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Report
#160-2007 - October 25, 2007 - Thursday
Assembly Human Services Committee
10/24 Info Hearing
* AB 12 Pilot Could Help Direct Worker
Health Care Says Beall
* Autism Commission Presents Findings
and Recommendations
* Direct Care Worker Wages, Retention
and Training Highlighted
SACRAMENTO (CDCAN) - With a huge growing State
budget shortfall of over $10 billion projected for next year, the
soaring costs of healthcare coverage for thousands of workers employed by
community-based organizations serving children and adults with developmental
disabilities was one of the critical issues highlighted during
the Assembly Human Services Committee informational hearing on the Lanterman
Developmental Disabilities Services Act held Wednesday (October 24) at the
State Capitol.
California Only State In Nation To Have Civil
Rights Law for Persons with Developmental Disabilities
No other state in the nation has a similar law, which
is named after the Republican Assemblymember, Frank Lanterman, who
authored the legislation that was passed in 1969 and signed into law by
then Governor Ronald Reagan.
Over 220,000 children and adults with developmental
disabilities are currently served by the 21 non-profit regional centers
overseen by the Department of Developmental Services.
Thousands of community-based organizations and individuals provide actual
services and supports in the community. Included in the total
number are about 3,000 people with developmental disabilities who reside
in the five state owned and operated developmental centers and also two
other smaller facilities. Included in the total is another 8,900
or so persons with developmental disabilities reside in privately owned
or operated health facilities (skilled nursing facilities and
intermediate care facilities).
According to the most recent data from the Department
of Developmental Services, 86,500 persons (or 42% of the total population
served under the Lanterman Act) are white, followed by 67,000 persons
(32%) who are Hispanic, 20,900 who are African-American (10%), 11,800 who
are Asian-American (6%), 4,165 who are Filipino (2%), Native Americans 822
(0.4%) and Pacific Islanders with 458 persons (0.2%) and others making up
16,359 persons or 8%.
Second Informational Hearing Set For November
16th in San Jose
November 16, 2007 - Friday afternoon 1:30 PM to
5:00 PM
Campbell Community Center - Roosevelt Room
1 West Campbell Avenue
Campbell, CA (near San Jose)
Subject: "The Lanterman Act: Expanding
Opportunities for Employment and Community Participation for People with
Developmental Disabilities"
Note: CDCAN is planning a series on of on-going
community hearings on Olmstead, the Lanterman Act and other related
disability, senior and mental health issues. For more information
see special CDCAN reports or go to CDCAN website at www.cdcan.us
Olmstead Informational Hearing Set for November
14th
Though not directly connected to the Assembly Human
Services Committee, another panel, the Assembly Aging and Long Term Care
Committee has scheduled an informational hearing that directly impacts
persons with developmental and also other disabilities, mental health
needs and seniors.
That informational hearing will focus on California's
implementation of the 1999 US Supreme Court Olmstead Decision, which
required the states to take measures to avoid the unjustified
institionalization of persons with disabilities and seniors. That
informational hearing is scheduled for November 14th, Wednesday from 10:00
AM to 12:30 PM , at the Wilshire Grand Hotel, 930 Wilshire Boulevard, in
Los Angeles. See separate CDCAN Report for more details.
Oct 24th Hearing Focused on Autism Commission
Report and Worker Issues
The October 24th Assembly Human Services
informational hearing, the first of two scheduled, started off first with
a report by the Legislative Blue Ribbon Commission on Autism's findings
and recommendations to the Legislature and Governor. The hearing also
included four panels focusing on worker issues, including a panel
of adults with developmental disabilities (Jonathan Rosinus, Darcy
McCann, and Nick Feldman). and a support worker (Tamara
McClatchey, of Becoming Independent in Santa Rosa) - sometimes
referred to as a direct care worker. That panel testified about the
impact on their lives of high turn-over of workers due to low wages, and
the need for training. Two other panels, including representatives
from regional centers and providers, community colleges, and SEIU
(Service Employees International Union) spoke, covering other
areas of worker retention, wages and training, including the impact on
person centered planning.
Terri Delgadillo, director of the Department of
Developmental Services,, provided an update on the state's response
regarding the fires in Southern California and that has impacted persons
with developmental disabilities, and also provided a brief update on
what the department is doing, including a focus on employment of people
with developmental disabilities.
Public testimony followed at the end of the hearing,
including testimony provided by several persons with disabilities,
family members and providers. Several persons who testified
included persons with developmental disabilities and family members who
are participating in an advocacy training program called "Partners
in Policymaking". For many of those persons, it was the first
time testifying at a real legislative hearing in the State Capitol.
Assemblymembers Express Support for Workers -
But Budget Deficit Fears Raised
No votes on any actions are taken at informational
hearings, though the committee chair, Assemblymember Jim Beall, Jr.
(Democrat - San Jose, 24th District) and committee members in attendance -
Assemblymembers Tom Berryhill (Republican - Modesto, 25th District) and
committee vice chair, Mike Davis (Democrat - Los Angeles, 48th
District) , Mark DeSaulnier (Democrat - Martinez, 11th District), and Paul
Krekorian (Democrat - Burbank) all pledged to continue to look at ideas and
possible solutions.
But with a budget deficit that many analysts predict will
swell to over $10 billion - finding money for many of the suggestions and
recommendations to help services and programs - including increasing worker
wages, will not be an easy task - a point of view echoed by virtually every
member of the committee who was present.
Most analysts agree that a huge budget deficit next year
could mean budget proposals that will reduce, freeze or cut spending on many
programs and services, including those that impact people with disabilities,
mental health needs and seniors.
Worker Health Care Costs Highlighted -
Beall Says AB 12 Pilot Might Help Provide Possible Solutions
The health care issue, which has been raised publicly as
a top priority by Governor Arnold Schwarzenegger, Assembly Speaker Fabian
Nunez (Democrat - Los Angeles), Senate President Pro Tem Don Perata
(Democrat - Oakland), and also by Sen. Sheila Kuehl (Democrat - Santa
Monica), while not the main focus of the informational hearing, was raised
by at least one community-based provider as a critical issue in keeping
their doors open - and to hire and retain good workers. Training
Toward Self Reliance (TTSR), said that their health care insurance coverage
costs continues to soar, draining tens of thousands of dollars more each
year, - increasing 12% since last year, while state funding to pay for
providing services to adults with developmental disabilities to live
independently remain frozen. Nancy Chance, executive director of TTSR,
said her health care costs for her 45 employees grew from $76,000 in 1999 to
$197,000 this year, while cost containment measures imposed by the State
continues to freeze funding to her agency that serves over 300 persons with
developmental disabilities.
The issue of health care for workers and the rising costs
for community-based organizations to provide it was raised also by the
Autism Commission report.
Assemblymember Jim Beall (Democrat - San Jose), committee
chair said he understood the dramatic impact of health care costs on
community-based agencies and workers with some possible help being addressed
in a pilot program in Santa Clara County in legislation, AB 12 authored by
him, that was recently signed by Governor Schwarzenegger. The funding for
that bill was made possible in part because of a special Medicaid grant.
What AB 12 Pilot Program Does
AB 12 creates the "Adult Health Coverage Expansion Program",
a pilot project administered by the county's health care system, to provide
health care coverage to 5,000 or more low-income adults who reside in
Santa Clara County and who are employed in small Santa Clara County
businesses - including small community-based organizations who provide
supports and services to persons with disabilities. The program can
exceed 5,000 persons if approved by the Department of Managed Health Care
and defines small business as Define "small business" to mean an
entity located in Santa Clara County that employs 50 or fewer persons,
with at least 35% of the employees earning less than 350% of the
federal poverty level for a family size of one, and that has not
offered health care coverage to its employees for the past 12 months,
provided that the provisions of any such prior coverage required the
employer to contribute at least 50% of the total amount of the premium for
that coverage. Include individual franchise outlets within the
definition of a small business.
The county's health care system, called the Santa Clara
Family Health Plan, is a state licensed managed care plan (Knox-Keene
licensed health plan) that currently provides coverage under Medi-Cal,
Healthy Families, Healthy Kids, and Medicare programs.
Beall, who also sits on the Assembly Budget Subcommittee
on Health and Human Services that reviews developmental services, Medi-Cal,
In-Home Supportive Services, SSI/SSP (Supplemental Security Income/State
Supplemental Payment) and other programs that impact people with
disabilities, mental health needs and seniors, said that the Santa
Clara County pilot program goal is to improve the health
status of low-wage workers, including those employed by community-based
organizations serving persons with disabilities, by providing participants
with coverage and access to comprehensive, primary, and preventive
health care through the county's existing health care system.
Beall, who has an adult step-son with developmental
disabilities and is a former Santa Clara County Supervisor, said that his
bill shares responsibility for funding the health care coverage -
called a "three-share" model, in
which portions are contributed by the employer, employee and by
the county, which will use funds from a special Medicaid demonstration grant
awarded recently to the county by the Department of Health Care Services. In
April 2007, Santa Clara County was selected by the Department of Health Care
Services to receive $20,700,000 yearly for three years beginning September
2007 in federal funding under the Health Care Coverage Initiative to
implement expanded coverage for adults in Santa Clara County.
Other Worker Issues Main Focus of Hearing
Other major issues impacting hiring and retention of
thousands of workers - sometimes referred to as direct care workers -
included outlining the problems, the need for training and examples of
training programs and the impact of low wages.
Tens of thousands of persons work in various
programs and services for persons with developmental disabilities
including those in supported living services, independent living services,
supported employment, work activity programs, day programs, respite
programs, recreational and social programs, residential services, certain
types of health facilities and other programs. These workers and
programs are in addition to other services and programs for persons with
disabilities - that also serve children and adults with developmental
disabilities, including In-Home Supportive Services and special education.
Three panels were devoted to covering different aspects
of direct care worker issues - though many of those issues were previously
in legislative budget hearings and in policy committees on bills impacting
workers, including most recently, AB 1427 by Assemblymember Paul Krekorian
(Democrat - Burbank).
The Autism Commission report also underscored the need
for increased worker wages and training.
One panel highlighted the impact of low worker wages and
training on person centered planning, with updates by regional centers, a
provider representative and an update from University of California,
Berkeley, Center for Labor Research and Education.
Another panel focused on training, including a
report on a program at Taft Community College near Bakersfield serving
people with developmental disabilities on independent living, and also one
focused on training for direct support staff, who can earn an Associate of
Arts degree upon completion. A report on how community colleges
provide a career ladder for direct care workers and an update on the College
of Direct Support (implemented by Arc California) was also given as a part
of this panel.
The subject of low wages and benefits for persons
who work to provide services and supports to children and adults with
disabilities in general and specifically persons with developmental
disabilities, has been an on-going issue for decades now, and was the
focus of a October 1999 California State Auditor's Report that said
"any additional funding should be earmarked specifically for increasing
compensation for qualified direct care staff and reducing the caseloads for
regional center case managers".
See separate CDCAN Report for more details and coverage
on the worker issues covered in the hearing.
LEGISLATIVE AUTISM COMMISSION PRESENTS REPORT
Sen. Darrell Steinberg (Democrat - Sacramento), chair of
the California Legislative Blue Ribbon Commission on Autism,
Dr. Lou Vismara, senior staffer to Senate President Pro Tem Don Perata
(Democrat -Oakland) who also provides staff support to the commission (along
with executive director Sue North) and commission member Rick Rollens, a
parent of a child with autism, presented the Commission's findings and
recommendations at the Assembly Human Services Committee informational
hearing. For a copy of the full report and executive summary, go to
the CDCAN website at www.cdcan.us
Commission Created By Senator Perata's
Legislation in 2005
The commission was created by SCR 51 by Senate
President Pro Tem Don Perata in 2005, to identify the gaps in
programs, services, and funding for autism
spectrum disorders and to develop recommendations to close
those gaps, to the State Legislature and Governor Arnold
Schwarzenegger to address these gaps. New legislation this
year (SCR 55), also by Sen. Perata, was passed that extended the work of the
commission (originally set to end November 30, 2007) to November 30,
2008.
All through 2006 and this past year, the Autism
Commission, composed of appointees of the Senate and Assembly, including
many parents and advocates, held a series of hearings and meetings at the
State Capitol and in several locations across the state.
The commission intends to work to introduce legislation
to implement many of the recommendations they have made, and also urge the
Governor and Legislature to make the issues connected to autism spectrum
disorders a "high priority" and a coordinated approach to
addressing and solving the problems.
Commission Says Several Issues Need Further Work
The Commission said it was not able, given the time-frame and resources,
to identify and make recommendations on many other issues impacting
persons with autism spectrum disorders and their families, but said that
further work and analysis was needed to find solutions to these
following problems not addressed in the commission's recommendations:
* There is an insufficient number of
developmental pediatricians, speech and language
therapists, behavioral therapists, occupational and
physical therapists, psychiatrists, psychologists,
neurologists, and other health care providers to provide services
to individuals with autism spectrum disorders.
* Low-income Californians who receive health
and mental health care services through
the Medi-Cal program experience serious
problems locating primary care and other
health care providers with autism spectrum disorder
expertise.
* A diagnosis of autism does not entitle
children and youth who are full-scope Medi-Cal eligible and under age 21
to receive specialty mental health services
through county mental health plans under
the Early and Periodic Screening, Diagnostic,
and Treatment (EPSDT) benefit.
* There is a need for long term quality assurance and monitoring of the efficacy, or alternatively any specific
risks, of the interventions and treatments provided
to individuals with autism spectrum disorders.
* The needs of older adults with
autism spectrum disorders must be addressed in a
comprehensive way as the population, their
parents, and other caregivers for this
population age.
* There isa far-reaching problem of inadequate compensation and other
incentives for service providers across systems of care to serve
persons with autism spectrum disorders and other special needs.
Findings of the Autism Commission
1. There is a significant number of children with autism
spectrum disorders who have not been screened, assessed,
or referred to early intervention services in an appropriate
and timely manner. These delays are longer and occur
with more frequency in underserved populations and communities.
2. In many communities, public awareness, education, and outreach efforts on
autism spectrum disorder programs and services must be
intensified and expanded.
3. Many existing systems of care are very
complex, and a significant number of families confront
major barriers in accessing and navigating
programs and services. Transitions across
systems and programs are especially difficult
for children with autism spectrum disorders at age three.
In addition, families report problems accessing services
through their health insurance coverage.
4. There are many autism spectrum disorder programs and services that
require greater coordination and integration to
comprehensively and effectively serve individuals with autism
spectrum disorders throughout their life span.
5. Many programs for persons with autism spectrum disorders are often categorical in nature
with eligibility criteria and the types of services
offered that may vary across the state.
6. Many such programs and services could be improved by
the availability of additional resources, infrastructure, and supports to
meet the needs of all individuals with autism spectrum
disorders and their families.
7. Many programs and services would benefit from the availability of additional
professional and paraprofessional development and
training.
8. Some programs serving persons with autism spectrum disorders that
involve the public and private sectors
require clarification about the roles and
responsibilities of each group that provides
services.
9. In many regions of the state, some
programs, services, and persons who are involved with and respond to specific emergencies, such
as medical and public safety responders, require additional information and training on autism
spectrum disorders.
10. Many programs that provide services to individuals with
autism spectrum disorders and their families could benefit from additional
resources and assistance to promote effective strategic planning, communication, and collaboration between service agencies
and consumers and their families, and
thereby also avoid contentious disputes.
11. Some highly effective programs and services for persons
with autism spectrum disorders should be identified, analyzed, evaluated,
and replicated throughout the state.
12. Throughout the state, there is an intense need to plan for and address the
impending housing, transportation, employment, and
educational needs of the huge number of young people with
autism spectrum disorders who will soon transition
into community settings.
Recommendations of the Autism Commission
The recommendations made by the Commission are linked to the
three key areas identified in Senate
Concurrent Resolution 51:
1. Early identification of autism spectrum disorders
2. Education and treatment of children,
adolescents, transitional youth, and adults
with autism spectrum disorders
3. A comprehensive and integrated continuum
of programs, services, and funding required
to address the "aging out" of
children who comprise the current autism
epidemic.
EARLY IDENTIFICATION AND INTERVENTION
* Establish a demonstration project at multiple sites that will serve as a
template to expand early identification programs.
* The demonstration project should focus on distressed communities; ensure
the timely diagnosis of and intervention for
children with autism spectrum disorders; improve collaboration
among providers; provide support to families and caregivers; establish a seamless
system for service delivery between regional
centers and local education agencies; and promote smooth transitions across programs
for children from birth to kindergarten.
HEALTH INSURANCE COVERAGE
* Enact legislation, regulations, and other policies to ensure
appropriate and equitable coverage for autism
spectrum disorders by private health plans and
insurers.
THE AUTISM SPECTRUM DISORDER PUBLIC HEALTH CRISIS
* Implement a statewide public awareness
campaign on autism spectrum disorders linked to innovative efforts by the
Department of Public Health to improve access to
and navigation of programs and services.
EDUCATION OF CHILDREN WITH AUTISM SPECTRUM DISORDERS
* Address the need to increase the number of teachers, paraprofessionals,
and other school-based personnel trained in
education of children with autism spectrum disorders.
RESOLUTION OF SERVICE DISPUTES
* Empower families and local education agencies to collaborate in establishing appropriate and effective individualized education programs
for children with autism spectrum disorders.
* Have the state of California conduct a comprehensive and independent review of the process for
resolving service disputes and identify and promote effective dispute resolution
models.
NEEDS OF YOUTH AND ADULTS WITH AUTISM
SPECTRUM DISORDERS
* Expand postsecondary educational opportunities and establish
new and effective career technical education
models, including intensive support.
* Expand innovative community-based approaches to supported employment,
transportation, social-recreational programs, and
housing.
AWARENESS OF AUTISM SPECTRUM DISORDERS IN EMERGENCY SITUATIONS
* Provide training and information on autism spectrum
disorders to peace officers, first responders, allied judicial public agencies, and
emergency response systems.
Please: Contributions
Urgently Needed!
Advocacy Without
Borders
Advocacy
Without Borders: Connecting People With Disabilities, Mental
Health Needs, Seniors, Traumatic Brain & other injuries,
People with MS & other health needs, including People of
color, different languages, cultures, Families,
Workers, Providers, & Organizations to Rights &
Unified Action. This report - and the CDCAN townhalls, and
other events and projects are for all of them and for
promoting advocacy without borders toward unified action.
We are one community.
To
respond to this report reply to: Marty Omoto at martyomoto@rcip.com
CDCAN website: www.cdcan.us
To
continue the CDCAN website, the CDCAN News Reports.
sent out and read by over 45,000 people and organizations,
policy makers and media across California and to continue
the CDCAN "Advocacy Without Borders Townhall
Telemeetings" which since December 2003 have connected
thousands of people with disabilities, seniors, mental
health needs, people with MS and other disorders, people
with traumatic brain and other injuries to public policy
makers, legislators, and issues. Please send your
contribution/donation (make payable to "CDCAN" or
"California Disability Community Action Network):
CDCAN
1225 8th Street Suite 480
Sacramento, CA 95814
or go to the CDCAN website at and click on
"DONATE TO CDCAN" to contribute using credit card
via Paypal.
The CDCAN Townhall Telemeetings are partially funded by a
small grant from the USC UCEDD, Grant #90DD0540 from the
Administration on Developmental Disabilities. (note: the
opinions expressed or content in these reports do not
necessarily reflect the views or opinions of the USC UCEDD.
THANK
YOU AGAIN - STEP!
MANY THANKS to Manteca CAPS, Training Toward Self Reliance,
UCP, California NAELA, Californians for Disability Rights,
Inc (CDR) including CDR chapters, CHANCE Inc, Parents
Helping Parents, Arriba, Strategies To Empower People,
Parents Helping Parents, Asian American parents groups,
Resources for Independent Living and many other Independent
Living Centers, several regional centers, People First
chapters, IHSS workers, other self advocacy and family
support groups, developmental center families,