years.

Where we are heavily reliant on a federated system to support our health care. It's the second largest health care system in California in Santa Clara County.

And so to now see the state proposal, which is sympathetic in trying to make impossible choices due to the situation that that we're in. But as the Chair has commented, won't be receiving a lot of sympathy from the state legislature on trying to balance our budget on the backs of people who are already pushed on the brink.

And our push our persistent exclusion of revenue options to alleviate state and county concerns is also deeply troubling.

And so I recognize that the difficult position that the administration is in and our capable, Department of Finance. But I would presume that this committee and several members of the legislature will be pushing back very forcefully in ways that we haven't perhaps in the past.

And do more than just register our displeasure because decisions that this committee makes based on the recommendations of the department will have very consequential effects that will impact these communities for decades to come.

And I think there's a better way of doing it. And I would charge us to try and look at those solutions, including revenue that needs to be on the table. Because we can't cut our way out of this budget without irreparable harm in two communities that are already pushed to the brink.

And as the Chair has mentioned very publicly that in the past, bad things happen when people are pushed to desperate levels of basic human decency.

And it is our charge to take care of the least among us. And I take that responsibility very seriously as to my colleagues. And so I merely suggest that we're going to be, we're going to mean what we say when we say we need to go back and look at other solutions because this truly needs to be compromised and leaving no stone unturned.

But the suggestions that I'm hearing about, as the Chair mentioned, I have to go back to my county too and and effectively advocate in their best interest. And I can, in good conscious, support or not speak up of the cost shifting it to the county.

I do they're just going through too many devastating fronts that they don't need ones created by us. And I know that many of you and all of you know that, but I do think that we need to be more loud about finding other solutions. Thank you, Mister chair.

Doctor Sharp-Collins.

I wanted to say to Anna, thank you. You being here, I know that it took a lot. It took a lot. And I'm watching you not only through your testimony, but even as my colleagues speak. You're tapping your leg now.

The funding for this means the world to you and everybody else here in this room. And you being here, as I always talk about humanizing the situation, putting a face to the name, reminding us that this is the reason why we're here. You're right.

Well, I can't go back to my district without having an answer, without having a fix. But I just wanted to acknowledge you so you'll know that you are seen and you have been heard here today.

It's on and it's on record that you are here advocating not only for yourself and for your family, but your providers. You said you have 12 that come into your home?

Yes, ma'am. 12 caregivers.

12.

And we have as a backup another six. In total, they're 18.

That's your livelihood. You guys are all family now.

Yes, ma'am. We are. I have the lucky to say they are my family. I immigrated to this country, and I don't have nobody except my caretakers To count on it. And for me, they are my family.

And all the families that I serve in my nonprofit, they are the people. They are my family. And these subjects, regional centers, medical, in home super service, touch home. And for me, it's the work.

And that's what I want to highlight in this conversation that it's not just about there being your providers, your caretakers. These are this is your family. This is what what happens when you have services such as IHSS. You know, when you do have the original senior centers and everything else, it's not just about the services, but this is your livelihood. This is their livelihood, and this is what you need to be able to, you know, to do what you do.

I did put forth a three part budget as one, of course, still rejecting the proposal to ship the state share of IHSS per I mean, hours per case growth to counties. I also that that letter talks about the projecting the proposal for the alignment. It also talks about basically all three points that were made in the last panel. We did we did we did submit that budget letter, the budget ask.

And so not only is myself and colleagues who've all signed on to that letter, but we're gonna continue to advocate to ensure that we do what we know is right and not cause more hurt and pain, put more burden on you guys, adding more walls, more barriers, putting more barriers in place.

So just seeing you and others in this room, I'm heavy. I really am heavy. It's not that often I get this humble, Doctor Jackson.

I'm like, this is very heavy, and this is why I'm here. So I thank you for allowing me to be here and to hear your story. My county is struggling as well. They've been here. We've had our conversations.

I've spoken with UDW and others. The county can't handle it. They're trying to shift funds from reserves and all these things to try to be able to move forward. But it's hard when they're in a budget crisis too. So, Doctor Jackson, thank you for leading this work.

As I said to one of my colleagues yesterday about them being a moral compass of a certain field, you are also a moral compass when it comes to advocating for social services. I appreciate you.

I appreciate you too, and we appreciate our witnesses. And

Thank you.

Obviously, there's nothing more there's no community more unifying that brings Democrats and Republicans together than our IDD brothers and sisters.

And there's not gonna be as much and I've we promised from the very beginning. I promised three years ago, this community is not at the back of the line. They are now at the front of the line. And we're gonna keep that commitment.

And so we're gonna do whatever we can to make sure that at the end of the day, what goes on between states and the county, that's for us to worry about.

What you need to worry about is do you get the services that you need to making sure that you stay stable and that you can have a high quality of life and be on your pathway to thrive. We'll figure out the rest of it.

But at the end of the day, that remains our priority. Director, I'm gonna ask, you to provide us, with, some sort of harm mitigation strategy. What are we gonna do to make sure?

Like, what are you all planning for to make sure that the services that are that clients are being provided with are gonna be able to stay stable. Right? And what can be some alternatives to just a cost shift that can help to ensure that we are keeping clients stable and we are preventing any threat of a possible lowering of hours and those type of things. We've gotta figure this this baby out.

And so we're gonna ask if you can provide us with some harm mitigation strategy before the May revise. And all the different things we can do, whether it's through from I that will, again, keep these families stable.

Trying to figure out what are some other options as well. CDSS, if you can help us out, especially in terms of the in home supportive services part of it, it's gonna be important.

And then we're also going to ask for the same type of help from Department of Healthcare Services if they need to be a part of any type of harm mitigation. We just need to know what our options are.

One of the greatest mistakes we made during the great recession and the reason why we're asking all these questions is that we did a lot of across the board type cuts that we are now just recovering from decade later or more than decade later.

How old am I? Sorry. I just had some trauma there. I had the oh, Lord. How old am I?

Dang it. What happened? What happened to me?

I'm 36.

Stop.

You almost made me cuss.

But a part of that is because so we wanna make sure that we take a surgical approach here. There's no doubt we have to live within our means. But to me, that means it's just a priority issue and is us making sure that we're being as innovative as possible. And that, even if the way to do this becomes more complicated, the complication is worth it to us.

But it takes us having these conversations now instead of the very rushed and chaotic process that happens a week after the May revise, where we don't get any sleep, where we are forgetting what our priorities can be.

We're missing details, and we don't wanna do that. We don't wanna harm anyone that does not need to be harmed if humanly possible. And so we're gonna ask, for this, harm mitigation strategy, whatever your strategy is to prevent harm and to prevent any instability.

And if there are alternative ways we can accomplish this, because I understand there's a structural deficit that the Governor wants to solve for.

We understand that much of the increases or significant portion of the structural deficit is in the MediCal space. Totally understand that. But we also wanna make sure that we are looking at all of our options as possible as well. So if you can provide that to us before the May revise, hopefully, by Friday, May 1, that'll be great. Happy to please, if there's follow-up questions, fire away through our staffs as much as we can.

Whatever we need to do, let's think about this. But I wanna make sure, our goal is to, prevent harm. Okay? Any other questions or comments? LAO, do you have anything?

Any other questions or comments from panelists? Everyone good? Okay. Thank you very much for this panel. Thank you.

Okay. Now we're gonna start going through a series of trailer bills proposed by the administration.

We'll start off with issue number three. And DDS, you may begin when you are ready.

Good afternoon, Doctor Jackson and members of the committee. My name is Dana Simon, and I am a Deputy Director with the Department of Developmental Services. Thank you for the opportunity to be here today.

The proposal I'm speaking on this afternoon is the Trailer Bill for Rate Reform Quality Incentive Program Contract Exemption. The proposal seeks to extend the contract exemption previously authorized in the annual budget act through 12/31/2030.

This department also proposes extending the timeline to finalize Rate Reform Regulations from 06/30/2028 to 12/31/2030. These extensions will provide the department additional time and flexibility to procure services and issue operational guidance necessary for the continuation of the full implementation of person centered outcomes based rate models and the associated quality measures introduced as part of rate reform.

Existing law also requires the department to review and update current rate models every two years. The department posted the first of these updates just this past January.

Although we do have percentage increases for each of the rate models due to the changes in service codes through rate reform, along with the lag in current utilization data. It is difficult to develop an accurate cost projection at this time.

The update process itself requires a detailed cost analysis of each service codes rate model using the available information at the time. This has been supported by the expertise and technical guidance of our current contractor.

Changing this now would cause delays and inefficiencies before the knowledge transfer is complete to our department. Additionally, current law requires the department to complete Rate Reform Regulations by 06/30/2028.

However, substantial technical revisions to title 17 regulations, the complexity of the rate models across hundreds of service codes, and the need for stakeholder engagement require more time for the regulatory process to be completed.

These extensions are budget neutral and no additional funding is required. This proposal is generally supported by our community partners, although we are aware of concerns including the new provider requirements that have been put in place, as well as addressing the individuals with the most intensive support needs.

Through current directive authority, we are able to address issues as they arise rather than waiting for public comment period within the regulatory process. A recent example of this was the Behavior Analyst positions within the behavioral day programs.

Through provider engagement, we were made aware of the hiring difficulties of this position and were able to extend the original twelve month compliance period to add an additional fifteen months before auditing in this area would go into effect.

Although one of the goals of rate reform was to standardize the vendorization process through rate models, we do acknowledge that we are serving individuals with very specialized needs and not every service rate, not every service is going to fit into a standard rate.

We continue to explore options with our current contractor to look at these areas, current examples being specialized residential homes and respite. The department remains committed to collaboration with our community partners as we continue the rate reform process.

Thank you again for this opportunity to share. Turn over to Aaron.

Good afternoon. My name is Aaron Christian. I'm a Chief with the Department of Developmental Services. Appreciate the opportunity to talk about the Quality Incentive Program and respond to some of the questions that were included in today's agenda. Do wanna call out and express gratitude for the write up that was included in the agenda.

I felt it provided a really good overview of the Quality Incentive Program, the status of the administration of the program, as well as the complexities associated with administering the quality incentive program. Most importantly noted, the shift from a reimbursement based service to one that incentivizes the achievement of individual outcomes.

So I think that's gonna be really important for the individuals that we support in our our community. As noted in, the summary, there are those complexities that are associated with the rollout of the Quality Incentive Program.

This year's measures went live in November and the window for reporting closed at the February.

As noted, there there was a a series of directives that were released, in advance of the measures going live that helped outline what the criteria was to achieve those, individual or those measures by service category. We followed that up with a series of virtual town halls that had open ended question and answer to support providers in how to complete those surveys and achieve their their Quality Incentive Program rate, and then recorded those and posted them online so that service providers could access those at any time.

We also then worked with our providers to put together a, guide for a step by step guideline for our service providers to access and understand how to meet those those quality incentive measures and provided updated information on the newly required newly implemented prerequisite requirements that included the need to register for the electronic visit verification, be compliant with the home and community based final rule, as well as be compliant for those that met the financial threshold for the independent audit and reviews.

In in doing so, we were able to support our providers to achieve those. As it stands today, we are currently sitting at a completion rate of about 81% of those providers that completed the quality incentive, measures and met the prerequisites that were set forth, in the trailer bill last year that added those prerequisites.

We are currently working with service providers to work through any technical difficulties that they experienced in the administration of those surveys and are committed to working those through and will honor the efforts made by the service providers to meet those goals.

With that being said, administering a program and making a shift of this magnitude is not without the hiccups. Providers did experience some difficulties in completing their surveys to no fault of their own.

As as such, we're working with our community and our service providers and provider organizations to do a look back and look at what worked well and what did not work well, and look at making those improvements for the next round of the quality incentive program.

Hopefully, to achieve those improvements and make and remove any administrative barriers that people experienced in accessing the program.

In in the agenda, there were a series of questions that related to how our our budget will be updated from the proposal that was included in the Governor's January budget.

At this time, we are still working on, getting final numbers on those that achieved the quality incentive measure and met those, and we'll update accordingly for the May revise.

With that being said, administering a program of this measure, this magnitude, is complicated. It is complex. It would not be possible without the support and being informed by the Quality Incentive Work Group, the subsequent focus groups that are associated to the Quality Incentive Program, and really is a partnership that we have with our community to roll out this program and make it a reality.

We are committed to continuing the improvement, removing any administrative barriers to accessing the program, and trying to promote the opportunity for all of our service providers to achieve the quality incentive rate for their services. Thank you.

Good afternoon, Mr. Chair, members of the subcommittee, or Doctor Chair. Sorry. My name is Barry Jardini, California Disability Services Association. We represent nearly 130 service providers throughout the state of California. It's my honor and privilege to be here with you all today.

And I thank Ms. Simon and Mr. Christian for their comments. I'm going to be focusing mostly on rate reform implementation and the Quality Incentive Program, but I do hope to have a little bit of time to weigh in on the trailer bill proposal as well. And I really want to focus on rate reform generally. It has been a massive undertaking.

A lot of work has been undertaken by the department, regional centers, service providers, individuals themselves in our system, and reflect a lot of gratitude for the department for their partnership and coordination with stakeholders throughout this process.

A lot of that rate reform has been on rate changes, service code realignment, and ultimately, QIP qualification or the Quality Improvement Program. And that's where I'm going to focus most of it today. I think the agenda sets out a really nice background on the QIP measures as being 10% of the overall rate.

At a baseline, I just want to make sure we're all operating from the same place. When rates were developed in rate models, 100% of the rate was meant to cover the cost of delivering these services. The 90/10 structure was meant to incentivize and make sure we were prioritizing and working towards quality. I think everyone is on board with that.

But the way the current system is set up with the 90/10, it's really more of a penalty structure for providers who do not comply with the measures that are set forth.

And therefore, risks further destabilization of services if they are unable to achieve their 10% and they then have fewer resources to pay their workforce, to take more clients on board, and other things that would actually evince quality in the long run. So I think it's important to establish that baseline, and as a result of this 90/10 structure kind of being more of a penalty structure, it makes qualification and meeting those QIP criteria even more important.

Mr. Christian, I reference the fact that about 81% of providers have met the QIP criteria for the next fiscal year. That means nearly one in five providers are looking down, potentially receiving 10% less than has already been established to be required to deliver services for the rest of the next fiscal year. Now there's some caveats to that because the department has been flexible in some ways, and that number may move a little bit, particularly with the audit and fiscal review requirements.

The department has provided an opportunity for later compliance to achieve that 10% for the next fiscal year. But we are looking at potentially a lot of providers and a lot of services operating with 10% of their funds taken away in the next fiscal year. When that happens, the agenda speaks to what are the adverse consequences. Well, you have wage structures that are set based on anticipated rates. Service providers operate exclusively state funded.

There aren't additional sources. And so while we're all proud of the achievement of rate reform, it's been a great collaborative effort from the administration to the legislature to everyone in the system. We are risking undermining a lot of that progress in the course of the next coming year. Qualification for those QIP measures, Mr. Christian also referenced that there were some technical challenges. Providers did face a lot of difficulty in completing their provider surveys.

Through no fault of their own, I know the department is going to recognize and acknowledge folks who made a good faith effort, but there's a lot of anxiety in terms of trying to complete those because of the substantial nature of the 90/10 structure and the risk to funding, it created a lot of concern. And as we go forward, I know that we're going to implement lessons learned and try to make sure that providers can ultimately achieve this.

I also mentioned the 90/10 is really kind of out of line with other systems in California for incentive structures, and also with other best practices for value-based payments. So I hope that that 90/10 structure is something we can keep in mind in the long run. Maybe not this year given the budget constraints, but something that I hope we can look at going forward.

Finally, I just want to mention, this is all against the backdrop of AB 2423, which Ms. Simon referenced. On January 1, we published new rates that show an average of 12% underfunding across all services. For some, it's as high as 23%. As of January, that's what providers should be getting to operate fully funded in our system. We are not in a fiscal condition where we're going to be able to come up with the $1.5 to $2 billion.

I know we don't have a distinct number from the department, but our back of the napkin kind of analysis shows that that's the kind of amount we're talking about. That's an amount that individuals with disabilities and our system is subsidizing the state budget deficit by not receiving those increases going forward. Again, maybe not the year for us to look for those increases, but maybe a defense against any cuts coming here.

And certainly appreciate your comments, Doctor Jackson, about saying we're no longer at the back of the line. We're going to be at the front of the line.

We're going to try to protect progress. Hopefully, that is in consideration of you and your fellow Assemblymembers as we go through the budget process this year. Very finally, on the TBL proposal, should I stop? Sorry, Assemblymember.

Just on the TBL, no concerns around extending the contract extension for Health Management Associates. I think that makes sense. We do have concerns with extending the regulatory timeline just because some of those new service requirements that were implemented via directive do create challenges and new obligations on service providers that we think would better be established through a comprehensive policymaking process of regulation. So thank you for that. Apologize for going over, and thank you for your time.

LAO.

Karina Hendren, LAO. We do not have comments on this trailer bill proposal, but we have some comments on rate reform implementation more generally. First, as the department noted, in 2025, the state enacted a budget solution that requires providers to meet three prerequisites

in order to be eligible to earn the quality incentive payments going forward. The actual savings that will be achieved in the current year depend on compliance with those new requirements. And as the department noted, they will be able to provide a revised savings estimate for that budget solution. So just flagging that the legislature should expect to see a revised estimate that may revise that savings amount.

Secondly, we wanted to note that providers have expressed some concerns about whether the department or regional centers would be able to provide any technical assistance to providers who might fail to meet future quality measures.

The department stated that its intent is to maximize the number of providers that can earn the quality payments, but it has not yet discussed in detail how it might approach circumstances in which providers might fail to meet the quality measures across multiple years. And so the legislature could ask the department to share its current thinking on how either the department or regional centers might be able to provide this type of technical assistance to providers going forward as future quality measures are developed and put in place.

Department of Finance.

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

Questions, comments from members at this time? I think my first question is, what does assistance look like to providers to help them get to 100%?

Yeah, I think that is the question at hand. I think going into this first round of the Quality Incentive Program, doing a series of virtual town halls, having open-ended questions, the guides and all of the things that we went over, we thought were pretty comprehensive. However, we still struggle to reach all of the providers and provide the level of assistance, sometimes, quite frankly, hand over hand to the service providers.

For this next round, we're pulling together a group of regional center staff, some providers, to really talk about what was the experience, what could we do better, what would be more effective to reach some of those service providers.

In past years, we rolled out a provider directory, which was aimed at including up-to-date contact information from leadership at each of the service provider levels. We leveraged that this time, used those contacts to push out regular updates, reminders, put information on the billing screens. Hey, remember to do your quality incentive surveys and data collection.

One of the ideas that we are looking at doing is maybe going out and doing in-person town halls and supports to groups of providers, looking at leveraging the resources at the regional center level to help reach some of the providers that they are familiar with in their respective communities to try to get to some of those providers.

What resources are in the budget to ensure that, I mean, sometimes when I had a real job, I looked at, Assemblyman, this is not a real job. I hate to tell you. This is not a real job. Hate to tell you that. I was in the nonprofit sector.

It took me from the time I started the nonprofit. It took me six, seven, eight years to be in a position to do a full audit. It's not an easy thing to be able to, number one, find someone who specializes in nonprofit audits, to ensure that I have the fiscal systems necessary to ensure that it'll capture all the information and be able to produce the type of reports necessary to make sure that someone can, when you have the thousand questions from the auditor.

So it's not an easy thing. And especially if someone has never done an audit before, and by the way, they might be providing fantastic programs.

They may be doing it based upon the latest research and best practices, but the back end might need a little help. Right? So what this committee is going to be looking for is, if we're going to hold them to, because I don't think we also can afford a weakening within our provider system either. And so we need them to be able to recoup 100% of their rate as soon as possible so that we maintain everybody. Unless a provider is just saying, you know what?

Y'all asking too much. I'm done. That's different. But if they're willing to do it, I think it's also our responsibility to strengthen our system. And we should be utilizing this opportunity to help strengthen them and get them to realize how they can continue to not just maintain programs, but maintain an institution that provides those programs to their community.

Right? So I'm wondering if there's, number one, we would love to begin to get to the point where you're going to be providing this committee with actual assistance. What does assistance look like? Because if we don't know what assistance looks like, I'm not sure we can hold them to that just 90% of funding because we're not doing our part either. Right?

So be ready for that. I'm not sure if we're there yet unless someone tells me different. So I would like for you to, number one, make sure that you are looking at the provider feedback. And I'm asking for you to provide this committee with a revised version of the administration's language, both in a new RN form format and a redline format that shows the changes to provide to the committee.

Also, And if you can provide this within the next week or two, that would be great. Would that be possible?

Chair. So just as part of the process here, I think this is part of the ongoing conversations for the May revision process. So as far as working through the language and feedback, we can take back feedback and request information. But I would like to just orient on timing that we do have the May revision process to continue dialogue.

Well, we would love to have this before the May revise. And if we don't get the feedback, we'll be rejecting the bill language. I just want to make that clear. We want to make sure that providers, their input, is being considered. It looks like there were not too far off.

It's not, it doesn't look like there's a lot of complications here. So I want to make sure that we understand that too. We just want to make sure, and is there a process to where if they're going to be asking for assistance, is there a way that maybe they don't get the full 10%, but maybe they get 5%? Right? Because they're making a good faith effort.

Right? But without assistance from the department, they can't get to that full 100%. Right? Let's, I want us to make sure, like, let's help each other out here and make sure everyone understands we're all on the same team. Right?

But we do want to make sure that our clients are receiving quality services too. Right? Because at the end of the day, we're all in the service of the client. And so if providers are not willing to provide the best service, because now, guess what, providers, you're part of the system too. You're one of us.

And which means that the system should always be doing what's in the best interest of the client. Not forcing clients to do what's in the best interest of the system. Right? And so let's make this happen together. But we also know that providers do need help.

We want to provide them with that help, and we want to continue to make sure that they are being reimbursed to the full extent of what it costs to provide the service as well. I also would like to receive as much information as possible about the potential loss of the 10% for providers, and what can be done to reduce that.

That's my whole point about, if they're making a good faith effort, maybe we can give them a part of the 10% while they are providing technical assistance. In my estimation, as long as they're willing to receive the help, and once receiving the help, they're responding to the help. Right?

Then I think we're improving in the right direction. Questions or comments, committee members? No?

Then I think we're improving in the right direction. Questions or comments, committee members? No?

And as always, committee staff is always available to be able to work out any iteration of the trailer bill language as well. But great start.

Let's get it to the finish line. Okay? Right. And again, please, please, please continue to work with this. I think we're almost there already.

And so I would hate for us to reject this bill proposal just because we're not having a communication and a good process. Thank you very much.

Alright. Thank you.

And, Barry, I think this is the first time I've seen you this year. Have I seen you?

Only on the webinar.

Well, come on. Get it together. Yeah. I miss you.

Let's do this.

I'm gonna take that. I'm gonna take that.

Issue number four. DDS, you may begin when you're ready.

Thank you, Dr. Jackson. Pete Cervinka, again, director of the Department of Developmental Services. Happy to do this. Ask for a description of the proposed trailer bill language on this topic. Let me first say that this falls in the category both of complex but also surgical.

Language is very simply to make sure that the boards of regional centers, most of whom at this point now operate or are responsible for budgets over a half billion dollars each, have the skills necessary to appropriately run a regional center, which is their task. And as you pointed out, the purpose of running a regional center is to serve individuals and families. But the regional center itself is the responsibility of the board.

They have a fiduciary obligation to make sure that the institution is operating correctly, and our language is intended to address that. The main points of the language are covered on page 22 of the agenda.

There are six topics there. Enforcement for the department when regional center performance is not where it should be. We also are proposing an administrative simplification, but I think also an important emphasis on the purpose of regional centers. The purpose of regional centers is not to do things. The purpose of a regional center is to do things well and try to do them better over time.

And so what we are looking for here, we have a core contract between the department and regional centers. We also have what we call a performance contract between the department and regional centers. And in the last several years, we've seen an investment in regional center performance measures.

And what we are proposing to do is collapse all of those three things into a single contract to deduplicate, and make sure that it's very clear for regional centers and for the public and the department, to be very clear about what we expect in terms of performance from regional centers.

The third item, although it sounds mundane, which is fiscal allocation authority, we have seen various gyrations at the federal level with our ability to access federal funding, and we need to be incredibly nimble in response to the things that can happen on that front.

We have three primary sources as I mentioned earlier. Medicaid funding is our primary, but we also get $58,000,000 in federal early start funding, and it seems to be moving around within the federal administration. And at one point, wasn't clear whether we'd be getting it at all. And we have a very small federal grant for the foster grandparent senior companionship program. It's only a million and a quarter, but we actually had to sue to get that released to us.

So what we're seeking is authority not to have to execute formal contract amendments through the state's contracting process, but so long as the funding is maintained within the budget allocations, to be able to write fiscal letters to regional centers to allocate that money. It would still be personal into the contract terms, but it would be essentially an exhibit at the end of the contract that could be swapped out as long as it stays within the budget.

It's a much faster mechanism than requiring everybody to execute agreements. Number four, I think I already stated the intent of the language. We really wanna professionalize and improve the support available to regional center boards, and I'll talk about that perhaps in another minute.

And there are a couple, and then the last two are what we perceive to be barriers to provider capacity. Simply put, one, there's what we consider to be an outdated requirement that if you are going to provide services within a regional center's geographic catchment area, you have to have a physical office location there. Of course, that makes sense if you're providing residential services or a day program. You need a location.

But if you're offering speech therapy, it doesn't make sense that you would need an office location for that. In large part, your business is traveling to people's homes to provide that service.

And the last one is what's referred to as courtesy vendorization. This is essentially that when Judy approves somebody to do business, and then I want that person to do business at my regional center too, I shouldn't have to put that person through another vendorization process or wait for paperwork to be transferred. If you're approved to do business, you should be able to do business. So those are the basic outlines of the actual language.

Of course, I said and the agenda notes as its first question, there's a volume of stakeholder input on this proposal.

It covers several pages, which I flipped out of order. But there's a fair amount there. What I would also say is that it's not insurmountable. Meaning, these problems that people are raising by and large can be resolved. Whether everybody, including the administration, would be thoroughly happy with the outcome, that's not the nature of the negotiation, but I think everybody shares the purpose.

We all want regional centers that function better and have more oversight and accountability with clear performance expectations along with the provider benefits that I talked about. So if I can tick through really quickly just in response to the first question, appreciate State Council's support. One of the things that we're proposing to do, not all regional centers actually have what's called a consumer advisory committee. So we're proposing that instead of that being permissive, that become mandated.

In addition, the language would mandate that that consumer advisory committee could on its own appoint two members to the governing board of the regional center.

So right away, you know, I'll cut to comments here, but we're proposing that boards be 10 to 15 members large. So right off the bat, we're proposing that 20% of the board be people with a disability themselves. A number of stakeholders raised concerns in statute. There's a current requirement that half of the board be reflective of people with disabilities or their family members, including a quarter of them being individuals receiving services themselves.

Our intent in that was not necessarily to dilute the voice of individuals and families in the governing board.

I think primary focus for the administration and primary importance is that members of the governing board complete the initial training across a number of competencies that we've suggested be covered and also have annual refresher training on those. The problems that we see with boards involve their operation of meetings under parliamentary process. We've had some problems with open meeting notices not being correct, the operation of boards themselves have not always been efficient because people don't understand the rules and the vote taking.

There's a distinction between what must be covered in open session versus closed session.

And so these are a smattering of the things that we think it's important that boards be aware of in addition to the demographics of the catchment area and things like that. So more important for us than the composition requirement is that the composition of the board reflect the competencies necessary to properly operate a board. There are some revisions as well. Boards, as I said a minute ago, the vast majority of them now have half billion dollar budgets.

Contracts under $250,000 have been exempt from approval of the board itself.

That, in part, allows the small business to proceed without the board needing to take a vote on that. Not all boards meet twelve months a year, for example, so that can cause some delays. We think it's time to both update that threshold to $350,000, and also index it every five years by another $50,000 in recognition that that's not a lot of money.

And there are some contracts, for example, vendor authorizations for services that are also exempt, but we think that this is a reasonable thing recognizing the history, but also allowing the board the time not to have to get involved in every little detail, but still maintain their oversight.

We're also recommending that the boards all have access to independent legal services, both for board operations, like appropriate meeting notices, board member conflict of interest in the voting on different issues before the board, and how to deal with closed session versus open session, and what level of minutes need to be taken.

It's a little bit weird for some regional centers today to rely on legal counsel employed by the executive director, and that legal counsel is then, for example, writing the contract for that executive director even while they work for them. We think the board is best served by independent counsel that's not employed by the regional center board.

We put in language and we understand and accept that others may want it to be more meaningful about the support available to people with intellectual and developmental disabilities and their family members so that they can meaningfully participate in the boards. We have language there that I think was a start at that, but it's been indicated that can be improved and we're amenable to that.

And we're also including language that requires more specificity around the topics that our regional center executive director should be annually evaluated on by the board.

We've seen some examples where board members have provided evaluations to an ED that aren't particularly tied necessarily to the performance of the executive director in some cases, but also in some cases have been not specific enough so as to be unhelpful. For example, saying things like you need more leadership training, but not explaining what that is or what the training would be, what specific topics the board would be prepared to support the ED with. So we have some language around that as well.

And also requiring the regional center board every year to evaluate the performance of the regional center itself and make some recommendations based on community input to the executive director for changes that could be made. Appreciate at the bottom of page 24 and onto the top of 25.

Appreciate support from the Disability Services Association for some of the eliminations of barriers to providers. And continuing on page 25, you know, some question has been raised as to the appropriate number of board members. Our proposal was 10 to 15. We found that larger boards tend not to operate as efficiently as they can, but we also know that 10 sometimes can raise a question about the viability of achieving a quorum at any particular meeting. Disability Voices United has suggested 15 to 18.

The difference between our 15 top and their 18 top is not a surmountable obstacle. There is some drafting language that we could clean up as well to the Disability Voices United's third bullet around whether people have lived experience or not. As I've said, board composition to the administration is less important than the competencies possessed by the board. And open to additional language either about topics or the format or content of training provided to board meetings as well.

I think you get the point.

I worry that I'm droning on here, but these are really examples where I'm trying to say consensus is entirely possible, and we appreciate the input that so many folks have provided here. This particular piece of language has generated more comment than most, but I think it's a recognition of its significance and importance, particularly in a time where we've seen budgets exploding, caseloads exploding, provider capacity needing to grow, federal questions about program integrity and so forth.

So we feel pretty strongly this should be in the budget process for the reasons I've articulated and those as well. And again, as I said in my opening remark, if there's some direction that the legislature wants to provide about how to achieve that consensus, we're happy to either come back with a cleaner set of language or work with leg staff to accomplish that. So thank you very much.

Thank you very much. DRC.

Thank you for the opportunity to speak today. My name is Vivian Haun. And in addition to my role at DRC, I have a brother who's a regional center client. Given the ever increasing complexity of these times, we have to level up our system. No question.

We'll need more and stronger professional expertise at regional centers to make that happen, and we appreciate the department for emphasizing that in this proposal. But what regional center boards are best positioned to do goes back to their founding principles that no one with a disability should be left out or left unseen in their community. And that the more we listen to disabled people, the more we'll know how to truly make California a place where everyone belongs.

Ensuring that boards reflect and are responsive to the communities they serve means so much more than complying with a rigid mathematical target for the racial or ethnic composition of the board. It means making sure that professional expertise doesn't crowd out the wisdom and expertise of lived experience.

It means not just including, but centering the voices of those served by regional centers. You can't do that without a critical mass of self advocates on your board. But frankly, it's not that hard to meet a certain percentage or quota. What's harder is ensuring that board members with IDD have the support they need to meaningfully understand all the materials and issues before them so that they can be full participants, not feel good tokens. That's the real work.

It takes dedicated intention, time, and resources, and we need to make it a standard board practice. As my colleague, Ms. Epstein, stated earlier, as more public benefits are pared back based on things like assets and immigration status, few priorities are more urgent than equity. If our system is a safety net, then we need to tighten its weave. What regional centers are doing now around language access, translating IPPs, cultural competency, and especially generic services is more critical than ever.

Boards must be dialed into and regional centers must be held accountable for this vital harm reducing work.

Finally, regional center performance measures. We support the department's proposal to consolidate what are now various scattered measures into one place so that expectations can be focused and clear. However, our system has had performance measures for regional centers for years. How will this version be any different? To achieve the kind of progress that Director Cervinka mentioned, to achieve outcomes for people, regional center performance measures have to be more than aspirations written on paper.

The sticks and the carrots that come along with them have to be real. It will also take hands on direction, capacity building, and support to regional centers, all of which has been lacking for years. We would urge the department to provide much more specificity and detail about the process it will take for this to happen. Thank you.

Thank you. I'm Judy Mark. I'm the president of Disability Voices United, an organization led by and for people with disabilities and their families. And I'm also the proud mother of a 29 year old autistic son named Josh who relies on the regional center system. So before you is an enormous amount of trailer bill language, moving through a much less transparent budget process with many provisions not directly related to the budget.

So that alone should give this subcommittee pause. But I wanna focus on the most concerning parts for our organization. So the proposal removes the long standing requirement that regional center boards include at least 50% of people served and their family members. That is not a technical change. It is a fundamental shift away from ensuring that those most affected by the system have a strong voice in how it is governed.

We appreciate the requirement that two members of the consumer advisory committee sit on the board, but that is not enough representation. 20% is not enough. And there is no requirement that a board member be a parent or family member. That is a profound departure from the vision of the Lanterman Act, which was created by parents who fought to ensure that families would always have a strong voice in the system. We are also concerned, as you heard Director Cervinka say, that 10 members are just too few.

We are lowering the number of board members while increasing our expectations of them. And I have a little show and tell for you to show you all the boxes that need to be checked by a regional center board. You have to have diversity by race and ethnicity, diversity by geography, diversity by disability, somebody with two years of legal experience, somebody with two years of management experience, including managing subordinate supervisors.

You need to have somebody with one year of governance experience, not at a regional center. You need to have somebody with two years of professional financial experience.

You need to have somebody with one year of policy advocacy or three years of IDD program administration noting aside from lived experience, which our organization found to be problematic. And then, obviously, you have two members of the consumer advisory committee. If you have a board of 10 people, even if you have a board of 15 people, it is going to be impossible for regional centers to meet these goals.

We are not questioning whether this diversity is valid or beneficial, but you're gonna have to have a larger board to meet those requirements. Regional centers oversee budgets that can reach up to a billion dollars.

A 10 member board is simply too small to provide meaningful governance at that scale. Board members, let's not forget, are volunteers. They have professional and personal responsibilities. A small board will struggle to meet quorum and fulfill its duties. So boards, first of all, should have the flexibility to determine the size that is needed to govern effectively.

More importantly, we need boards that are deeply connected to the IDD community, grounded in equity, inclusion, and transparency. Boards that are accountable to the community they serve and that ask thoughtful questions and provide real oversight, not simply boards that rubber stamp decisions. And to do that, board members must feel safe. No one should fear losing services for themselves or their family members because they speak up as a board member.

We recommend adding strong grievance procedures and anti retaliation protections, including oversight of any service reductions affecting board members or their families.

At its heart, the system exists for people with disabilities and our families. Professionals play a critical role and we are grateful to them, but they cannot be the voices heard louder than ours. So preserving meaningful community representation and oversight is essential to ensuring an equitable and accountable system. Thank you.

Good afternoon. My name is Amy Westling. I'm the executive director of the Association of Regional Center Agencies. As you can imagine, we have a lot to say about this one, but trying to be respectful of everyone's time. Much appreciation to the sergeant for handing out our complete letter on this to members who are present today.

Much appreciation for the opportunity to speak to the Chair and members for engaging in this important dialogue. The system, as Director Cervinka highlighted, is at an inflection point where regional centers have become major corporations, but they are still rooted in the principles of community driven organizations. And they must be informed and led by the perspectives of the people we support and their families. The system is rapidly growing, and the capacity of providers must grow to support it too.

But the regional centers play a major role in quality assurance activities, so the two need to be balanced.

We recommend rather than advancing the proposed language related to the elimination of requirements related to physical sites and courtesy vendorization, that we take a step back and that by 2028, instead, we provide the administration with the marching orders to streamline the vendorization process to address some of these issues, but to do so in a thoughtful way that also considers who's responsible for quality.

If you have regional center service providers being vendorized in areas outside where their offices are physically located, quality assurance becomes much more difficult to measure and to retain. Second, we support the fiscal allocation letter authority. And as Director Cervinka noted, it allows for more dynamic and real time allocations to meet community needs.

Today, we see sometimes regional centers bumping up against their contract authority and running into a situation where they may not be able to cut checks until they get that next contract allocation, which is a lengthy process.

So we believe this will address that. Next, we support the inflationary adjustment and clarifications to the board contract review. The level was set at $250,000 back in 2011. Inflation would have taken it to $363,000 by now, so we view this as just keeping up with the times. And then most importantly, we view the boards of directors of regional centers as carrying out a really critical role, or perhaps it should be stated really critical roles.

They are the bridge between the state who holds the contract with them and their community, which is why they were established to provide a place outside of Sacramento where people could come and help shape their own services and their own policies. They also provide oversight of very large organizations as my fellow panelists have noted. We believe that it is essential that we don't lose the lived experience of individuals served and their families on the boards.

We believe that all of that should be retained at current levels, but we must support them to carry out their prescribed functions with adequate training, support, and increasingly, as Director Cervinka noted, legal consultation. But the legal consultation needs to be a funded mandate for regional centers.

Similar to the way Mr. Jardini described some of the shortfalls in funding for service providers, regional centers are operating at historic deficits for what it would take to carry out all of their functions already.

That being said, in terms of all of the support that regional center boards need, one thing that we've learned in doing extensive training with regional center boards and with regional center staff is that training interspersed with real world application of information over time is far more effective than a large amount of upfront training, because that model allows for synthesizing and applying information, which in turn results in greater retention.

And so our proposal would be for board members to complete the training within the first year of their service. As Ms. Mark demonstrated, and I appreciate the graphic.

You can have it.

I don't need it. I have it memorized. I may have a tattoo of it. But it is exceptionally difficult for regional centers to manage to all of these expectations and requirements. And one way that they do that is through their

is through their board development or board nominating committees. We believe that regional center board members should go through these board development or board nominating committees because it helps with compliance and ensuring that you have a well balanced board. And we view the role of the provider advisory member on the board differently given the statutory limitations on their participation. Specifically, they can't act as officers and they, of course, can't vote on certain things.

And then in conclusion, the ultimate question to be asked is how we best set up regional centers to have the tools at their disposal to meet the needs of modern large organizations.

And we greatly appreciate that the administration is taking a fresh look at that issue and started an important conversation with the introduction of its proposed language. Thank you.

LAO?

Karina Hendren, LAO. We have no concerns about the fiscal allocation letter component of the proposed TBL. And then for the components on the regional center oversight and the board composition, we do not have any comments at this time.

Department of Finance.

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

Questions or comments from committee members? Okay. You will, once I'm done. So number one, this is a good problem to have. The difference between a good institution in the community can make a world of a difference based upon the quality of your board.

And so we have to take this seriously. And the more various experiences that a board has, the better the quality because you never know what an organization's gonna face. And you want someone to at least know where to look, whether they're legal issues, fiscal issues, governing issues. It's horrible to have a board that doesn't know how to run a meeting. It is a waste of everybody's time.

That doesn't mean it can't be learned either. And representation does matter. And I am more concerned about the quality of the board than I am the number that's on the board. I don't care whether it's 10. I don't care if it's 15.

20 starts to get a little shaky. Right? Because quorum is quorum. Whether you have 20 people, that means you need more people to show up. Right?

And so quorums are kinda funny too, which means you wanna make sure you have the right people who are going to. I mean, my HOA rarely has quorum.

Well, it might be a good thing. Yeah.

Alright. Sorry. No one's asking you, director.

I apologize.

Even though it probably will save rates from going up. Anyway, that's my own trauma. Okay. So a few things. Number one, we gotta get somewhere. I'm not in a rush.

So I just wanna make that clear. Whether we get this done this year or next year, it all depends on the good faith effort. I'm always gonna land on the side of making sure that we have a good governance structure than I am about making everyone feel good.

We're talking about public dollars that continue to be allocated, and we have to make sure that we are doing our fiduciary responsibility, which means we have to have the right people on the board in order to safeguard public dollars. Okay?

There's a couple of things I want to point out that I would love. Number one, you already know. We're gonna ask you all to sit down together and try to work some things out, provide us with a working draft along with the changes that are lined out and all that good stuff as we're going through the process. But there's things that I know that I have concerns about already.

The first thing is there's nothing wrong with the level of expertise you want on the board.

I think it's good that you're asking for that kind of expertise. Is it hard to get into on a volunteer basis? Yes. But that doesn't mean it's not necessary either. And there may be a way to say, hey.

If you've made a good faith effort, maybe you can be exempt for this position if you can't find that many people who are willing to do it on a volunteer basis. But that doesn't mean that it's not important to have. Okay? I am not willing to budge from a 50% threshold. Now I think the 50% from people with disabilities can be coupled with 50% made up of those with lived experience and parents and guardians of those with lived experience.

I think the two can work together. And you might be able to find some of those that actually help also to fit some of the expertise that you have. Right?

We agree.

So I'm saying there might be a way to mix that in so that we make sure that we're not missing out on parents and guardians that might actually have some other professional expertise that might be valuable to the board. But then also making sure that we are not diluting, but we're also making sure that clients are at the table as well. Right? So I think 50% should be in those two categories.

You can work out the nuances amongst yourselves on that, but I still think it's important.

You never wanna lose the voice because then there are some people who forget what they're there for, and they're more in favor of being in the position than serving the clients. So I do not wanna have calls about that. I mean, I know Judy's gonna try to call me if there is after that. Right?

Also, Let's have better rationale in terms of the cost of contract threshold. I wanna think a little bit. I need to understand your rationale a little bit in terms of the $250,000 to $350,000. Can you provide me some feedback in terms of what you were thinking or whoever thought of this was thinking about changing the threshold?

I was writing them down. I'm happy to respond to all of those points if you'd like. I didn't mention in my overview, while we've proposed this as trailer bill, we've actually asked that the board composition and competency requirements. We have offered one year until 07/01/2027 for boards to come into compliance. So we know as of July 1, right after this budget is enacted, that's not realistic.

The language already allows a year for boards to come into compliance, meaning they have a year to find people and get them through the training. So I think we're like minded on better do it right than better than fast. You heard me say earlier those competencies, and I am gonna take your arm for it because the important thing about this is that nobody has suggested something be crossed off this list. Exactly. Right?

This is the right thing to do. It's a good thing to do, and it's an important proposal. And having these things is more important to the administration than a 50%. We're happy to retain the language that's in current law around that, making sure that it's not just family members, but legal guardians and others. And in terms of the contract exemption threshold from board review, again, there are lots of contracts that regional centers do.

They do hundreds of them every single year. We want the board focused on the things that are material. The $250,000 threshold in current law has not been adjusted in, like, thirty years, I think.

So it's based upon an inflation type of thought process?

My colleague Amy Westling from ARCA said, if we applied an inflation factor, we'd be at $363,000. We've proposed $350,000. So it's like an inflation catch up adjustment. That's the rationale I would offer to you. But please, yeah.

So all that to say is that we wanna just make sure that we're gonna ask administration and stakeholders to see if we can come to a reasonable agreement. Right? I've kinda told you what my thinking is. There's no way this is gonna be perfect. I mean, in a way, we might have to revisit it again at some point.

Hopefully, not every year or something, you know. But, I mean, what we're doing is we're trying to make the best assumptions as possible. And we have to be okay with that. Right? But if we start to see some red flags, right, if we start to see things like the board is so stacked that even in the midst of family concerns and client concerns, they're still doing something that is actually harming clients, you better believe we're gonna pay attention to that.

Yep. Right? And I know that's not the intention, but the intention is we have to raise the level of quality on our boards to ensure that we safeguard public dollars. Right? That's really what it's all about.

And we don't wanna waste public dollars on lawsuits and all of those kind of things too. Because then that's our additional dollars that are not going to the clients. Right? So please take that into consideration. Department of Finance, you have?

Can you hear me? Okay. Dr. Jackson, Chris Odneal with the Department of Finance, and we really appreciate the conversation that's happening today, and there seems to be consensus on the way things are moving. Just to clarify on expectations of process of where we're at. So we obviously, the administration put forward its proposal at governor's budget.

It's been out there for review. We have received all the same stakeholder feedback and are going through those changes as well. What we're prepared for at this point is to react to maybe those changes that are prioritized by the legislature and provide feedback in TA on that type of, and have that kind of iterative process. But we're not in a position to produce another draft as to the way that you're requesting at the moment.

So I just wanted to clarify the process.

I respect that, but I need to clarify that if there isn't additional feedback from the clients and with the revision that reflects some things, some common ground, there won't be a trailer bill approved. So I also wanna make that clear. Right? And so I would suggest that this is important enough that we are not comfortable moving forward without the stakeholders being a part of the process, because we don't wanna make a decision. In other words, nothing for us without us.

And so I would say that I don't think it's appropriate for the legislature just to make that decision. I think it's appropriate for those who have the real experience to figure it out as much as possible. And then if there are a few technical things, then we'll make some hard decisions. And I think everyone in the room knows that I'm not afraid to do so. But so I would caution the administration of taking that stance.

We can have additional conversations, but just know we are in no hurry to approve this.

Understood, Dr. Jackson. We weren't intending to suggest that we were putting this on the legislature and that stakeholders wouldn't be involved. But I think, as you've noted in some of your comments today, you've pointed out areas of interest like the dollar threshold and board composition where we can take a look at and have those continued conversations with stakeholders.

But what may be helpful for the administration in having those conversations with stakeholders is maybe having just clear expectations of, like, where interest is with the legislature in making those changes. So if we could request information like that, but stakeholders would be involved in conversations as well as, obviously, the legislature.

But we do want this to be a collaborative process. We just wanted to make sure we were clear on what expectations are for the process. So

Absolutely. And I would just say that when you look on, let me see here, when you look on starting on page 23, when you see all the different feedback, I would pay particular attention to those items where organizations that are labeled in the agenda where they're opposing some things, that we have a conversation with those organizations to ensure that those are, whether those are hard opposes. And if they are hard oppose, how can we come to some conclusion?

If we can't come to a conclusion, we're more than happy to do our part to say whether it should be something warranting a halt of the trailer bill or not.

Right? And this might be something where we're gonna build this as we go. Right? But all I'm saying is that we wanna make sure that if this is the administration's proposal, that the administration needs to do the work. If the administration is not willing to do the work, then we are in no hurry to approve this.

Okay.

Understood, Dr. Jackson. Thank you.

I appreciate it. Thank you. Additional questions or comments? Any questions or comments from

I just wanna add, Judy Mark, Disability Voices United, that Director Cervinka and I have had conversations about this trailer bill language. And I actually don't think we're that far apart. We both have the same interest in making these boards be accountable to the communities that they serve as well as provide effective oversight of the regional centers. I don't believe in the current form with the 50% and everything that we're doing now. I don't think this is working today, and we agree on that.

We believe that there needs to be reform of boards. I don't know that we should rush it. It's the issue. I mean, I think this is a very large topic, and it's gonna require a lot of conversation and ensure that we have all the right stakeholders in the room to have the discussion. But I do believe that we are coming to it from the same place. I do believe the director and I are coming to it from the same place.

Absolutely. My request is to do what you can. At some point, we will check in and then see where we're at. And if we think we need more time, we'll take more time. But if we think that we can get somewhere and what we're not agreeing on doesn't warrant enough to just say no.

Don't do anything. We're not looking for 100%. Right? Because I've never seen that exist. Right?

And nor should we really. We need to make sure that as many thoughts and viewpoints are there as possible. And so I think we're headed in the right direction here. I think we have some common principles that should guide our discussion. And I think with that, we'll see where we go from there.

Issue number five, DDS. When you're ready, go for it.

Good afternoon, doctor Jackson, doctor, Shape Collins. I'm Mary Krusakon, deputy director for early childhood and youth services division at the Department of Developmental Services. Thank you for the opportunity to speak with you today, and I'd like to, acknowledge the committee staff's very helpful summary of our proposal. As noted in the agenda, the department is seeking three year time limited authority to issue written directives to local educational agencies and regional centers operating early intervention programs.

Our proposed legislation includes changes in law reflecting the end of our department's interagency agreement with the California Department of Education to oversee and monitor early intervention programs funded with federal grants and operated by local educational agencies.

It is a mutual decision by both departments to end the agreement. The proposal also consolidates transition related provisions for toddlers exiting early intervention programs in the current law into a new government code chapter. The proposal transfers the Department of Education's oversight responsibilities of LEA programs serving infants and toddlers with vision, hearing, and orthopedic disabilities to the department. Thereby creating a unified statewide oversight structure that strengthens fiscal and programmatic compliance and streamlines monitoring of part c programs.

On quest with regard to vetting with partners, we are engaged in discussions with the CDE, and our department would like to acknowledge our colleagues at the California Department of Education for their partnership on this transfer of state duties.

The department is also engaged in discussions with state special education local planning areas and the fiscal subcommittee of the special education administrators of county offices. We have provided a presentation among other things at their membership meetings. Thus far, the discussions with state SELPA and the fiscal subcommittee of the special education administrators of county offices have yielded clarity on what is changing.

Most significantly, it is clarified that the changes in state level duties will not in any way disrupt provision of services to children and families in the program. Both partners had the opportunity to understand the department's record review process as a process for reviewing program compliance of local early intervention programs.

In addition, it yielded understanding and clarity on first, a federal part c grant funds will be allocated to LEAs going forward. And secondly, the federal grant requirements the state and the local programs must comply with. On question four, the administration has presented our proposal, and we assume that the legislature will have a reaction at an appropriate time. And then lastly, this is the administration's proposal at this time, but we'll continue to engage in discussions with California Department of Education. With that, I'm happy to answer any questions.

LAO.

Karina Hendren, LAO. The proposed trailer bill language aligns with a recommendation from a 2018 LAO report that evaluated the state system for serving infants and toddlers with special needs. In our 2018 report, we recommended that the state unify the early intervention system under regional centers as a single lead agency towards the goal of providing more timely services and providing more equal funding for each child served. In the report, we found that regional centers already serve the majority of infants and toddlers with special needs.

They provide more parental choice, and they are better equipped to access public and private insurance billing.

So given this, we do not have concerns to raise with the proposed trailer bill language at this time.

Department of finance. Moore Sanchez, Department of Finance.

Nothing further to add.

My question to DDS is what is our how has the conversations between your colleagues in education and special education, What conversations have happened? Is everyone on the same page? What does that look like?

Thanks. Thank thank you for that question, doctor Jackson. It has been a productive conversation, series of conversations really with the Department of Education. We actually spent more than three months to ensure that there's, smooth transfer of duties. They have provided us with provided us with forms that they've been using to track.

They have connected connected us with the leadership at the local level through, you know, the state SELPA and also the subcommittees so that everyone is understanding what exactly is changing. And on so on that note, it it has been very helpful.

Can you give us a description of that process? That'll be helpful to the committee to make sure that all the stakeholders, everyone involved in this subject area has been, you know, that conversation. The one you've just outlined it, but if you can just provide that process in writing, that'd be great.

The inter the interagency agreement between both departments is is focused on the process to flow the federal part c grant funds from the US Department of Education's Office of Special Education program to the departments of as lead agency into CDE into LEAs. So when when that ended at the end of fiscal year 2425, so June 2025.

We proactively had a series of meetings with the Department of Education to make sure that they can transfer to our department all the forms and paperwork related to how they allocate the grant funding to the local educational agencies that do serve those specified pop the specified population. We also work with them in continuing some of the monitoring work for local programs operated by LEAs. So it it's been hand to glove.

I mean, we could not be more proud of the partnership during that transition process. I mean, we've had meetings to go over what forms, what processes they they do currently in flowing those funds, in doing the data collection, in doing the the monitoring of those programs. And as I've mentioned, they connected us with pertinent parties at the state SELPA the state SELPA and also the the special education administrators of county offices.

And through those presentations with their membership, we were able to engage in q and a so that we can clarify what exactly is changing, how it will affect or not affect the the current processes that they used to. And with that, that that that's that explains how I describe it as productive.

No. I appreciate that. If you can get that to us in writing, that'll be great. Because this is generally something that would go through a policy process, have you have you has this have you gotten this language to our education committee counterparts?

On the no. On this on this issue. So as was mentioned mentioned was that this proposal is the governor's budget proposal on this issue. So the intention is that the legislature will review as part of the governor's budget process. And also noting that the the rationale behind this going through the trailer book process is given the the nexus to the budget with the resources and the resources moving back to the Department of Developmental Services through the termination of the IA. That that is an access to to the budget and for this process.

I think the the issue is we just wanna make sure that although the administration we don't have we're not in generally in opposition to the process in which we're going through now. We just wanna make sure that the appropriate people who generally has jurisdiction over the education portions of this, that they are have an opportunity, to, give feedback as well.

And one thing you don't want to happen and this will actually save all of us some headache because you don't want someone calling me, some chair of some other committee saying, what's going on and why y'all doing this. Right? So I think it'll be to all of our benefit for you to ensure that this is reviewed or at least given to our policy counterpart in terms of on education.

And I'm not saying there probably would be any issue, but we just wanna make sure we're covering our DAS because if I if we get any pushback somewhere else, it could actually derail everything. And we don't and we don't want that to happen. Alright? Is there any other people who or organizations or or stakeholders who have had concerns about this?

Not that we are are aware of it this time.

Okay. Okay. Well, appreciate it. Please. Please. Please. We will be checking back on whether you have been able to get this to our education committee staff. That's gonna be a a big deal for us. So please don't take that lightly. Any questions, comments on this? Oh, okay. The only

Doctor Sharp Collins?

The only comment I would do is echo what what our chair is saying, because of the proposed new structure for CDE as well. So it would it would be be nice for you to be sure to talk to our education counterparts just to kinda see where we are in regards to that aspect to ensure that what this proposal is doing can still carry over if that new structure actually come in comes in into play. So but yeah. Because there there could be pushback in that area.

So just wanted to make sure. But thank you. Thank you, chair.

I just know my people, and we are a bunch of cats around here. Okay? That's all I have. Thank you so much for you.

Thank you. Doctor Jackson.

Thank you so much. Issue number six. We're almost there. No. Is the sun is the sun still out? Oh, okay. Oh, no. Okay. Whatever. Who's who's for issue six?

Is Aaron here? Did you fall asleep, Aaron? Were is this too long for you?

I know. My apologies.

I got some five hour. Hey, I'm ready. I'm ready.

Well, good afternoon again. Aaron Christian with the Department of Developmental Services here to talk about the life outcome improvement system, proposal. As outlined in the summary in the agenda, the life outcome improvement system is, an effort that we are underway to replace and modernize our existing legacy systems. The current systems that are used in our in in the IDD service, area are really outdated. They're 40 plus years old, and are really only internally facing to the regional centers at this point.

The lowest system is aiming to, change that and create a more user centric approach that, has end to end, user capabilities that is inclusive of individuals that are receiving services, having access to information about them, creating a a more informed user experience where they can see in real time services that are authorized, the amount of services authorized, and amount of services that are utilized. We're also aiming to enhance communication between individuals and families and service coordination staff to improve and facilitate, service delivery.

We, also want to look at creating, more fiscal transparency for users so they can see what is being utilized, how much is being spent on them, what is in process of, the approval, and really have real time information about them that's contained in this system. As outlined in the agenda, we embarked on a series of town halls throughout the state that were held in person that began in the 2025 and continued all the way through the 2025.

I say town halls, they're really more facilitated listening sessions where we invited individuals and families to attend those and tell us about what they would like to see out of this type of system.

A lot of what, the outcome of those those town halls are what you see included in the legislative intent in the bill in itself. And it it is all of those, core components that I just listed off. So having that transparency and access to information. It was really informative and empowering. Also included in the legislation is really centered around creating a a more formal governance structure around the existing legacy systems.

And what we're seeking to do is have, the regional center seek approval from the department before making any updates or changes to the the different, you know, fragmented systems they're using today. And the intent behind that is to make sure that we are, one, protecting the lowest project, so we define the business rules from end to end as they they are today and make sure that when we go out to procure those, that they're reflective of the current processes.

And if we have different regional centers doing different things, we then lose control over that that kind of end to end flow. So, in the proposal, that is what, we are aiming to do. Included in the governor's budget was funding for the project team and to continue efforts on data cleanup.

One of the things that we wanna do is make sure that we create a solid foundation of information about our service providers, about our individuals and families, and what they're receiving, the types of services, the, financial aspects of that. What the efforts have yielded thus far is is, quite substantial in terms of our ability to submit federal, reimbursement, upwards of a $100,000,000 thus far.

So, it is really, an effort that's been funding itself, so to speak, but we, are looking to really make sure that we enhance that governance structure and and controls about the upgrades to the existing system. So that's really what the the bill before you aims to do.

Thank you very much, LAO.

Karina Hendren, LAO. As the agenda notes, we find it reasonable for DDS to continue the planning process for the lowest project, particularly given that the department was able to secure enhanced federal funding for planning. The planning process that the department is undertaking will eventually result in a cost estimate as well as a timeline for the finalized project. And once the legislature receives this information in the future, it will be able to evaluate the merits of the proposed project.

We do wanna note, though, that given the fiscal constraints facing the state, legislative oversight of this IT project, its costs, and its progress will be particularly important over the coming years.

And to this end, the legislature could ask the department if the project would be eligible for enhanced federal funding for project maintenance and operations after the planning stage is complete.

Department of finance?

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

Mister Christian, another technology project. There's one thing that scares me to death, and that is a technology project created by the state of California. How do we ensure that it will not exceed projected cost?

And how in the world do we ensure that the project will be done before I retire? That's a real question.

Yeah. No. No. Okay. I think that really emphasizes the the planning stages that we're currently in today.

We've done an ex this this project has gone through extensive extensive planning and preparation and different iterations where we lumped in multiple projects into one, wanted to make sure that we are moving at the same pace. We we've just wrapped up some market research looking at what existing platforms are out there. We are consulting with other states to look at what they've implemented, try to learn the pitfalls from even some of our sister departments and implementation.

I'm I'm know that I'm stating the obvious, but these are all things that we take into consideration. I think the planning is is really the key piece of this and making sure that we understand what we are asking and what we are we are gonna be buying and working with the the the vendor that gets selected once we go to procurement on a realistic timeline and and fixed costs for each one of the stays the stages of the the implementation.

LAO, this might be one of the things that we need your help on in terms of accountability measures, in terms of finding ways that the legislature can continue to get updates and have some some better or increased participation in the process so that we can make sure that, especially as we're going through a transition to another administration, Priorities might change things like that. There's no doubt this what we're hearing is this is something important that we need to do. I think how how old is the current infrastructure?

They're 40 plus years old.

Have mercy. Yeah. So, I mean, there's no doubt we gotta get into the twenty first century. Right?

Absolutely.

But we wanna make sure that, you know, what process has started now continues on in a efficient way, a productive way, and making sure that we're all informed along the process. So if there's recommendations on additional language we need to do to codify, for the legislature to help with that consistency, We want to make sure that we do that. Again, the more money we spend on delays and things like that or less money we can do to provide to get to the clients as well. Right?

So we wanna make sure we're good stewards of our dollars. Any questions or comments on this item?

I think it was answered.

Doctor Sharp Collins.

I think it was answered. This is going back to LAO of your about being able to provide an overall project timeline and expect the cost broken down by physical years. But but by the actual years, would that only happen after the planning process is complete? Or I I just want a point of clarification.

Yes. That's correct. So the legislature has not received that information yet, but it will.

I just wanna make sure I had that right. Okay. Thank you.

Absolutely. Especially the in terms of the reasonableness of the time in which timelines can be provided, I think, could be something that we we we start to to work on. And then also, just some check-in points, I think, is gonna be important as well. Okay? As you know, again, Lord, please please let this be done before I leave the legislature.

That will be that will be great. I know. I can't retire because I don't have a real job. Alright. Thank you very much to this panel.

Thank you.

Issue number seven. May begin when you're ready, mister Cruz.

Hello, doctor Jackson. Good afternoon. My name is Ernie Cruz. I'm deputy director in the community services division at DDS. I'm here to speak on the trailer bill language on remote services. The department is seeking to establish permanent authority for the continued option of remote service delivery within the regional center system. The services where remote the remote option would apply include day programs, look alike day programs, independent living, behavior therapy services, and clinical assessment activities.