The 2023-24 Budget: Department of Developmental Services

2023-24 BUDGET The 2023-24 Budget: Department of Developmental Services GABRIEL PETEK | LEGISLATIVE ANALYST | FEBRUARY 2023 SUMMARY The Department of Developmental Services (DDS) coordinates a wide variety of services for about 400,000 Californians with intellectual or developmental disabilities or similar conditions. In this brief, we provide some basic background on DDS before describing and assessing the Governor’s 2023-24 budget proposals for the department. Relative to other recent budgets, the Governor’s proposal contains relatively fewer major new initiatives and we do not find major issues with these or with the administration’s underlying caseload assumptions. Recognizing that the state has in recent years undertaken a wide variety of policy initiatives related to DDS, we dedicate the majority of this brief to ongoing oversight and implementation issues. In particular, we provide background and issues for legislative consideration on the following six issues: (1) implementing service provider rate reform, (2) addressing racial/ethnic and other disparities in the per-person amounts spent on services, (3) complying with the federal Home- and Community-Based Services (HCBS) final rule, (4) complying with required service coordinator caseload ratios, (5) encouraging employment opportunities for DDS consumers, and (6) rolling out the Self-Determination Program (SDP). BACKGROUND Lanterman Act Lays Foundation for California Early Intervention Services Act “Statutory Entitlement.” California’s Lanterman Ensures Services for Eligible Infants and Developmental Disabilities Services Act (Lanterman Toddlers. DDS also provides services via its Early Act) originally was passed in 1969 and substantially Start program to any infant or toddler under the age revised in 1977. It amounts to a statutory entitlement of three with a qualifying developmental delay or to services and supports for individuals ages three who are at risk of developmental disability. There and older who have a qualifying developmental are no income-related eligibility criteria. As of disability. Qualifying disabilities include autism, December 2022, DDS serves about 50,000 infants epilepsy, cerebral palsy, intellectual disabilities, and toddlers in the Early Start program. and other conditions closely related to intellectual Regional Centers (RCs) Coordinate and Pay disabilities that require similar treatment, such as for Individuals’ Services. DDS contracts with traumatic brain injuries. To qualify, an individual 21 nonprofit RCs, which coordinate and pay for the must have a disability that is substantial, expected direct services provided to “consumers” (the term to continue indefinitely, and which began before the used in statute). Services are delivered by a large age of 18. There are no income-related eligibility network of private for-profit and nonprofit providers. criteria. As of December 2022, DDS serves about In addition to state General Fund and some smaller 330,000 Lanterman-eligible individuals and another funding sources, these services are purchased in 2,900 children ages three and four who are part through federal funding obtained through the provisionally eligible. Medicaid HCBS waiver, described below. www.lao.ca.gov 1 2023-24 BUDGET Governor’s Budget down throughout 2023, before being phased out completely by January 2024. We estimate this Proposed Budget Reflects Significant change will increase General Fund costs by about Growth. The Governor’s budget proposal $20 million in 2022-23 and decrease them by about includes $13.6 billion total funds in 2023-24, up $60 million in 2023-24 relative to the Governor’s $1.6 billion (13 percent) over the revised 2022-23 budget.) The administration’s caseload projection is level ($12.1 billion). Of the proposed 2023-24 consistent both with our office’s projection and with total, $8.2 billion is from the General Fund, up longstanding trends. $1.4 billion (21 percent) over the revised 2022-23 level ($6.7 billion General Fund). This significant Includes Relatively Few Proposals for New year-over-year growth in DDS spending follows Spending. Relative to recent years, the proposed the spending growth trend over the past ten budget contains fewer major initiatives. Among the years, as shown in Figure 1. Primary drivers of the most notable proposals for new spending are: year-over-year General Fund growth include: growth • Enhancing the Safety Net for Consumers in caseload, increased utilization of services, With Relatively Severe Needs. The budget additional costs for ramping up 2022-23 initiatives, contains several related proposals—including and the expiration of a temporary 6.2 percentage $15.9 million ($9.8 General Fund) one time point increase in federal Medicaid funding. (The to convert some care facilities to a higher proposed budget assumes this temporary increase, level of intensity and $1.6 million ($1.1 million which was initially tied to the federal public health General Fund) ongoing to better support emergency declaration, ends June 30, resulting foster children in DDS—intended to enhance in General Fund costs beginning at the start of the state’s service options for consumers 2023-24. However, based on recent federal actions, with relatively severe needs. These proposals we now expect this increase to gradually wind are consistent with a broader effort to serve Figure 1 Department of Developmental Services Spending Continues to Grow Rapidly (In Billions) $16 14 Federal and Other Fundsª 12 General Fund 10 8 6 4 2 2013-14 2014-15 2015-16 2016-17 2017-18 2018-19 2019-20 2020-21 2021-22 2022-23 2023-24 a The bulk is federal Medicaid funding, with minor other federal and state special funds. Note: 2022-23 amounts are estimated and 2023-24 amounts are proposed. 2 LEGISLATIVE ANALYST’S OFFICE 2023-24 BUDGET these individuals in more integrated settings preschool programs to include more children following the closure of most of the state’s with exceptional needs. The Governor proposes Developmental Centers (DCs). delaying the implementation of this two-year • Establishing an Autism Services Branch program until 2024-25. In last year’s analysis, Within DDS. The budget provides $1 million we raised several issues with the design of these ($800,000 General Fund) ongoing for six grants—all of these concerns still apply. Given state-level positions focused on autism. the Governor’s budget projects multiyear deficits This proposal is intended to help the state (in addition to the current budget problem), the better track current science so as to better Legislature may wish to consider eliminating serve its most rapidly growing subpopulation this program. of DDS consumers. Proposals Generally Reasonable. Aside from our ongoing reservations about the preschool Proposes Delaying Preschool Inclusion inclusion grant program (noted above), we do not Grants by Two Years as a Budget Solution. have any serious concerns or questions about the The 2022-23 budget package included $20 million Governor’s proposals at this time. General Fund over two years for grants to enable DDS OVERSIGHT ISSUES In recent years, the DDS system has undergone The 2021-22 budget initiated a five-year plan to some significant changes that warrant continued phase in that study’s rate models. The 2022-23 legislative oversight. Below, we highlight six areas budget accelerated this phase-in to become a of particular interest for the Legislature: four-year plan. The Governor’s budget proposal (1) implementing service provider rate reform, maintains the accelerated time line, including (2) addressing racial/ethnic and other disparities $1.2 billion total funds ($230 million General Fund) in the per-person amounts spent on services, in 2023-24 for further implementation of the rate (3) complying with the federal HCBS final rule, study. Full implementation of the new rate system is (4) complying with required service coordinator expected by July 1, 2024. caseload ratios, (5) encouraging employment Once Fully Implemented, Rate Reform opportunities for DDS consumers, and (6) rolling Must Include New Quality Incentive Structure. out SDP. For each, we provide some general Following full implementation of the new rate background and updates on the implementation of system, statute requires that 10 percent of each recent policy or spending initiatives. We also raise service provider rate be reserved for a “quality issues for legislative consideration. incentive payment.” These payments are to be tied to performance metrics specific to each IMPLEMENTING SERVICE category of provider. These metrics and associated PROVIDER RATE REFORM standards are to be determined by a workgroup of stakeholders led by DDS. (Prior to the full Background implementation of the quality incentive payment State Recently Began Implementing a as 10 percent of the total rate, the state began Major Overhaul of Service Provider Rates. providing some smaller quality incentive payments For decades, the state paid DDS service on top of providers’ typical rates in 2022-23.) providers according to an outdated and overly Issues complicated rate structure. In an attempt to State Still Faces Major Questions About modernize and rationalize this structure, the Quality Incentive Structure. Developing the state commissioned a study of service provider incentive structure poses significant challenges. costs. This study was published in January 2020. www.lao.ca.gov 3 2023-24 BUDGET These include determining appropriate measures ADDRESSING SPENDING for each provider category and developing a DISPARITIES reasonable plan for collecting relevant data. Although the administration has voiced confidence in the Background workgroup’s ability to meet the time line to develop Longstanding Interest in Disparities in the incentive structure, we have heard concerns from the Amount of Spending on Services Among stakeholders that meeting the time line (which has Racial/Ethnic Groups. Starting in 2011-12, state been accelerated by one year relative to the initial law requires all RCs to annually publish data on rate study implementation plan) will prove difficult. the amount spent on services for consumers In particular, we have heard concerns that providers disaggregated by the race/ethnicity of these will have insufficient time to familiarize themselves consumers. These data consistently have shown with new outcome measurements and performance large disparities in the average amounts spent among standards before being subject to potential these groups. In particular, spending for downward adjustments in their rates received. Hispanic/Latino consumers is about half that for In addition, many service providers have white consumers on average. expressed concerns about the size of the proposed State Provides Ongoing Grants to Address incentive payments. In some cases, the 10 percent Spending Disparities. The state has allocated reserved for incentive payments would exceed $11 million annually since 2016-17 ($77 million to the difference between old and new provider date) for “equity grants” to help close disparities in rates, meaning providers who do not meet quality spending. As part of the 2021-22 spending plan, the standards may see their rates adjusted to below state also required DDS to contract with a research the level they saw pre-reform. As providers do entity to evaluate the effectiveness of these grants. not yet know the standards they will be asked to The state recently contracted with a team from meet, the risk of an overall downward adjustment Georgetown University to develop that study. in rates causes considerable concern. Given these challenges, the Legislature may wish to reconsider Issues the time line or structure of the quality incentive In Spite of Funding for Equity Grants, program to provide the workgroup additional Racial/Ethnic Spending Disparities Persist. time to review all potential options and providers Unfortunately, the available data suggest relatively additional time to familiarize themselves with new little movement in terms of reducing spending measurements and standards. (We raised significant disparities since equity grants were first introduced. concerns about the quality incentive program in a In fact, Figure 2 shows the disparity in average previous analysis, and this analysis could help inform spending per Hispanic/Latino consumer as a share some current policy discussions.) of the average spending per white consumer has Additional Questions About Underlying Rate actually widened since 2015-16. Models. In addition to concerns about the quality incentive program being developed, we have heard Figure 2 several concerns about the underlying rate models. For example, we have heard that the inputs used Some Spending Disparities in some rate models may be inappropriate. This is Have Increased in Recent Years most evident in the rate for Independent Living Average Spending on Hispanic/Latino Consumers Services, which assumes staffing costs equivalent to As a Share of Spending on White Consumers Supported Living Services despite the former being a much more intensive service model. In addition, 60% 60% 59% we have heard concerns about the lack of ongoing 57% 57% 57% 56% inflation adjustments. In a recent report, we provide a framework for the Legislature to weigh such 15-16 16-17 17-18 18-19 19-20 20-21 21-22 inflation-related concerns against the state’s broader fiscal interests. 4 LEGISLATIVE ANALYST’S OFFICE 2023-24 BUDGET State Lacks Insight Into Drivers of These Service Provider Compliance With New Disparities in Spending. One potential reason Federal Rule Required to Draw Down Federal the ongoing equity grants have not yet addressed Medicaid Funding. The federal Centers for spending disparities is that they are not guided Medicare and Medicaid Services approved a new by a clear understanding of why such disparities rule in 2014 that requires states to ensure that exist. Although the administration has pointed to any Medicaid-funded HCBS services promote some factors which explain a share of the overall person-centered planning, individual choice, disparities (most notably, that Latino/Hispanic and increased independence and are provided consumers are more likely than white consumers in the most integrated setting possible. The rule, to live with their parents and thus consume fewer originally set to take effect in 2019, has been residential services), to date, no attempt has been pushed back twice, with the first key date set made to document comprehensively the drivers for March 17, 2023, when all service providers of disparities and to quantify their likely effects. must have adopted policies consistent with the The Legislature may wish to consider its options final rule. for developing such a study, which could be used State Provides Grants to Assist Providers as the basis for a more coordinated effort to in Reaching Compliance. Chapter 3 of 2016 address disparities. (AB X2 1, Thurmond.) provided DDS $11 million General Fund annually to support grants for COMPLIANCE WITH HCBS service providers to modify their programs and FINAL RULE services to make them compliant with the final HCBS rule. Background Issues Nearly All Types of RC-Coordinated HCBS Many Providers Still Are Not in Compliance Services Are Eligible for Federal Funding. HCBS With HCBS Final Rule Set to Take Effect services are considered services and supports in March. Figure 3 shows the share of that allow an individual to live in community-based providers (broken out by service category) settings, rather than in institutional settings. who have compliant policies set in place as of They include residential services, independent December 29, 2022. (The figure also shows that and supported living services, day programs, almost all service providers required by DDS to transportation, supported employment, and respite. have an assessment of their level of compliance Nearly all types of RC-coordinated services are with the federal HCBS requirements have considered HCBS and are eligible to receive federal done so.) Although a large number of providers HCBS funding (when provided to a consumer remain out of compliance, DDS indicates that they enrolled in Medi-Cal, the state’s Medicaid program). Figure 3 Many Services Providers Not Yet in Full Compliance With Home- and Community-Based Services Final Rule As of December 29, 2022 Completed Assessment? Have Compliant Policies? Identified for Completed Not At All or Service Type Assessment Assessment (%) Yes (%) Some (%) Residential 5,006 96% 47% 53% Day Service 1,907 98 58 42 Supported Employment 134 99 70 30 Work Activity Program 40 100 70 30 Overall 7,087 97% 50% 50% www.lao.ca.gov 5 2023-24 BUDGET are providing outreach and technical assistance to Issues these providers and are seeing compliance rates All RCs Still Working to Meet New Caseload consistently improve. (The department indicates Ratios for Young Children. Figure 4 shows the they will have updated compliance data to share average caseload ratios for young children at in the coming weeks.) A recent communication each of the RCs. As of October 2022, no RC was from DDS to RCs stated that noncompliant meeting the new 1:40 standard, suggesting all likely providers could no longer receive new referrals as will have to hire additional service coordinators to of March 17, providing an additional incentive for reach compliance. providers to develop new policies. Current HCBS Caseload Ratios Risk Loss of Federal Funding. The state’s funding agreement COMPLIANCE WITH with the federal government caps caseloads for CASELOAD RATIOS consumers on the HCBS waiver at 62 per service coordinator, but Figure 5 shows that no RC was in Background compliance with this ratio as of October 2022. This Statute Stipulates Caseload Size for RCs’ is not an anomaly—HCBS caseload ratios have Service Coordinators. Statute sets the following been out of compliance for multiple years. Although average service coordinator-to-consumer ratios the federal government has not taken any action for RCs: against California as of yet, history suggests these out-of-compliance ratios put federal funding at risk. • 1:62 for consumers enrolled in Medicaid HCBS waiver programs. • 1:40 for children five years of Figure 4 age or younger. All Regional Centers Exceed • 1:25 for consumers who have New Required Ratio for Young Children (0-5) complex needs. Average Number of Consumers Served by a • 1:66 for all others. Single Service Coordinator, October 2022 The state also still requires Required Ratio 40 specific caseload ratios for South Central Los Angeles 91 consumers who recently East Bay 87 transitioned out of a DC, but Westside 77 these ratios were largely rendered Inland 75 San Diego 72 obsolete when the state closed Harbor 71 its last large DC in January 2020. San Gabriel 70 In addition, the 2021-22 budget San Andreas 69 included $10 million ongoing Orange County 68 Tri-Counties 67 to implement service Kern 67 coordinator-to-consumer ratios North Los Angeles 66 of 1:40 for consumers who have a East Los Angeles 66 Alta California 65 low level or no services purchased Redwood Coast 65 by RCs (on the basis that these Golden Gate 64 consumers may be underserved). Central Valley 64 Far Northern 62 However, this caseload ratio was Lanterman 60 not stipulated in statute. Valley Mountain 57 North Bay 53 Note: Caseload ratios are defined as the number of consumers served by a single service coordinator. Statute requires a 1:40 ratio for young children (ages 0-5). 6 LEGISLATIVE ANALYST’S OFFICE 2023-24 BUDGET Figure 5 For example, in 1997, the federal government found that RCs had All Regional Centers Are Out of Compliance with numerous quality problems. Required Federal Medicaid HCBS Waiver Caseload Ratios In response, the federal Average Number of Consumers government froze enrollment in Served by a Single Service Coordinator, October 2022 the HCBS waiver program until RCs implemented agreed-upon Required Ratio 62 changes, which meant the state Golden Gate 98 could not access federal matching South Central 91 funds for services provided to East Bay 90 North Los Angeles 89 consumers who otherwise would Westside 85 have been new waiver enrollees. Alta 85 When the freeze was fully lifted Orange 84 Lanterman 83 several years later, DDS estimated San Andreas 82 the state had foregone nearly Tri Counties 81 $1 billion in federal funding. At that Kern 79 San Diego 79 time, the federal government Valley Mountain 79 and California agreed to limit the Inland 77 size of caseloads as one way to Harbor 77 Redwood Coast 76 avoid compromising the quality of East Los Angeles 73 RC services. North Bay 73 State Has Not Made Progress San Gabriel 71 Central Valley 70 in Reaching Required Caseload Far Northern 65 Ratios in Recent Years. Figure 6 shows the number of people Note: Caseload ratios are defined as the number of consumers served by a single service coordinator. above the required statutory Statute HCBS requires a 1:62 ratio for consumers enrolled in the Medicaid Waiver. ratios for three service categories HCBS = Home and Community-Based Services. between 2017 and 2022 (these categories were selected because they maintained a consistent Figure 6 definition and required ratio over State Is Drifting Further Out of Compliance that time period). Of these three With Some Required Caseload Ratios categories, the state was closest to reaching compliance for Early Start, but the previously required ratio of 1:62 for this population was superseded in late 2022 by HCBS Waiver the new 1:40 required ratio for any consumer under the age of six. Increasingly Out-of-Compliance Caseload Ratios Suggest Case for Revisiting Core Staffing Formula. The state allocates funding for RC operations primarily through the core staffing formula, the inputs for which largely have not been updated since 2017 2018 2020 2021 2022 HCBS = Home and Community-Based Services. www.lao.ca.gov 7 Out of Compliance 20 People and Over 15 People and Over 10 People and Over 5 People Over Required Ratio 5 People Under Requirement Meets Difference Between Statewide Average Consumers Served By Single Service Coordinator and Required Ratio All Others Early Start 2019 2023-24 BUDGET the 1990s. Regardless of their funding level, ENCOURAGING EMPLOYMENT RCs must offer a competitive salary to attract OPPORTUNITIES FOR DDS service coordinator candidates. Consequently, CONSUMERS the difference between the amount the state allocates for service coordinators and the amount Background RCs actually pay has grown over the past several Relatively Few DDS Consumers Are decades. In part, RCs have made ends meet by Employed. According to Employment redirecting funds awarded to them from obsolete Development Department data presented on portions of the core staffing formula (mostly those DDS’s RC Oversight Dashboard, the employment related to specific secretarial work that, in the rate for people with developmental disabilities in age of computers, no longer requires full-time California increased somewhat from 17 percent staff). The state also has responded to caseload in 2016-17 to about 20 percent in 2020 (the challenges by providing targeted supplements, most recent year for which we have data). To the such as using a higher service coordinator salary extent national data are available, they also show assumption for the recent move towards smaller relatively low levels of employment, although caseloads for young children. However, in spite of perhaps at somewhat higher levels than California. these funding augmentations, rising salary costs For example, a widely cited 2013 survey estimated alongside the consistent growth in the population the national employment rate for individuals with served have resulted in gradually increasing intellectual disabilities at 34 percent (including average caseloads for service coordinators, as 18 percent who were employed in a competitive Figure 7 illustrates. Given the challenges related integrated environment [defined below] and to the current formula for staffing, the Legislature 13 percent who were employed in a sheltered may wish to consider other options for addressing work program; the remainder were largely this problem. self-employed). California Is an “Employment First” Figure 7 State. State and federal policy have shifted Overall Service Coordinator in recent years toward promoting competitive Caseloads Have Increased integrated employment (CIE) for individuals with developmental disabilities. (In this context, Statewide Average Consumers Per Single Service Coordinator, All Categories “competitive” means market rate wages.) Chapter 667 of 2013 (AB 1041, Chesbro) created 78.17 California’s employment first policy, which makes 76.46 CIE the highest priority for working age consumers, 75.70 regardless of the severity of their disability. In 73.03 72.77 73.34 2014, Congress passed the Workforce Innovation and Opportunities Act, which promotes CIE and increases training and supports (particularly for those age 24 and younger), and generally prohibits 2017 2018 2019 2020 2021 2022 employers from paying less than minimum wage to employees with developmental disabilities. Chapter 339 of 2021 (SB 639, Durazo) Phases Out Subminimum Wage. Currently, about 3,800 consumers who are working earn less than minimum wage. About 3,600 of these consumers are served in work activity programs (WAPs), where they earn a wage based on their specific level of productivity. Paying subminimum wage to an individual with a disability requires 8 LEGISLATIVE ANALYST’S OFFICE 2023-24 BUDGET a federal certificate issued under the Fair Labor This is because trailer bill language passed as Standards Act. Chapter 339 phases out the use of part of the 2021-22 budget package doubled the these certificates in California by January 1, 2025 amounts given per CIE incentive. (or when the required multiyear phaseout plan led …These Programs Still Benefit Relatively by the State Council on Developmental Disabilities Few Consumers. Although 2021-22 represents an specifies, whichever is later). all-time high in the amount of funding utilized for State Has Funded Various Programs to CIE and paid internships, this funding still served Encourage Employment. Chapter 3 provided just about 3,000 individuals—a few hundred less DDS $20 million General Fund ongoing to than were served by these programs before the support (1) incentive payments for supported COVID-19 pandemic. Unless the state finds a way employment providers and (2) consumers’ paid to reach additional consumers with these existing internships in CIE environments. The 2021-22 programs, it is unlikely to significantly improve budget provided $10 million one-time General the employment rate for DDS consumers. This is Fund to DDS to support grants to organizations particularly true given the impending closure developing innovative strategies to increase of WAPs. CIE among consumers. The 2022-23 budget included $8.3 million ($5 million General Fund) one ROLL OUT OF SDP time to establish a pilot program for expanding employment opportunities for DDS consumers, Background particularly those affected by the phaseout of the SDP Offers an Alternative to Traditional subminimum wage. Service Coordination. Chapter 683 of 2013 (SB 468, Emmerson) created SDP to provide Issues consumers greater control over which services While State Recently Spent a Larger Share they will receive and from whom. Participants are of Employment Funding... Figure 8 tracks the provided a fixed amount of resources (based on share of funding made available for CIE incentives that participant’s purchase of service expenditures and paid internships which has been actually over the prior 12 months) with which to purchase utilized each year since 2016-17. Notably, 2021-22 the services of their choosing. marked the first year in which over half of the State Has Made Numerous Recent appropriated money was spent for these programs. Investments to Support SDP. The 2020-21 spending plan included $4.4 million total funds ($3.1 million Figure 8 General Fund) ongoing to Much of the Funding to Promote Competitive support administration of SDP. Integrated Employment and Paid Internships Goes Unused In addition, the 2022-23 spending plan provided $7.2 million total Share of Available Funding Spent Number of Consumer Participants funds ($4.4 million General Fund) 3,402 ongoing to cover the costs of 3,248 3,049 Financial Management Service 60% providers for SDP participants. 2,073 1,972 Financial Management Services 43% 45% are outside firms that help consumers manage their budgets 691 24% 25% and purchase services. Under prior law, participants were 62% required to pay for these costs 2016-17 2017-18 2018-19 2019-20 2020-21 2021-22 from their fixed funding amount. www.lao.ca.gov 9 2023-24 BUDGET Issues Racial/Ethnic Disparities Apparent in SDP Rollout. Enrollment in SDP does not SDP Rollout Continues to Lag. reflect the racial/ethnic composition of the DDS Chapter 683 created a phase-in period for SDP, consumer population. Figure 10 shows that limiting enrollment during the first three years to white consumers comprise a plurality of SDP 2,500 individuals. During these first three years participants (45 percent), despite making up only (July 2018 through June 2021), DDS and RCs 30 percent of all DDS consumers. By comparison, enrolled just 625 participants, with two RCs Latino consumers comprise only 23 percent enrolling fewer than ten people. Per Chapter 683, of SDP participants, but 40 percent of all DDS the program was made available to all interested consumers. These disparities may speak to consumers as of July 2021. As Figure 9 shows, specific challenges in promoting the SDP to some enrollment has grown steadily since the program communities. As with disparities in spending, was opened to all, but has not quite reached the better understanding the drivers of disparities in initial 2,500-person cap. SDP enrollment could help the state develop a coordinated plan for ensuring greater take-up of Figure 9 this program across all consumers. SDP Enrollment Still Below Initial Cap Figure 10 3,000 SDP Enrollment Initial Cap 2,500 Disproportionate by Race/Ethnicity 2,000 50% 1,500 45 40 1,000 35 Share of Total RC Population 30 Share or SDP Participants Enrollment 500 25 20 15 10 December 2021 2022 2020 5 SDP = Self-Determination Program. Hispanic/Latino White Asian Black/African Other American RC = Regional Centers and SDP = Self-Determination Program. 10 LEGISLATIVE ANALYST’S OFFICE 2023-24 BUDGET www.lao.ca.gov 11 2023-24 BUDGET LAO PUBLICATIONS This report was prepared by Ryan Anderson, and reviewed by Mark C. Newton and Carolyn Chu. The Legislative Analyst’s Office (LAO) is a nonpartisan office that provides fiscal and policy information and advice to the Legislature. To request publications call (916) 445-4656. This report and others, as well as an e-mail subscription service, are available on the LAO’s website at www.lao.ca.gov. The LAO is located at 925 L Street, Suite 1000, Sacramento, California 95814. 12 LEGISLATIVE ANALYST’S OFFICE