In the middle of a health pandemic state government should ease the challenges for those suffering most and at highest risk, and last Friday our State Senate voted to do exactly that by approving their proposed budget which would protect people with disabilities from multiple funding cuts. The Senate’s plan demonstrated strong leadership by the Legislature and prioritizes the state’s safety-net services amidst a budget shortfall due to Covid-19. The Senate will now negotiate their proposed budget against Governor Newsom’s budget – which includes much deeper cuts to disability services – and a budget yet to be approved by the State Assembly. The budget must be finalized and sent to Governor Newsom by the constitutional deadline of June 15, making the next two weeks of advocacy critically important.
On May 14th Governor Newsom released his May Revise budget, which is an update to his January budget based on more recent revenue projections. As expected, the Governor’s revised budget projected a massive budget deficit and included major cuts to state programs, including approximately a $500 million cut to regional center services, a cut to SSI benefits, a 7% reduction in IHSS hours, and a total elimination of adult day services (CBAS). The Governor’s budget, however, also included a provision that would remove (referred to as a “trigger”) all of those cuts if the U.S. Congress passed a new stimulus package that provided at least $14 billion in stimulus relief to the State of California by July 1.
The Senate’s proposed budget rejects all of the cuts to disability services proposed by Governor Newsom and instead relies more heavily on existing budget reserves to prevent deep cuts. The Senate also proposes to give an 8.2% increase to Early Start Specialized Therapeutic Services, Infant Development Programs and Independent Living services, which were unfairly omitted from last year’s 8.2% increase. The Senate’s version, however, still assumes the state will receive $14 billion from the U.S. Congress, otherwise significant budget pressures will continue to exist.
A comparison of the Governor’s May Revision and the Senate’s proposed budget can be found here:
DDS starting on page 47
IHSS starting on page 59
SSI/SSP starting on page 58
CBAS starting on page 38
Special Education starting on page 4
May 14, 2020 – California Governor Gavin Newsom proposed his May Revise budget, which is an updated revision of his January budget proposal. As a result of the Covid-19 crisis, California’s revenue has plummeted from a $6 billion surplus in January to a projected deficit of $54 billion today. It is important to remember that this is only the Governor’s proposed budget, and it must now be debated in the state Legislature, where changes will happen and then a final budget will be sent to the Governor by June 15. The Governor’s Budget summary can be found here. A summary from the Department of Developmental Services (DDS) can be found here. The Arc of California’s summary of the impacts this budget will have on our community can be found here and is below:
Federal Funding Is Needed!
Governor Newsom made it painfully clear that unless Congress passes another stimulus bill to assist states, counties, and cities as they grapple with this health crisis then significant cuts to state services would be part of his solution. If, however, Congress passes a significant stimulus package – such as the HEROES Act or similar legislation – then many of the proposed cuts would NOT need to occur. The Arc of California strongly supports the HEROES Act, which includes funding and support specifically for the disability community, including:
Dedicated funding for Medicaid home and community-based services (HCBS).
Personal protective equipment (PPE) for direct support professionals.
Paid leave for all caregivers.
Economic impact payments for all people with disabilities.
Regional Center Services
The Governor’s May Revise budget estimates regional center caseload growth from 348,187 in the current year to 366,353 in 2020-21, reflecting a decrease of 2,269 from the Governor’s January Budget due to Early Start caseload growth coming in lower than projected. The budget for community services is proposed to be $8.7 billion. Specific items include:
CUTS THAT WILL NOT HAPPEN IF WE GET FEDERAL FUNDING BY JULY 1:
Rate Reductions, Expenditure, and Utilization Reviews—Adjust provider rates and review expenditure trends resulting in anticipated cut of $300 million General Fund in 2020-21. (This is approximately a 10% cut to community based services).
$31.3 million cut by implementing the uniform furlough schedule, requiring consumers and families to go without community based services, and staff to be furloughed 14 days per year.
Cost Sharing for Higher Income Families—Establish a cost-sharing program that would result in a cut of approximately $2 million General Fund in 2020-21 and $4 million ongoing.
Regional Center Operations—A reduction to the operations budget for Regional Centers. This proposal results in a cut of $30 million General Fund in 2020-21 and $55 million ongoing.
THE FOLLOWING PROPOSALS ARE WITHDRAWN FROM THE GOVERNOR’S JANUARY BUDGET:
Enhanced Performance Incentive Program—Would have aligned Regional Center performance contracts and require Regional Centers to meet an advanced tier of performance measures and outcomes to be eligible for an incentive payment. This results in a savings of $60 million General Fund in 2020-21, 2021-22 and 2022-23.
Enhanced Caseload Ratios for Young Children—Would have reduced the regional center services coordinator caseload ratio for children who are three to five years old. This results in a savings of $11.8 million General Fund in 2020-21.
Systemic, Therapeutic, Assessment, Resources and Treatment Training—Would have provided training and supportive services for individuals with co-occurring developmental disabilities and mental health needs. This results in a savings of $2.6 million General Fund in 2020-21.
Provider Rate Adjustments—Would have provided supplemental rate increases for Early Start Specialized Therapeutic Services, Infant Development Programs and Independent Living services. This results in a savings of $10.8 million General Fund in 2020-21 and $21.6 million in 2021-22.
The number of residents in the remaining developmental centers is projected to increase from 302 in June 2020 to 322 in June 2021, due to increases in the secured treatment area of Porterville. Both Fairview and Porterville general treatment area are projected to have all residents moved out by June, 2020.
SSI/SSP CUTS THAT WILL NOT HAPPEN IF WE GET FEDERAL FUNDING BY JULY 1:
The May Revision assumes an offset to the SSP grant that is equivalent to the amount of the federal January 2021 cost of living adjustment to the SSI portion of the grant. This proposal would result in a cut of $33.6 million General Fund in 2020-21, but no reduction in overall SSI/SSP grants received by recipients compared to the prior year.
There are no changes to the CalFresh program. The budget retains funding for both the Supplemental Nutrition Benefit and the Transitional Nutrition Benefit program which were created in 2018 to help households that lost federal SNAP benefits when SSI recipients were made eligible for SNAP.
IHSS CUTS THAT WILL NOT HAPPEN IF WE GET FEDERAL FUNDING BY JULY 1:
IHSS Service Hours—The May Revision assumes a 7-percent reduction in the number of hours provided to IHSS beneficiaries, effective January 1, 2021. This proposal would result in a cut of $205 million General Fund in 2020-21.
County and Public Authority Administration—The May Revision freezes IHSS county administration funding at the 2019-20 level. This proposal would result in a cut of $12.2 million General Fund in 2020-21.
Healthcare (Medi-Cal, Dental, Therapies, ICF-DDs) CUTS THAT WILL NOT HAPPEN IF WE GET FEDERAL FUNDING BY JULY 1:
Adult Dental and Other Optional Benefits—The May Revision proposes to reduce adult dental benefits to the partial restoration levels of 2014. In addition, the May Revision proposes to eliminate audiology, incontinence creams and washes, speech therapy, optician/optical lab, podiatry, acupuncture, optometry, nurse anesthetists services, occupational and physical therapy, pharmacist services, screening, brief intervention and referral to treatments for opioids and other illicit drugs in Medi-Cal, and diabetes prevention program services, for a total General Fund cut of $54.7 million.
Proposition 56 Adjustments—Beginning in 2020-21, the May Revision proposes to shift $1.2 billion in Proposition 56 funding from providing supplemental payments for ICF-DDs, physician, dental, family health services, developmental screenings, and non-emergency medical transportation, value-based payments, and loan repayments for physicians and dentists to support growth in the Medi-Cal program compared to 2016 Budget Act.
THE FOLLOWING PROPOSALS ARE WITHDRAWN FROM THE GOVERNOR’S JANUARY BUDGET:
Elimination of the proposal for Full-Scope Medi-Cal to undocumented older adults.
Elimination of the proposal for the expansion of Medi-Cal to aged, blind, and disabled individuals with incomes between 123 percent and 138 percent of the federal poverty level and it proposes not to implement the Aged, Blind, and Disabled Medicare Part B disregard
Proposes to revert and reduce funding from various augmentations that were included in the 2019 Budget Act including:
– Behavioral health counselors in emergency departments
– Medi-Cal enrollment navigators
– Medical Interpreters Pilot Project
– Augmentation for caregiver resource centers
In his presentation of the May Revision, Governor Newsom made special note that even in these very difficult financial times for the state, he is not backing down from his commitment to find solutions to and invest in our crisis in special education. The May Revision maintains the Administration’s commitment to increasing special education resources and improving special education financing, programs, and student outcomes. Specifically, the May Revision sustains the Governor’s Budget proposal to increase special education base rates, updated at May Revision to $645 per pupil (reflecting the suspension of the 2.31 percent cost-of-living adjustment), apportioned on a three-year rolling average of local educational agency ADA (allocated to Special Education Local Plan Areas). This new base rate represents a 15 percent increase in the Proposition 98 General Fund contribution to the base formula funding over the amount provided in the 2019 Budget Act.
As in the Governor’s Budget, the May Revision proposes that all other existing AB 602 special education categorical funding sources remain as in current law until a finalized formula is adopted.
Further, the May Revision includes $15 million federal Individuals with Disabilities Education Act (IDEA) funds for the Golden State Teacher Scholarship Program to increase the special education teacher pipeline, and $7 million federal IDEA funds to assist local educational agencies with developing regional alternative dispute resolution services and statewide mediation services for cases arising from the COVID-19 pandemic special education distance learning service delivery models.
Finally, the May Revision maintains funding for a study of the current special education governance and accountability structure, and two workgroups to study improved accountability for special education service delivery and student outcomes. The $1.1 million Proposition 98 General Fund used to fund these proposals is replaced with federal IDEA funds. An additional $600,000 federal IDEA funds is proposed for: (1) a workgroup to study the costs of out-of-home care, and how these services can be funded in a way that better aligns with the existing provision of these services, and (2) the development of an individualized education program addendum for distance learning.
In response to decades of underfunding for regional center services, which has caused individuals with disabilities, their families, and their direct support staff to suffer, state Senator Henry Stern and state Assemblymember Jim Frazier have proposed a three-year budget plan that would restore health, safety, and opportunity for Californians with intellectual and developmental disabilities.
The Plan, which proposes to increase funding by $1.7 billion over three years for regional center funded services and regional center caseloads, focuses on five main areas:
Phase-in the Department of Developmental Services (DDS) Rate Models for service providers over three years;
Make immediate corrective actions for services omitted from emergency funding increases last year, including Independent Living, Infant Development, and Early Start Specialized Therapeutic Services;
Take immediate actions to comply with Federal and State caseload ratios at regional centers;
Ensure all DDS funded services & supports receive adjustments for state minimum wage increases;
Secure a foundation for long-term planning by removing the suspension date of January 1, 2022 for emergency funding approved last year.
The Plan has been submitted to both the State Assembly and Senate, and is next scheduled to be discussed on Wednesday, April 22 in the Assembly Budget Subcommittee #1 (the Senate Budget Subcommittee #3 was originally scheduled to hear the proposal this Thursday, March 19, but the hearing was canceled due to Covid-19).
In the coming weeks it will be critical for additional members of the Assembly and Senate to sign on and support the letter. To get involved and learn more please go to www.TheLantermanCoalition.org.
Last Wednesday the Assembly Budget Subcommittee No. 1 on Health and Human Services held a public hearing. Many topics affecting the I/DD community were addressed. In a time when Regional Center services are underfunded by $1.4 billion we need to stay as informed as possible.
Regional Center services are underfunded by $1.4 billion! The assembly and senate have several upcoming hearings that are critical opportunities for our community to let them know how much these services are needed. In these hearings our community must let our representatives know that we need them to fix it and restore health, safety, and opportunity for people with intellectual and developmental disabilities.
MAKE YOUR VOICE HEARD come to any or all of the following hearings:
March 4, 2020 – 2:30 PM
Assembly budget hearing – at the California State Capitol
March 19, 2020 – 9:30 AM
Senate Budget Subcommittee #3, Developmental Services budget
April 22, 2020 – 2:30 PM
Assembly Budget Subcommittee #1, Update on DDS System and Fiscal Reform Task Force
In response to decades of underfunding, the Lanterman Coalition – a coalition of statewide and regional organizations representing people with intellectual and developmental disabilities and their families – has proposed a multi-year strategic investment plan which ensures that the I/DD community and the promise of the Lanterman Act moves from a time of crisis and into a time of opportunity, innovation, and measurable outcomes. With that plan in place, the state of California will enter a new era of community inclusion, including employment opportunities, robust early intervention, legally-required case- load ratios for service coordination, access to housing, and individual health and wellbeing. In addition, the 150,000 direct support professionals in California will finally have job stability and a livable wage.
The plan would do the following:
Phase-in the recently published CA Department of Developmental Services (DDS) rate models over three years (the DDS rate models identified a $1.8 Billion shortage in funding for I/DD services and supports);
Make immediate actions to increase funding for early intervention services and other services committed from recent budget increases, and take immediate actions to reduce regional center caseload ratios;
Ensure all DDS funded services & supports receive adjustments for state minimum wage increases;
Secure a foundation for long-term planning by removing the recently enacted suspension date for all budget increases of January 1, 2022.
Thursday, January 10th, 2020, Governor Newsom released his 2020-21 budget blueprint. The budget projects continued surplus revenue for 2020-21, but less of surplus than last year. In this Budget, as with last year’s, the majority of the surplus is devoted to one-time spending. Overall the Governor proposed a 2.3% total increase in state spending. Below is a summary of the governor’s proposed budget and its impact on Californians with intellectual and developmental disabilities and their families:
*note: budget amounts are shown in Total Fund amounts, which equals state’s portion (GF or General Fund) plus the federal government’s portion. Some amounts also show just the GF (General Fund) amount for comparison.
Regional Center Services
The proposed budget estimates regional center caseload growth from 333,000 clients in 2019, to 350,00 clients in 2020, and 368,000 clients in 2021. The Governor’s Budget proposes $8.75 billion ($5.3 billion GF) for the Regional Center system, an increase of $952 million ($613 million GF) as compared to the updated current year budget. The increase is mainly a result of caseload adjustments and increases to minimum wage.
On Friday the Department of Developmental Services released their updated rate models to conclude the DDS Rate Study. Also released were the summary of public comments in regard to the draft rate models. More analysis of the rate models will be forthcoming; however, the finalized rate models continue to demonstrate that services for Californians with IDD are underfunded by nearly $2 billion.
The Budget proposal includes $18 million ($10.8 million General Fund) in 2020-21 and $35.9 million ($21.6 million General Fund) in 2021-22 to provide supplemental rate increases for Early Start Specialized Therapeutic Services, Infant Development and Independent Living services, consistent with the supplemental rate increases included in the 2019 Budget Act. These services did not receive the 8.2% rate increase that was passed in last year’s budget. The reasoning for their omission was that the draft rate studies indicated that those services should actually get a decrease. Those conclusions in the draft rate models were later admitted by the contractor of the study to be based on bad data inputs. This budget investment aims to correct that mistake. Unfortunately, however, the Governor’s proposes to wait until January 1, 2021 to correct the mistake, which would be a full year after those services should have received the increase.
The Budget proposes to delay the suspension date of provider rate increases from December 31, 2021 to July, 2023.
The Governor proposed an increase of $78.0 million ($60.0 million GF) to establish a Performance Incentive Program for Developmental Services administered through Regional Centers. The Performance Incentive Program would align with each Regional Center’s performance contract and require Regional Centers to meet an advanced tier of performance measures. (It is unclear at this time if these funds would be tied to the rate models as finalized in the DDS rate study, and/or if these funds are proposed to fund regional centers or service providers.)
Enhanced Caseload Ratios for Young Children—The Budget proposal includes $16.5 million ($11.2 million General Fund) to establish a reduced regional center service coordinator caseload ratio for consumers who are under the age of five years.
Systemic, Therapeutic, Assessment, Resources and Treatment Training—The Budget proposal includes $4.5 million ($2.6 million General Fund) to provide training on person-centered, trauma-informed, and evidence-based support services for individuals with co-occurring developmental disabilities and mental health needs.
Warm Shutdown of Fairview Developmental Center—The Budget proposal includes $11.9 million General Fund to extend the warm shutdown period at Fairview Developmental Center through 2020-21 until a site assessment is completed to inform the disposition of the property.
Community Crisis Homes for Children – Decrease of $4.5 million GF in onetime start-up funding.
Development of STAR Homes – Decrease of $3.0 million GF in one-time startup funding to develop two STAR homes in Central CA.
Enhanced Behavioral Supports Homes (EBSH) with Delayed Egress and Secured Perimeter (DESP) – Increase of $7.5 million GF to develop five EBSHs with DESP to reduce reliance on restrictive settings and provide opportunities for individuals to move to the community, with appropriate and necessary supports
Systemic, Therapeutic, Assessment, Resources and Treatment (START) Training – Increase of $4.5 million ($2.6 million GF) to support individuals in their current residential arrangement and prevent disruptions and admissions into more restrictive settings, such as Institutions for Mental Diseases, out-of-state services, acute psychiatric settings, Community Crisis Homes and STAR services through the provision of 24-hour crisis services and planning, and by providing training to families, direct support staff, and local partners (e.g., police, hospital staff, teachers) on person-centered, trauma-informed, and evidence based support services for individuals with co-occurring developmental disabilities and mental health needs.
In 2015, the state announced the planned closure of the three remaining developmental centers: Sonoma, Fairview, and the general treatment area of Porterville. The last residents at Fairview and the Porterville general treatment area are transitioning to the community in January 2020. The Department will continue operating the secure treatment program at Porterville, the Canyon Springs community facility, and state-operated acute crisis facilities in Northern, Central, and Southern California, with an estimated population of 322 by June 30, 2021.
Persons with intellectual and developmental disabilities who are deemed incompetent to stand trial (IST) often languish in county jails while awaiting a more appropriate placement. We are pleased that Governor Newsom has invested $8.9 million general fund dollars for the temporary activation of a 20-bed unit in the Porterville secure treatment program to help reduce the number of individuals awaiting placement. The Governor proposed budget includes:
$8.9 million General Fund for State-Operated Facilities to temporarily activate a 20-bed unit in the Porterville secured treatment program for individuals with IDD who are deemed incompetent to stand trial (IST). The additional unit will sunset June 30, 2024, are more integrated community setting are developed.
$7.5 million General Fund for Community Services to develop 5 enhanced behavioral support homes with secure perimeters aimed at providing long-term placement for individuals who are deemed IST.
$24.6 million General Fund to implement a Community Care Collaborative Pilot Program, a 6-year pilot in 3 counties, to provide incentives to treat and serve individuals deemed IST.
$8.9 million General Fund ($11.2 million General Fund thereafter) to expand Jail-Based Competency Treatment programs in 8 additional counties.
Department of Youth and Community Restoration $289.7 million ($260.8 million GF) 2020-21 and $295.6 million ($266.8 million GF) annually thereafter to establish the Division of Juvenile Justice as a new Department of Youth and Community Restoration. $2 million for an Interagency Agreement between Department of Youth and Community Restoration and California Volunteers for navigators.
In his presentation the Governor stated that special education in California is in crisis and it’s a real shame.” The Governor cited his own benefits from special education as a child. As a result the Governor proposes significant investments and made mention of “leaning into” SELPAs. The proposed budget included $900 million for each workforce development, and the Budget proposes an additional $250 million ongoing Proposition 98 General Fund based on the number of children ages 3 to 5 years with exceptional needs served.
Effective January 2020, the maximum SSI/SSP grant levels are $943 per month for individuals and $1,583 per month for couples. The projected growth in the Consumer Price Index is 1.7 percent for 2021. As a result, the maximum SSI/SSP monthly grant levels will increase by approximately $13 and $20 for individuals and couples, respectively, effective January 2021. CAPI benefits are equivalent to SSI/SSP benefits. The 2019 Budget Act included $25 million General Fund ongoing to assist homeless, disabled individuals applying for SSI/SSP benefits.
The Budget includes $14.9 billion ($5.2 billion General Fund) for the IHSS program in 2020-21, a 16-percent increase in General Fund costs over the revised 2019-20 level. Average monthly caseload in this program is estimated to be 586,000 recipients in 2020-21, a 4.5-percent increase from the revised 2019-20 projection. Other Significant Adjustments: • Minimum Wage—The Budget reflects $1.1 billion ($523.8 million General Fund) to support planned minimum wage increases of $13 per hour on January 1, 2020 and $14 per hour on January 1, 2021.
Electronic Visit Verification—Federal law requires states to implement an electronic visit verification system for personal care services by January 1, 2020, and for home health care services by January 1, 2023. Failure to comply with the electronic visit verification requirement would result in an escalating fiscal penalty in the form of a percentage point reduction in federal matching funds. To comply with federal law, the Budget includes $34.9 million ($5.3 million General Fund) to implement an electronic visit verification solution and enhancements to the Case Management, Information and Payrolling System for personal care services.
California Access to Housing and Services Fund—The Budget provides $750 million one-time General Fund to establish a new fund, with the goal of reducing street-based homelessness and increasing the number of stable housing units.
NEW Department of Early Childhood Development
The Budget proposes to establish the Department of Early Childhood Development under the Agency to promote a high-quality, affordable, and unified early childhood system that improves program integration and coordination.
The budget proposes to launch a Medi-Cal Healthier California for All initiative (formerly known as CalAIM, or the California Advancing and Innovating Medi-Cal initiative), which builds upon waiver demonstration programs such as Whole Person Care, the Coordinated Care Initiative, Health Homes, and public hospital system delivery transformation. Medi-Cal Healthier California for All proposes to provide a wider array of services and supports for patients with complex and high needs. Medi-Cal Healthier California for All has three primary goals:
Identify and manage member risk and need through whole person care approaches and addressing social determinants of health;
Move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility; and
Improve quality outcomes and drive delivery system transformation through value-based initiatives, modernization of systems, and payment reform.
The end of this month two hearings will take place in the state Capitol building which will impact California’s I/DD community. Please share this information within your network and attend if you can.
9:00AM, January 22, 2020
State Capitol, Room 4203
Senate Budget Sub 3 Informational Hearing: DDS Rate Study and Reform in the Developmental Services System
The Senate Budget Subcommittee on Health and Human Services will be holding an informational hearing on January 22 at 9:00am. There will be a discussion on the next steps concerning the DDS rate study, as well as the rate study-related provisions of Senate Bill 81.
1:30PM – 4:30PM, January 28, 2020
California State Capitol, Room 127
CA State Assembly Select Committee on Intellectual and Developmental Disabilities Statewide Summary: Hearing on Living with Intellectual and Developmental Disabilities
This statewide summary is the culmination of 8 Select Committee hearings conducted across the state over the past year. Families, providers and legislators are invited to attend and hear results from the Select Committee on how different regions of the state service the needs of those with intellectual and developmental disabilities.
Each year The Arc of California discusses and decides on budget and legislative priorities for the coming year. We want to hear from you, the intellectual and developmental disability community, about improvements, challenges, and changes that you would like The Arc of California to consider while developing our policy package. Your input could be specific ideas for a legislative bill, or could simply be an issue that is impacting you, your family, or organization. If you’d like to provide input then please click here. Your input will be sent directly to staff at The Arc of California.
Assemblyman Chris Holden (D) of Pasadena said recent budget victories for the developmentally disabled represent a big step, “but that there is more to do.”
With passage and signing of the first state budget under Gov. Gavin Newsom (D), Holden can point to his leadership in securing what grew to be $400 million for developmentally disabled service providers, as well as to having helped in the fields of speech pathology and music therapy.