California’s 2019-20 Budget
The California Legislature has passed and sent a budget and several associated trailer bills to Governor Newsom for his signature prior to the constitutional deadline.The $215 billion budget follows nearly six months of budget hearings in the Legislature on the Governor’s budget that he proposed in January and his updated May Revise and final negotiations between the leaders of the two houses of the Legislature and the Governor. The intellectual and developmental disability community will benefit from this budget through increased rates for services and supports, restoration of Medi-Cal benefits, and other specific investments. A summary of the impacts this budget will have on the community is below:
Regional Center Services
The number of individuals with developmental disabilities in the community served by regional centers (consumers) is expected to increase from 333,524 in the current year, to 350,487 in 2019-20. Total budget for regional centers is proposed to increase to ap-proximately $8.2 billion in 2019-20 from $7.5 billion in 2018-19.Specific items include:
Service provider rates received an initial investment of $125 million next year, increas-ing to $250 million the following year, but added a sunset date (a date when those in-vestments would stop) of December 31, 2021;
Requires the department to consult, commencing in the summer of 2019, with specified stakeholders to discuss system reforms to better serve consumers with developmental disabilities, and to perform various duties, such as evaluating compliance with federal rules relating to specified services, to report on the progress of these efforts, and to post specified material on its internet website, including a summary of public comments. The meetings will specifically focus on “how to create a sustainable, innovative, cost-effective, consumer-focused, and outcomes-based service delivery system.”
- Suspends the Uniform Holiday Schedule, a predetermined 14 days when all re-gional center funded programs were closed, until January 1, 2022.
- $.5 million for Best Buddies program;
- Approves $11 million in funding and prohibits requiring families to use private insurance and make co-payments, as required by federal law.
The population on July 1, 2018 was 514 residents. The Department projects an ending population of 326 residents on July 1, 2019. Overall funding for the developmental centers is projected to be $404.4 million ($316.7 million GF)
Regional Center Transparency and Accountability
- Provides, in trailer bill, that regional centers will be required to provide a list of agreed upon services and supports at the end of an IPP meeting, including the amount and duration of the services, which must be translated into the consum-er’s or the consumer’s family’s native language.
- Provides in trailer bill that regional centers must post on their website the as-sessment tools and guidelines for determining the need for some of the most common services: independent living, supported living, personal assistance and transportation along with the post respite assessment tools and guidelines al-ready required.
- Provides $8 million dollars for additional DDS staff to support increased transpa-rency and accountability and includes the following reporting by regional centers:
– Regional center boards to hold an annual meeting regarding the National Core Indicators, identify needed areas for improvement in consumer services and a meeting regarding contract performance measures and needed im-provements. Both meetings must provide language access for consumers and families who do not speak English.
– Development of standard informational packets for consumers and families that provide an overview of the early start and regional center system, provide a resource guide, and information about consumer rights and translate these packets.
– Regional Centers must provide DDS with copies of corrective action plans and sanctions issued to providers.
– Increased reporting to the legislature regarding HCBS compliance, safety net for individuals in crisis or complex behavioral needs, and disparities identification and improvement.
Services for Individuals in Crisis or Who Have Complex Be-havior Needs
- Provides lower service coordinator caseloads for individuals with complex service needs.
- Limits the use of restraints in community crisis homes and requires the depart-ment to develop restraint guidelines by March 2020.
- Requires, effective January 1, 2020, a 6500 commitment order for individuals placed in Institutions for Mental Disease (IMD) not to exceed 13 months.
- Limits the proposed use of Canyon Springs, a state-run community institution, to individuals transitioning from a short-term acute crisis unit, an IMD, or a provi-sional placement from a developmental center. The use of Canyon Springs for this purpose ends on June 30, 2022.
- Provides $4.7 million one-time, temporary funding to open an acute crises unit at Porterville Developmental Center until additional central valley-based state-operated community-based acute crises units are developed and operational.
- Expands the number of community crisis homes, including crisis homes for children, and requires the department to develop guidelines for the use of restraint in these homes.
- Requires the department to identify new service models and the state’s role in providing services for individuals private providers will not serve.
- Requires DDS to notify the clients’ rights advocate (CRA) of individuals when the regional center initiates a 6500 commitment petition for an individual in an IMD, and when a regional center consumer is placed in a psychiatric hospital or at the Canyon Springs state-run community facility.
- The budget does not include any increase in the SSI/SSP grant.
- CalFresh Expansion to SSI Recipients: The budget makes permanent the “hold harmless” programs created in the 2018-19 budget and provides $86 million for the cost of benefits. The Supplemental Nutrition Program (SNB) and the Transi-tional Nutrition Program (TNB) were created to ensure that CalFresh households that lost CalFresh benefits due to the expansion would be made partially or completely whole if their households lost CalFresh benefits.
- Includes trailer bill language requiring that the development and implementation of the electronic visit verification system adhere to specified principles including the prohibition that it not utilize geo-tracking or GPS capabilities.
- Restores the IHSS seven percent reduction to service hours through December 31, 2021.
Healthcare / Medi-Cal
- Restores critical Medi-Cal benefits : $17.4 million General Fund in 2019- 20 and $40.5 million ongoing to restore the following Medi-Cal benefits: optical, audiolo-gy, podiatry, speech therapy, and incontinence creams and washes. These benefits were cut in 2009, and after more than 10 years, will be restored effective January 1, 2020.
- Ends the “senior penalty”/ raises the Medi-Cal Aged & Disabled (A&D) income limit: $124.9 million ($62.4 million General Fund) ongoing and placeholder trailer bill language (TBL) to raise the Medi-Cal A&D program income level to 138% of Federal Poverty Level (FPL) so that seniors and persons with disabilities are no longer subject to unfair income limits. This is effective no sooner than January 1, 2020.
- Expands Medi-Cal to income-eligible adults up to age 26 regardless of immigra-tions status: $98 million ($74.3 million General Fund) to expand full-scope Medi-Cal coverage to undocumented young adults age 19 through 25 effective no sooner than January 1, 2020.
- Health enrollment navigator funding: $60 million ($30 million General Fund) one-time funding to support health enrollment navigators for two years to provide outreach, enrollment, retention, and utilization assistance in Medi-Cal and placeholder TBL.
- Provides $50 million in Proposition 63 funding ($10 million of this is ongoing) for the Mental Health Student Services Act to provide competitive grants to partnerships between county mental or behavioral health departments and school districts, charters schools and county offices of education.
- Provides $10 million in ongoing General Fund (suspended December 31, 2021) for the Emergency Childcare Bridge Program for Foster Children to provide addi-tional access to early care and education services for abused and neglected children.
- Provides $152.6 million in ongoing Proposition 98 funding to bring all LEAs to the statewide base rate for special education funding and $493.2 million to provide grants to LEAs serving three and four yearolds with Individualized Education Plans. Adopts trailer bill language to require ongoing funding to be contingent upon the passage oflegislation in 2020-21 budget to reform the special education system to improve outcomes for students.
- Provides $300 million in one-time General Fund for the Full-Day Kindergarten Facilities Grant program and prioritizes schools converting part-day to full-day Kindergarten programs and allows for any remaining grant funding to be used for other one-time costs to implement the full-day kindergarten program.
- Approves 10,000 full-day State Preschool slots for non-LEAs beginning April 1, 2020 and allocates $31 million in ongoing funds in 2019-20 and approximately $125 million in 2020-21 to annualize these additional slots.
- Provides $195 million in one-time funds for the Early Learning and Care Work-force Development Grants Program to increase the educational attainment of the childcare workforce.
- Approves of $23 million Proposition 56 for Medi-Cal trauma screenings and $60 million Prop 56 one-time for provider trainings on administering trauma screen-ings.
- Homeless Emergency Aid: The budget includes $650 million in one-time funds for local governments and continuums of care to address homelessness. Funds can be used for a range of uses, including emergency shelters, navigation cen-ters, hotel and motel conversions, supportive housing, rapid rehousing, and em-ployment programs. Funding is contingent on demonstrating collaboration be-tween cities and counties.
- Housing Disability Advocacy Program: As part of the Governor’s initiatives to re-duce homelessness, the budget includes $25 million in ongoing funding for the Housing and Disability Advocacy Program (HDAP) to engage in intensive SSI advocacy for disabled persons who are likely eligible for SSI, and to provide housing assistance. Budget trailer bill language expands use of the funds to continue housing assistance for SSI recipients after they are found eligible for SSI.
Earned Income Tax Credit (EITC):
The Governor and the Legislature have agreed to include a large increase in the state Earned Income Tax Credit in the budget, expanding eligibility from approximately 2 mil-lion to 3 million Californians. Additional details to follow.
California’s 2018-19 Approved Budget
June 27th, 2018 – California Governor Jerry Brown signed into law the 2018-19 State Budget. The intellectual and developmental disability community will benefit in two major areas: Investments made to SSI/SSP and special education. The Budget, however, lacks the needed investments into community services and supports. A summary of the impacts this budget will have on the community is below:
Regional Center Services
The budget estimates regional center caseload growth from 317,837 clients to 332,738 clients. The budget includes $330 million increases in regional center purchase of services; of that amount $178.5 million is due to increases in the state minimum wage. Total budget for regional centers is proposed to increase to $6.9 billion in 2018-19 from $6.35 billion in 2017-18. Specific items include:
- $25 million provider rate increase for only one year. Money will be used as a “bridge” to help fund services until a new rate study is released in 2019;
- No restoration of social recreation or camping services (these critical services were eliminated during the recession and advocates have fought hard to restore them and it was approved by both the Assembly and Senate, but it was eliminated in last minute negotiations with the Governor);
- Implementation of the 14-day mandatory furlough schedule will be delayed for one year;
- Half-day billing (essentially a cut to provider reimbursement rates) could be implemented for a loss of $1.4 million (this statute has existed since it was enacted in 2009; however, due to The Arc California’s lawsuit the state has not recently enforced it. The Governor’s budget did not suggest that they would begin to enforce it again but it could be possible that they would try);
- $200,000increase to provide supplemental payments to ICF-DDs consistent with a corresponding Medi-Cal rate increase;
- $300,000 increase to Kern regional center for management oversight and accountability;
- $1.5 million for Best Buddies program;
- Requires each regional center to include on its Internet Web site any procedures and assessment tools used by the regional center to determine the level of respite services needed by each consumer (this is in response to last year’s budget change which removed the cap on respite services that was enacted in 2009, and reports that some regional centers are not updating their respite policies as a result);
The number of residents in the remaining developmental centers is projected to decrease to 534 by July 2018, and 323 by June 30, 2019. Sonoma Developmental Center is scheduled to close December, 2018. Overall funding for the developmental centers decreases from $485 million to $385 million, including:
- $10 million for the Department to address deferred maintenance issues at the Porterville developmental center.
SSI/SSP recipients received a big win in this year’s Budget. The Budget includes $2.8 billion General Fund for the SSI/SSP program. The average monthly caseload in this program is estimated to be 1.3 million recipients in 2018-19, a slight decrease from the 2017-18 projection. The SSI/SSP caseload consists of 70 percent people with disabilities, 28.6 percent aged, and 1.4 percent blind.
- Effective January 2018, maximum SSI/SSP grant levels are $910 per month for individuals and $1,532 per month for couples. The federal cost of living adjustments based on the current Consumer Price Index growth factors are 2 percent for 2018 and a projected 2.6 percent for 2019. As a result, the maximum SSI/SSP monthly grant levels will increase by approximately $20 and $29 for individuals and couples, respectively, effective January 2019. CAPI benefits are equivalent to SSI/SSP benefits, less $10 per month for individuals and $20 per month for couples.
- SSI/SSP Cashout Repealed – The budget repeals state law that cashed out eligibility for federal SNAP (CalFresh) benefits in exchange for a $10 increase in the SSI/SSP grant amount. By ending cashout beginning in June, 2019, the state will permit SSI recipients to apply for CalFresh. It is estimated that as many as 375,000 SSI recipients may become eligible for CalFresh. Benefit levels will be based on a table developed by DDSS in consultation with stakeholders.
- Transitional Nutrition Benefit (TNB) Program – The budget establishes a second new program to “hold harmless” households that will lose all eligibility for CalFresh due to the end of cashout. CalFresh households which include one or more SSI recipients will now have the SSI income considered when calculating CalFresh eligibility and benefit amounts. It is estimated that over 7,000 households will lose all CalFresh due to the end of cashout. The TNB will provide a monthly supplement to the CalFresh amount so long as the family remains on CalFresh when cashout ends and the SSI recipient remains in the household.
- State Supplemental Payment Cost of Living Adjustment (COLA) – The budget restores the COLA for the state portion of the SSI/SSP grant beginning July 1, 2022 based on the California Necessities Index. The SSP COLA was suspended in 2009 during the recession and only one COLA has been provided since that time.
IHSS Provider Paid Sick Leave – The Budget includes $29.9 million General Fund to reflect implementation of eight paid sick leave hours for IHSS providers beginning July 1, 2018. Also, no later than February 1, 2019, would require the State Department of Social Services, in consultation with the Department of Finance and stakeholders, to reconvene the paid sick leave workgroup for in-home supportive services. The bill would require the workgroup to discuss how paid sick leave affects the provision of in-home supportive services and to consider the potential need for a process to cover an in-home supportive services recipient’s authorized hours when a provider should need to utilize his or her sick time. The bill would require the workgroup to finish its work by November 1, 2019.
Home Health Rate Increase – The Budget includes $64.5 million for a 50-percent rate increase and associated increases in utilization for home health providers that provide medically necessary in-home services to children and adults in the fee-for-service system or through home and community-based services waivers.
The restoration of full dental services for adult beneficiaries in the Medi-Cal program became effective January 1, 2018. This year’s budget includes other major investments that will specifically benefit the special needs community:
- Allowances for Additional Time for Individuals with Special Health Care Needs: Based on stakeholder feedback, dental providers will be reimbursed for additional time needed by individuals with special health care needs. The associated supplemental payment will be 60 percent of the Schedule of Maximum Allowances(SMA).
- Supplemental payment categories include restorative, endodontic, prosthodontic, oral and maxillofacial, adjunctive, and visits and diagnostic services. These payments will be maintained for 2018/19 at 40 percent increase of the SMA.
The budget includes several investments into special education funding in California, including funding to recruit and retain special education teachers and capacity building for early care. See The Arc California’s June 25th Monday Morning Memo for detailed information. Approved budget items are below:
- $167.2 million in Proposition 98 funding for the Inclusive Early Education Expansion program. Under this program grants will be provided to local educational agencies (LEAs) to increase access to subsidized early care and education programs for children from ages zero to five.
- $10 million in one-time funding to establish the Inclusive Early Care Pilot Program. Under this program, county offices of education may apply to receive grants to increase access to early care and education programs for children with exceptional needs, including severe disabilities, from ages zero to five.
- $50 million in one-time Proposition 98 funding for teacher residency programs for special education teachers and another $50 million in one-time funding to recruit and retain special education teachers.
$1.5 million tocreate a 3-year pilot program in the Counties of Sacramento and Los Angeles for the purposes of increasing long-term employment opportunities for young adults with autism and autism spectrum disorder. The “Breaking Barriers in Employment for Adults with Autism Pilot Program” requires the Workforce Investment Board to (a) Work with an experienced nonprofit organization on the outreach, selection, training, and compensation of young adults with autism to participate in the program.
(b) In collaboration with stakeholders, create a manual to train employers in building workplace capacity for the targeted population.(c) Once the manual is developed implement free employer trainings in Sacramento and Los Angeles counties based on the manual.
Eligible uses of pilot program funds include, but are not limited to, stakeholder outreach, student trainings, employer trainings, administrative resources, and stipends for participating young adults.