A Fiscal Primer On California’s Regional Center System

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A Fiscal Primer on California’sRegional Center SystemPeter Vogel, J.D.Samantha Gerleman, J.D.Carly Hite, J.D.Lane Zuraw, J.D.Joshua AltmanResearch Fellow, Stanford Law SchoolAlison Morantz, J.D., Ph.D.Director of SIDDLAPPJames and Nancy Kelso Professor of Law, Stanford Law School20190559 Nathan Abbot Way Stanford, CA 94305law.stanford.edu/siddlapp/

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Table of Contents(i)Table of Abbreviations. 3(ii)Table of Regional Centers . 5I.Project Motivation and Overview . 6II.Executive Summary . 8III. Historical Overview. 10A.Major Statutory and Structural Reforms: 1965–2018 . 10B.The Changing Pace of Deinstitutionalization . 16C.The Development of Early Intervention Services . 19D.Changes Over Time in Lanterman Act Eligibility Criteria . 20E.Growth of Services that Promote Consumer Independence . 21F.A Demographic Snapshot of Today’s Regional Center Consumers . 23IV.A Budgetary Survey of the I/DD Service Delivery System . 26A.California’s Budgeting Process. 26B.Trends over Time in Expenditures . 28C.Overview of DDS Expenditure Categories . 33D.Breakdown of State and Federal Funding Sources . 37V.(1)Description of State Funding Sources. 38(2)Description of Federal Funding Sources. 39Mounting Fiscal Pressures. 43A.An increasing percentage of California residents require services . 43B.The consumer population is aging, which will likely increase costs . 45C.The caregiver population is aging . 45D.A growing percentage of consumers have autism, a uniquely costly disability . 46E.Below-market rates are driving some service providers out of the industry . 47F.Regional centers struggle to recruit and retain qualified personnel . 49G.Rising labor costs are driving up the cost of direct services . 50H.The high cost of housing is a barrier to community-based living. 51I.California is not in compliance with the CMS Final Rule . 53VI.Conclusion . 552

(i) Table of AbbreviationsAcronymA&D S WaiverHOICFI/DDIDEAIEPIPPLOCTermAged and Disabled Federal Poverty Level Medi-CalApplied Behavioral AnalysisAged, Blind, and Disabled Medically-Needy Medi-CalAchieving a Better Life Experience AccountLanterman ActAmericans with Disabilities ActAdministrative Law JudgeAssociation of Regional Center AgenciesBehavioral Health TreatmentCommunity Care Facility (such as licensed group homes)Client Development Evaluation ReportChildren’s Health Insurance ProgramCompetitive, Integrated EmploymentCenters for Medicare and Medicaid ServicesCounty Social Services AgencyDevelopmental CenterDepartment of Developmental ServicesCalifornia Department of Health Care ServicesDisability Rights California (formerly Protection and Advocacy, Inc.)Early and Periodic Screening, Diagnosis & TreatmentFree and Appropriate Public EducationFederally-MatchedFederal Poverty LineFull-Scope, Federally-MatchedState General FundHome and Community-Based Services1915(c) HCBS WaiverHearing OfficerIntermediate Care Facility (funded by CMS, ICFs for Individuals withIntellectual Disability, or ICF-IIDs, technically include CA developmentalcenters)Intellectual and developmental disabilit(ies)Individuals with Disabilities Education ActIndividualized Education ProgramIndividualized Planning ProcessLevel of Care3

5(i) SPASSASSBGSSDISSITCMTMFTPWDPLeast restrictive environment (i.e. the right to community-based treatment)Modified Adjusted Gross Income MedicaidNational Core Indicators SurveyOffice of Administrative HearingsOperationsProtection and Advocacy Inc. (precursor to DRC)Program Development FundPurchase of ServicesQuality Assurance FeesQualified Intellectual Disability ProfessionalRegional CenterService Coordinator (regional center case manager)California State Council on Developmental DisabilitiesSubstantial Gainful ActivitySkilled Nursing Facility1915(i) State Plan AmendmentFederal Social Security AdministrationSocial Security Block GrantsSocial Security Disability InsuranceSupplemental Security InsuranceTargeted Case Management“The Money Follows the Person” (earmarked federal funding program)250% Working Disabled Medi-Cal4

(ii) Table of Regional WRCRegional Center Full NameAlta Regional CenterCentral Valley Regional CenterEastern LA Regional CenterFrank D. Lanterman Regional CenterFar Northern Regional CenterGolden Gate Regional CenterHarbor Regional CenterInland Regional CenterKern Regional CenterNorth Bay Regional CenterNorthern LA County Regional CenterRegional Center of the East BayRegional Center of Orange CountyRedwood Coast Regional CenterSan Andreas Regional CenterSouth Central LA Regional CenterSan Diego Regional CenterSan Gabriel/Pomona Regional CenterTri-Counties Regional CenterValley Mountain Regional CenterWestside Regional CenterLocationSacramentoFresnoAlhambraLos AngelesReddingSan FranciscoTorranceSan BernadinoBakersfieldNapaChatsworthSan LeandroSanta AnaUkiahSan JoseLos AngelesSan DiegoPomonaSanta BarbaraStocktonCulver CityRegional Center Oversight Dashboard, CAL. DEP’T DEVELOPMENTAL SERVS.,http://www.dds.ca.gov/RCOversight/Overview WRC.cfm (last visited Jan. 17, 2019).15Consumers 12714,11816,26514,6319,490

I. Project Motivation and OverviewIn 1969, California became the first state in the United States to grant individuals withintellectual and developmental disabilities (I/DD) the right to the services and supports they needto live more independent and normal lives. The Lanterman Act, now codified in the CaliforniaWelfare and Institutions Code, declared that “[a]n array of services and supports should beestablished which is sufficiently complete to meet the needs and choices of each person withdevelopmental disabilities, regardless of age or degree of disability, and at each stage of life, andto support their integration into the mainstream life of the community.”2 To this day, Californiais the only state in which the right of individuals with I/DD to be supported in the least restrictiveenvironment is construed as a civil right and an individual entitlement, not merely a right to“take a number and wait in line” until sufficient state resources become available.3To effectuate the goals of the Lanterman Act, California divides responsibility between theDepartment of Developmental Services (DDS), a state agency, and a network of twenty-oneprivate, nonprofit corporations called “regional centers” that are funded by DDS through annualcontracts. Each regional center (RC) serves a different area of the state, providing services andsupports to individuals with developmental disabilities in their local communities. DDS isresponsible for monitoring the RCs and ensuring that they implement the Lanterman Act.In the early years after the Act’s passage, DDS (and in turn, the regional centers) were largelyfunded through the state’s General Fund. Since the mid-1980s, however, a sizable portion offunding has been provided by the federal government. The Centers for Medicare and MedicaidServices (CMS) fund a significant portion of the residential, day, and family supports andservices that regional center consumers receive.As of this writing, California is not facing an imminent fiscal crisis and funding is relativelyabundant. Given its relative prosperity at this historical juncture, the state is ideally positioned toshore up the service delivery system in a thoroughgoing fashion. Confronting each of thechallenges that is threatening the system’s long-term viability will help safeguard the LantermanAct’s beneficiaries from the effects of the next fiscal crisis if and when one materializes.This report is part of a series issued by the Stanford Intellectual and Developmental DisabilitiesLaw and Policy Project (SIDDLAPP), at the request of Disability Rights California (DRC) andthe State Council on Developmental Disabilities (SCDD), to explore steps that the state mighttake to protect the Lanterman Act entitlement. The research was conducted from September,2017 through June, 2019, by a team of researchers—including Stanford law students, research2CAL. WELF. & INST. CODE § 4501 (2017).3See GRETCHEN ENGQUIST ET. AL., CTR. HEALTH CARE STRATEGIES, SYSTEMS OF CARE FOR INDIVIDUALS WITHINTELLECTUAL AND DEVELOPMENTAL DISABILITIES: A SURVEY OF STATES (Sept. 2012) (providing survey results ofdifferent states’ systems of care for individuals with I/DD, such as states with population and/or income gaps andthose states administering care via the HCBS Waiver) (last visited Feb. 14, 2019),http://www.chcs.org/media/IDD State Priorities and Barriers Snapshot 082812.pdf.6

fellows, and undergraduates—under the direction of Alison Morantz, Director of SIDDLAPPand the James and Nancy Kelso Professor of Law.Research team members used several complementary approaches to investigate each issueconsidered. First, they analyzed primary and secondary materials produced by each branch ofgovernment at the state and federal levels, such as statutes, regulations, administrative hearingdecisions, responses to Public Records Act requests, and judicial opinions. Second, theyexamined earlier reports on related issues released by nonprofit organizations, community taskforces, the California State Controller’s Office, The California State Auditor, legislative analysts,and consultants. Third, the team arranged in-person meetings with a variety of individuals withpertinent personal and/or professional expertise, including consumers of regional center servicesand their families, service providers, community activists, legislative staffers, and RC directors.Finally, the team sought to meet with various organizational entities that play leading roles in thedevelopment and analysis of state policy in the I/DD arena: DRC, SCDD, DDS, the Departmentof Health Care Services (DHCS), the Legislative Analyst’s Office (LAO), Public Counsel, andthe Association of Regional Center Agencies (ARCA). All of these individuals andorganizations, with the exception of ARCA, accepted the team’s invitation to discuss the issuesexamined in these reports.The project team wishes to gratefully acknowledge the input and assistance of the numerousindividuals and organizations who provided the information, insights, and knowledge on whichthese reports are based.The purpose of this report, A Fiscal Primer on California’s Regional Center System, is to providea comprehensive overview of the laws, institutions, and demographic trends that are shaping theregional center system in California. The report begins with a general historical overview,provides a budgetary survey of the I/DD service delivery system, and then summarizes theescalating fiscal challenges that are taxing the system.SIDDLAPP encourages dissemination of its publications. Additional reports in this series areavailable for download at https://law.stanford.edu/siddlapp/.7

II. Executive SummaryCalifornia’s regional center (RC) system has undergone transformative changes in the halfcentury since the passage of the Lanterman Act. Following the exodus of individuals withintellectual and developmental disabilities (I/DD) from state institutions, and their integrationinto their communities, came a dramatic proliferation in services designed to promote consumerindependence. This is not to say that the system has evolved in a consistent or linear fashion.For example, although eligibility criteria were expanded in the 1970s to include moredevelopmental disabilities, the eligibility criteria were tightened after the turn of the millenniumin ways that excluded some individuals from coverage. The pace of deinstitutionalization hasalso fluctuated over time, in part due to focused pressure from legal advocacy organizations.At the same time, the demographic composition of the consumer population has shifted in waysthat would have been difficult to anticipate a half century ago. About 40% of today’s regionalcenter consumers are Hispanic, and almost two-thirds are under the age of 22. Once a relativelyrare condition, autism has grown to comprise over a quarter of all diagnoses.The core fiscal challenge of California’ I/DD service support system has been to fund an openended entitlement system on a fixed budget. Despite the difficulty of anticipating the needs ofthe more than 325,000 consumers statewide who depend on RC support, the total budget of theDepartment of Developmental Services (DDS) is determined at the beginning of the fiscal year.Although the system was initially funded with state resources, the overall share of federalMedicaid funding has increased markedly over time. If current trends persist, most LantermanAct consumers will be eligible for two Medicaid programs designed to support individuals in thehome or in community-based settings. Although advantageous from a budgetary standpoint, thestate’s substantial reliance on Medicaid funds makes the system vulnerable to cuts in federal aid.A variety of fiscal and demographic trends are likely to tax the capacity of the service deliverysystem to adequately support consumers in the coming years. First and foremost, the percentageof California residents requiring regional center support continues to increase. The aging of theconsumer and caregiver populations, and the dramatic rise in the prevalence of autism, are likelyto increase costs while diminishing the capacity of family members to support relatives in theirhomes. The supply side of the service delivery system is also facing significant challenges.Below-market reimbursement rates, the high cost of housing, and rising labor costs are drivingsome providers out of the industry. Regional centers are likewise struggling to attract and retainqualified personnel due to their limited capacity to offer competitive salaries to qualifiedpersonnel. Finally, the failure of many home and community-based settings to comply withregulations issued by the Centers for Medicare and Medicaid Services could threaten theavailability of federal funding over the long term. Since the state is currently experiencing a8

period of relative economic prosperity, we recommend that it address these escalating challengesin a systematic fashion and thereby protect the Lanterman Act’s vibrancy for generations tocome.9

III. Historical OverviewA. Major Statutory and Structural Reforms: 1965 –2018In 1965, prior to passage of the Lanterman Act, 12,648 Californians with I/DD resided in largestate institutions.4 Even as thousands of Californians with I/DD waited an average of two yearsto gain admission to these facilities,5 newspaper and television reports nationwide exposed thedeplorable conditions faced by their residents. One report, produced by three nationallyrecognized experts in the field of intellectual disability, found that “[m]entally retarded patients[at Sonoma State Hospital] . . . [were] treated like, and consequently behaved like, animals in azoo.”6 Distressed by these reports yet unable to meet their children’s substantial needs at home,some parents advocated for a new option: government-funded, community-based services.Partly as a result of these advocacy efforts, the Study Commission on Mental Retardationreleased a report in 1965 calling on California to accept responsibility for supporting personswith I/DD through a regional system of community services.7 The report identified at least sevendifferent state agencies that shared partial responsibility for the care of persons with I/DD.8Finding that this disjointed system placed an unsustainable burden on individuals with I/DD andtheir families, the report recommended that California provide services “so complete as to meetthe needs of each retarded person, regardless of his age or degree of handicap, at each stage ofhis life development.”9 “Moreover,” the report continued, “no retarded person should enter aninstitution who can be cared for in the community, and no one should remain in an institutionwho can adjust outside.”10Later that same year, the California Assembly, led by Assemblyman Frank Lanterman, embracedthe Commission’s vision through the passage of Assembly Bill 691. The bill called for the4STUDY COMMISSION ON MENTAL RETARDATION, THE UNDEVELOPED RESOURCE: A PLAN FOR THE MENTALLYRETARDED IN CALIFORNIA 28 (1965) [hereinafter THE UNDEVELOPED RESOURCE]; See also FRANK D. LANTERMANREGIONAL CENTER, STRENGTHENING THE COMMITMENT . . . REINVESTING IN THE SYSTEM: A JOURNEY OFCOMMUNITY PARTNERSHIP 3 (2016) [hereinafter STRENGTHENING],https://lanterman.org/uploads/info resources general/Lanterman-50thHistory-r6(Blue)(web) final.pdf (last visitedJan. 17, 2019) (noting that in the 1950s there were sometimes as few as five, and sometimes as many as nine, stateinstitutions in which people with I/DD resided).THE UNDEVELOPED RESOURCE, supra note 4, at 28 (noting “the average waiting time for admission to statehospitals is about two years”).56STRENGTHENING, supra note 4, at 7-8 (quoting Dr. Gunnar Dybwad, Dr. Richard Koch, and Dr. Ivy Mooring).THE UNDEVELOPED RESOURCE, supra note 4, at 3 (calling for “Establishment of Regional Diagnostic andCounseling Centers, located no more than two hours’ driving time from any California family”).78Id. at 35 (identifying State Departments of Mental Hygiene, Education, Employment, Public Health, VocationalRehabilitation, Social Welfare, and Youth Authority).9Id. at 1.10Id. at 1-2.10

establishment of regional centers (RCs), which would contract with the Department of PublicHealth to provide diagnosis, counseling, and continuing services for “mentally retarded personsand their families.”11 Shortly thereafter, the first two pilot RCs—Children’s Hospital LosAngeles and San Francisco Aid for Retarded Children—began providing community-placementrecommendations for individuals who had been waitlisted for admission to state institutions.As the number of individuals residing in state institutions continued to grow, so too did interestin community-based alternatives. By 1968, 13,175 individuals with I/DD resided in stateinstitutions, which were operating at about 2,500 residents over capacity.12 In response to theseovercrowded conditions, the Assembly commissioned a study on the status of the two pilotRCs.13The resulting report, published in 1969, described the primary role of RCs as coordinating theprovision of services. The first step in assisting a family was to determine whether anotheragency (or agencies) bore responsibility for providing needed services and supports. If allneeded services were available from other agencies, the RC only assisted the family in securingthese resources, and the case was classified as one of “information and inquiry.”14 If, however,the family required services or supports that other agencies could not provide, the case became“active.”15 The report noted that “information and inquiry” cases outnumbered “active” ones bya two-to-one margin.16Another important source of variation among RC consumers was their receipt of purchase ofservices (POS) funds to cover services and supports that RC personnel were unable to providein-house. RC clients who received POS funds cost the state an average of 2,346 per year (about 17,347 in 2018 dollars), whereas “information and inquiry” clients averaged just 874 ( 6,461in 2018 dollars).17 Both of these figures were dwarfed, however, by the cost of state institutions111965 Cal. Legis. Serv. Ch. 1242 (A.B. 691) (codified at CAL. HEALTH & SAFETY CODE §§ 415–416.2 (1969))(repealed 1969).12ASSEMBLY OFFICE OF RES., CAL. LEG., A PROPOSAL TO REORGANIZE CALIFORNIA'S FRAGMENTED SYSTEM OFSERVICES FOR THE MENTALLY RETARDED E-1 (1969) [hereinafter PROPOSAL TO storicPub/1969 Cal FragmentedSvcsMR.pdf (last visited Jan. 17, 2019).CAL. DEP’T PUB. HEALTH, REGIONAL CENTERS FOR THE MENTALLY RETARDED: THE FIRST TWO YEARS 5–8(1969), 9 RCsfortheMR First2Yrs.pdf (last visited Jan. 17,2019).1314Id. at 4.15Id. at 4–5.16Id. at 4.17PROPOSAL TO REORGANIZE, supra note 12, at A4 (Nominal figures are given for FY 1967–68, and we calculatedthese annual averages by multiplying the average monthly state expenditures for FY 1967 –68 by 12); see also CPIInflation Calculator, U.S. BUREAU OF LABOR STATISTICS, https://fred.stlouisfed.org/series/CPIAUCSL (last visitedApr. 25, 2019) (converting January 1968 dollars to August 2018 dollars).11

care, which averaged 5,037– 7,190 per year ( 37,245– 53,165 in 2018 dollars).18 The reportpredicted that the annual cost of care for people receiving RC services would rise by about 5%annually.19 Based on these findings, the authors deemed the pilot RCs a success andrecommended that the model be expanded into a statewide system that would provide “diagnosis,counseling, referral, purchase of services and guardianship for people with developmentaldisabilities”20 through a mixture of public and private funding.21In 1969, Governor Ronald Reagan signed into law Assembly Bill 225, which proclaimed,“California accepts a responsibility for its mentally retarded citizens and an obligation to themwhich it must discharge.”22 This landmark legislation, and its subsequent statutory amendments,are generally known as the “Lanterman Act.”23 The Act required that a system of communitybased supports be developed to serve Californians with I/DD.24 The bill also restructured theway in which services were provided. Instead of being divided among eight different stateagencies, responsibility for the provision of services and supports was transferred to a network of18PROPOSAL TO REORGANIZE, supra note 12, at H1 (Nominal figures are given for FY 1967–68, and we calculatedthese annual averages by multiplying the average daily costs in FY 1967–68 of state institution care for thecategories “Generally Mentally Retarded” and “Intensive Nursing – Geriatric Care” by 365, respectively); see alsoCPI Inflation Calculator, supra note 17 (converting January 1968 dollars to August 2018 dollars).19PROPOSAL TO REORGANIZE, supra note 12, at A7.20Id. at 14.A PROPOSAL TO REORGANIZE, supra note 12, at vi (The report recommended: “Families of children under the ageof 18 who are receiving out-of-home services purchased by the regional center will be required to contribute to thecost of services depending upon their ability to pay, but not to exceed the cost of caring for a normal child at home.Fees shall be the same regardless of where the child receives care and shall take into consideration extraordinaryfamily expense in the care of the child. All funds thus collected shall be used for additional services.”)21221969 Cal. Legis. Serv. Ch. 1594 § 38001 (A.B. 225) (codified at CAL. WELF. & INST. § 4501 (2019)).It should be noted that there is some inconsistency regarding the use of the term “Lanterman Act.” The original1969 Act was officially titled the “Lanterman Mental Retardation Services Act of 1969,” see id. § 38000. Somesources simply refer to the original 1969 Act as the “Lanterman Act,” see, e.g., OFFICE HUMAN RIGHTS &ADVOCACY. SERVS., CAL. DEP’T DEVELOPMENTAL SERVS., A CONSUMER’S GUIDE TO THE LANTERMAN ACT 3(2001), https://www.dds.ca.gov/ConsumerCorner/docs/LA Guide.pdf (last visited Jan. 17, 2019) (describing theoriginal 1969 Act as the “Lanterman Act”). Other sources, however, use the term “Lanterman Act” to refer to the1977 legislation that expanded the scope of the original legislation, see, e.g., Lanterman Developmental DisabilitiesAct, WIKIPEDIA, https://en.wikipedia.org/wiki/Lanterman Developmental Disabilities Act (last visited Jan. 17,2019) (using “Lanterman Act” to refer to 1977 legislation). The popular names of each of the Act’s amendmentshave likewise evolved over time, and as a result may be inconsistently, see, e.g., History of Regional Centers and theLanterman Act, ALTA CALIFORNIA REGIONAL CENTER, ers (lastvisited Jan. 17, 2019) (noting that the original Act passed in 1969, originally called the “Lanterman MentalRetardation Act,” was renamed the “Lanterman Developmental Disabilities Services Act” in 1977). Since thesesemantic distinctions are relatively immaterial for our purposes, we have opted to use the term “Lanterman Act” torefer to the original Act as well as its subsequent statutory amendments.23241969 Cal. Legis. Serv. Ch. 1244 § 38100 (A.B. 225) (codified at CAL. WELF. & INST. CODE § 4620(a) (2019))(noting the importance of “provid[ing] a link between the mentally retarded and services in the community,including state-operated services, to the end that the mentally retarded and their families may have access to thefacilities best suited to them throughout the life of the retarded person”).12

independent, non-profit RCs. Declaring that “[t]he services provided to individuals and theirfamilies by regional centers [was] of such a special and unique nature that it [could not] besatisfactorily provided by state agencies,” the Act characterized the independence of the RCs as acritical precondition for the provision of appropriate support.25In 1977, the legislature passed Assembly Bill 846,26 which made permanent the system ofindependent RCs and further cemented Frank Lanterman’s vision of community-based servicesfor Californians with I/DD. The legislature also amended the Lanterman Act by requiring RCsto contract with the newly-created Department of Developmental Services (DDS),27 which wasvested with “jurisdiction over the execution of the laws relating to the care, custody, andtreatment of developmentally disabled persons”28 along with the oversight of state institutions forpeople with I/DD, known as Developmental Centers (DCs). 29 DDS, in turn, encouraged theformation of the Association of Regional Center Agencies (ARCA), an organization thatrepresents the RCs’ interests on issues of common concern.30 The formation of ARCA made itpossible for DDS to engage with a single representative entity instead of 21 individual regionalcenters, although agreements between ARCA and DDS are not binding on individual RCs unlessthe same provisions are included in regional centers’ respective contracts with DDS.31The Act also created several other entities whose intended functions were designed to beindependent of the RCs to provide system oversight and legal protections. The federally-fundedState Council on Developmental Disabilities (SCDD), which operated on a statewide level, wascharged with planning and advocating on behalf of persons with I/DD and their families.32 A25Id. (codified at CAL. WELF. & INST. CODE § 4620(b) (2019)).1977 Cal. Legis. Serv. Ch. 1252 § 550 (A.B. 846) (later known as the “Lanterman Developmental DisabilitiesAct” and codified at CAL. WELF. & INST. CODE § 4500 (2019)).2627See id. (codified starting at CAL. WELF. & INST. CODE § 4620 (2019)).28Id. § 549 (codified at CAL. WELF. & INST. CODE § 4416 (2019)).29Id. § 549 (codified at CAL. WELF. & INST. CODE §§ 4440–4440.1 (2019)). A state institution under the jurisdictionof DDS is known as a developmental center, see CAL. WELF. & INST. CODE § 4440.5 (2019).CAL. DEP’T FIN., FISCAL AND PROGRAM COMPLIANCE REVIEW OF DEPARTMENT OF DEVELOPMENTAL SERVICESREGIONAL CENTER OPERATIONS 93-94 (Apr. Pub/1979 FiscalPrgmComplianceReview DDSRCOPs.pdf (lastvisited Feb. 14, 2019).3031Id. at 94.32Developmental Disabilities Services and Facilities Construction Amendments, Pub. L. No. 91–517, § 134, 84 Stat.1316, 1319–21 (1970). The California State Council on Developmental Disabilities (SCDD) was established to“engage in advocacy, capacity building, and systemic change activities that are consistent with the policy containedin federal law and contribute to a coordinated, consumer- and family-centered, consumer- and family-directed,comprehensive system that includes the provision of needed community services, individualized supports, and otherforms of assistance that promote self-determination for individuals with developmental disabilities and theirfamilies,” see CAL. WELF. & INST. CODE § 4520(c) (2017); see also 42 U.S.C. § 15021 (2019); see also 42 U.S.C.§ 15025 (2019). SCDD’s main responsibility is to prepare and implement a State Plan at least every five years, and13

network of

Jul 01, 2019 · KRC Kern Regional Center Bakersfield 8,691 NBRC North Bay Regional Center Napa 9,617 NLACRC Northern LA County Regional Center Chatsworth 26,162 RCEB Regional Center of the East Bay San Leandro 20,568 RCOC Regional Center of Orange County Santa Ana 22,031 RCRC Redwood Coast Regional Center Ukiah 3,997 .