The 2024-25 Budget: Department of Developmental Services

2024-25 BUDGET The 2024-25 Budget: Department of Developmental Services GABRIEL PETEK | LEGISLATIVE ANALYST | FEBRUARY 2024 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 background on DDS before describing and assessing the Governor’s 2024-25 budget proposals for the department. The Governor’s budget proposes a new Master Plan for Developmental Services, as well as budget solutions, including a proposal to delay by one year the implementation of the final phase of service provider rate reform (with the next rate increase occurring July 1, 2025, rather than July 1, 2024). Recognizing that the state has in recent years undertaken a wide variety of policy initiatives related to DDS, we also address ongoing oversight and implementation issues. In particular, we provide background and issues for legislative consideration on the following three issues: (1) funding directed in statute to direct care staff compensation increases, (2) service provider quality incentive payments, and (3) service disparities and the Coordinated Family Support Services pilot. BACKGROUND Lanterman Act Lays Foundation for “Statutory are at risk of developmental disability. There are no Entitlement.” California’s Lanterman Developmental income-related eligibility criteria. As of December Disabilities Services Act (Lanterman Act) originally 2023, DDS serves about 56,000 infants and toddlers was passed in 1969 and substantially revised in 1977. in the Early Start program. It amounts to a statutory entitlement to services and Regional Centers Coordinate and Pay supports for individuals ages three and older who for Individuals’ Services. DDS contracts with have a qualifying developmental disability. Qualifying 21 nonprofit regional centers, which coordinate and disabilities include autism; epilepsy; cerebral palsy; pay for the direct services provided to “consumers” intellectual disabilities; and other conditions closely (the term used in statute). Services are delivered by related to intellectual disabilities that require similar a large network of private for-profit and nonprofit treatment, such as a traumatic brain injury. To qualify, providers. In addition to state General Fund and an individual must have a disability that is substantial, some smaller funding sources, these services are expected to continue indefinitely, and which began purchased in part through federal funding obtained before the age of 18. There are no income-related through the Medicaid Home- and Community-Based eligibility criteria. As of December 2023, DDS serves Services (HCBS) waiver. The HCBS waiver about 360,000 Lanterman-eligible individuals and provides Medicaid funding for eligible individuals another 8,000 children ages zero through four who to receive services and supports in their home and are provisionally eligible. community-based settings, rather than in institutions. California Early Intervention Services Act State Recently Began Implementing a Major Ensures Services for Eligible Infants and Overhaul of Service Provider Rates. For decades, Toddlers. DDS also provides services via its Early the state paid DDS direct care staff (sometimes Start program to any infant or toddler under the age referred to as direct service professionals) according of three with a qualifying developmental delay or who to a rate structure deemed by the Legislature to be www.lao.ca.gov 1 2024-25 BUDGET outdated and overly complicated. In an attempt Once Fully Implemented, Rate Reform to modernize and rationalize this structure, the Must Include New Quality Incentive Structure. Legislature passed legislation to authorize DDS Following full implementation of the new rate to commission a study of service provider costs system, statute requires that 10 percent of each to guide the development of a new rate structure. service provider rate be reserved for a “quality This study—commonly referred to as “the rate incentive payment.” These payments are to be study”—was published in January 2020. The tied to performance metrics specific to each 2021-22 budget initiated a five-year plan to phase category of provider. These metrics and associated in that study’s rate models. The 2022-23 budget standards are to be determined by a workgroup accelerated this phase in to become a four-year of stakeholders led by DDS. (Prior to the full plan, with full implementation of the new rate implementation of the quality incentive payment system scheduled for July 1, 2024. Budget-related as 10 percent of the total rate, the state began legislation to implement the accelerated phase-in providing some smaller quality incentive payments plan requires providers to use a specified on top of providers’ baseline rates in 2022-23.) percentage of rate increases to raise the wages, salaries, or benefits of direct care staff. PROPOSALS OVERVIEW was undertaken, in part, because the historical rate structure did not result in funding levels for service Proposed Budget Reflects Significant providers that kept pace with system growth Growth. The Governor’s budget proposal or supported an adequate supply of providers. includes $15.3 billion total funds in 2024-25, up (A series of rate freezes and rate reductions— $1.6 billion (12 percent) over the revised 2023-24 beginning in the early 2000s as budget solutions— level ($13.7 billion). Of the proposed 2024-25 meant that the rates had not kept up with rising total, $10 billion is from the General Fund, up costs over time.) The funding first allocated in $1.7 billion (21 percent) over the revised 2023-24 2021-22 was intended to raise funding levels for level ($8.2 billion General Fund). This significant service providers by increasing service provider year-over-year growth in overall DDS spending rates. These rates fund the wide variety of services follows the spending growth trend over the past and supports that service providers deliver to ten years, as shown in Figure 1. The average DDS consumers, including residential services, day annual growth rate in total funds over the past ten programs, employment support, independent and years is about 11 percent. Primary drivers of the supported living, and personal assistance. year-over-year General Fund growth include rising Service Provider Rate Reform caseload and increased utilization of services. Implementation Time Line Has Changed in The administration’s caseload projection is Recent Years. The original plan for service provider consistent both with our office’s projection and with rate reform established a five-year implementation longstanding trends. (The relatively higher growth time line starting in 2021-22. Under this plan, the rate in General Fund costs in 2024-25 is due to the final rate adjustment would occur in 2025-26. expiration of pandemic-era federal funds.) The original time line included the following steps: DELAY FULL IMPLEMENTATION OF • Year 1 (2021-22). Service provider rates SERVICE PROVIDER RATE REFORM increase beginning April 1, 2022. Rate increases equal one-quarter of the difference Background between a provider’s current rate and what Rate Reform Intended to Increase Rates for the fully funded rate model (as of 2021-22) Service Providers. The rate study initiated in 2016 would be according to the rate study. 2 LEGISLATIVE ANALYST’S OFFICE 2024-25 BUDGET Figure 1 Department of Developmental Services Spending Continues to Grow Rapidly (In Billions) $18 16 Federal and Other Fundsa 14 General Fund 12 10 8 6 4 2 2014-15 2015-16 2016-17 2017-18 2018-19 2019-20 2020-21 2021-22 2022-23 2023-24 2024-25 a The bulk is federal Medicaid funding, with minor other federal and state special funds. Note: 2023-24 amounts are estimated and 2024-25 amounts are proposed. • Year 2 (2022-23). The previous year’s rate • Year 1 (2021-22) to Year 3 (2023-24). increase is annualized and DDS implements Same as original plan. the first stage of the quality incentive program. • Year 4 (2024-25). Rate models will be fully • Year 3 (2023-24). The cumulative total of funded beginning July 1, 2024 as follows: this rate increase and the previous increase A service provider’s base rate will equal equals one-half of the difference between the 90 percent of its rate model, while up to provider’s rate as of March 30, 2022 (before 10 percent of its rate model will be available the first rate increase took effect) and the as quality incentive payments if the provider fully funded rate model. Additional funding is achieves specified performance and provided for the quality incentive program. outcome targets. • Year 4 (2024-25). Rates will sustain the Rate Reform Acceleration Responded previous years’ changes. to Concerns About Workforce Shortages. • Year 5 (2025-26). Rate models will be fully The state adopted this acceleration in response to funded beginning July 1, 2025 as follows: stakeholder concerns about a workforce shortage A service provider’s base rate will equal of direct care staff. Stakeholders proposed the 90 percent of its rate model, while up to acceleration because providers faced challenges 10 percent of its rate model will be available as filling vacancies for direct care staff positions. incentive payments if the provider achieves its Stakeholders stated that the accelerated time line performance and outcomes targets. would facilitate hiring of direct care staff. The 2022-23 budget accelerated the implementation time line from five to four years by eliminating the step planned for Year 4 under the original time line. The accelerated time line included the following steps: www.lao.ca.gov 3 2024-25 BUDGET Proposal have to decline referrals from regional centers due to lack of available staff. Consumers might therefore The Governor’s budget proposes to delay need to wait longer before a provider can begin to the final stage of service provider rate reform serve them. Additionally, a continuing shortage of implementation by one year to 2025-26. Under the direct care staff could disrupt service continuity proposal, rate models would be fully funded as of for those consumers who are successfully referred July 1, 2025, rather than July 1, 2024. The proposal to a provider due to staff scheduling challenges. provides $612.5 million in General Fund savings in We note that DDS has recently adopted workforce 2024-25. The reduction in General Fund spending initiatives that could improve workforce stability in would also reduce federal reimbursements by the longer run, such as bilingual pay differentials $408 million, resulting in a total reduction of about and Direct Service Professionals University $1 billion from planned spending in 2024-25. (a training and certification program tied to wage In addition to delaying the final rate increase, differentials for direct care staff). However, as these the proposal would also affect the implementation efforts are still in the early stages of implementation of quality incentive payments. Under the proposal, or not yet fully implemented, they are unlikely to quality incentive payments would comprise address providers’ immediate workforce needs 10 percent of the fully funded rate model beginning in 2024-25. in 2025-26, rather than in 2024-25 (as under current law). In lieu of calculating quality incentive payments Issues for Legislative Consideration as 10 percent of the rate model in 2024-25, the Consider Whether Alternative Approaches Governor’s budget proposes $137.5 million total Are Warranted. While the proposal would help funds as separate funding for a quality incentive address the state budget problem, it involves program. This proposed amount is equal to the trade-offs. Specifically, some DDS consumers may estimated amount of funding spent on quality not receive services as quickly as could be possible incentives in the current fiscal year. were the full rate reform implemented in 2024-25. Assessment Rejecting the administration’s proposal, however, requires dollar-for-dollar reductions in other areas Proposal Would Help Address the State of the budget. Alternatively, the Legislature could Budget Problem… The $612.5 million decrease consider a scaled-back budget solution that in General Fund spending for rate reform allows some level of funding for the final phase of implementation would help the state address its rate reform in 2024-25 while reducing the adverse budget deficit in 2024-25. (There are proposed impacts associated with the proposed solution. budget solutions across many other programs as For example, such a scaled-back approach could well. Our recent publication, The 2024-25 Budget: target select service provider codes where the Overview of the Governor’s Budget, provides workforce shortages are most acute. This approach more information on the state’s budget problem would require collaboration with the administration and the overall package of proposed budget and stakeholders. Additionally, it would still require solutions.) The delay would mean the rate model alternative budget solutions in other areas of the implementation would remain roughly half-way budget (although of a lesser dollar amount than implemented in 2024-25. would be required if the administration’s proposal …But Could Delay Addressing Direct Care were rejected completely). We note that delaying Staff Workforce Shortages. We have heard the final phase of rate reform is only a one-year concerns from stakeholders that the challenges budget solution. That is, the ongoing costs of faced by providers in hiring an adequate number of the final phase of rate reform are reflected in the direct care staff, which helped initiate rate reform administration’s multiyear estimates beginning acceleration in 2022-23, have not yet been fully in 2025-26 (when the state continues to face overcome. Providers indicate that a continuing budget deficits). shortage of direct care staff could delay service provision to DDS consumers, as providers might 4 LEGISLATIVE ANALYST’S OFFICE 2024-25 BUDGET MASTER PLAN FOR years. Accordingly, throughout this section, we raise key questions for the administration in order DEVELOPMENTAL SERVICES for the Legislature to fully consider the merits of Proposal the proposal. The Governor’s budget proposes DDS develop a State Has Recent Experience With Master Master Plan for Developmental Services by the end Planning Process. The concept of a master plan of calendar year 2024. The stated goal of the plan is has a recent precedent in the state, as California broadly to improve the experience of individuals and developed a Master Plan for Aging throughout families receiving developmental services. The plan 2019 and 2020. The Governor issued an executive would outline goals to make developmental order in June 2019 calling for the Master Plan for services more person-centered, equity-focused, Aging in response to anticipated demographic and data-driven. To inform the development shifts in the state’s aging population. In response, of the plan, DDS intends to reconstitute the the Legislature enacted legislation (Chapter 742 Developmental Services (DS) Task Force (originally of 2019 [SB 228, Jackson]) establishing the created in 2014 to inform the transition of DDS parameters and reporting requirements of the consumers from institutional settings to home- and plan. The development of the Master Plan for community-based settings). The California Health Aging involved significant stakeholder and public and Human Services Agency identified the Master engagement as well as cross-agency collaboration. Plan for Developmental Services as one of its The final plan, released in 2021, identifies 5 goals 2024-25 program priorities. There is no new funding and 23 strategies with a targeted implementation associated with this proposal. date of 2030. Six standing stakeholder committees inform the ongoing implementation of the plan. Assessment and Issues for The Master Planning Process Has Potential Legislative Consideration Value. While the Master Plan for Aging is still in In Concept, Proposal Appears Consistent the early stages of implementation and evaluation, With Existing Priorities… DDS is developing and it nonetheless sheds light on the possibilities for has initiated various efforts intended to address developing a master plan. A master plan can serve quality, equity, outcomes, and accountability. to focus and coordinate state efforts in a broad These efforts include, among others, service policy area that cuts across multiple state entities, provider quality incentive payments, implicit bias initiated by a process of setting priority goals and training at regional centers, efforts to expand developing an implementation plan to achieve the consumers’ access to social recreation services, goals. For example, the Master Plan for Aging’s five and standardized assessments for respite services. main goals address housing, health, community While these efforts have not yet been evaluated for integration, caregiving, and economic security. efficacy or efficiency, they are meant to improve The administration has taken various actions to the experience of individuals and families receiving start implementing the Master Plan for Aging, such developmental services. As such, the proposed as investing funds to construct or rehabilitate senior Master Plan therefore appears consistent with the housing facilities through the California Department department’s existing efforts and stated priorities. of Social Services’ Community Care Expansion Program, as well as expanding food benefit …But Details Provided to Date Are Scarce. eligibility for older adults as part of Food4All. At the time this analysis was prepared, the administration had not yet released substantive Legislature Has Opportunity to Inform the details of its proposal for the Master Plan for Vision for the Master Plan for Developmental Developmental Services. Particularly given the Services. At the time this analysis was current fiscal climate, understanding the potential prepared, the administration has not clearly scope and outcomes of this proposal is important. articulated a definitive vision for the Master Plan Depending on the specifics of the plan, it could for Developmental Services. This presents an create fiscal pressure on the Legislature to take opportunity for the Legislature to help establish certain budget and policy actions in coming the vision for both the development of the www.lao.ca.gov 5 2024-25 BUDGET Master Plan and the plan’s scope in the context the solicitation of stakeholder input. The Legislature of developmental services more broadly. Should could consider codifying a similar requirement for the Legislature wish to proceed with the concept the Master Plan for Developmental Services. of a Master Plan for Developmental Services, Relatedly, stakeholders have voiced the we recommend that the Legislature consider importance of giving a diverse representation introducing legislation, similar to that introduced of consumers the opportunity to meaningfully for the Master Plan for Aging to ensure that the engage in the development of the Master Plan. vision for the Master Plan for Developmental We recommend the Legislature ask DDS to provide Services reflects legislative priorities. Questions more information about its intended outreach to to ask the administration could include: Why is stakeholders and the role that stakeholders would DDS proposing to create a Master Plan now? Is play in developing the Master Plan. Questions a Master Plan the most appropriate vehicle to to ask the administration could include: Does achieve the department’s goals? Which types of the department plan to solicit participation from developmental services would the Master Plan consumers that historically have lower levels of affect? How would the department ensure that service provision/purchase of service expenditures? any programs resulting from the Master Plan are How would DDS make the stakeholder process inclusive of the diverse array of individuals served in accessible in multiple languages? How would the developmental services system? How would the DDS encourage participation of family members Master Plan expand upon the department’s existing that represent a wide range of consumer initiatives to address quality, equity, outcomes, ages, from Early Start to elderly consumers? and accountability? How would DDS educate laypeople about the While DDS indicated that it intends to collaborate developmental services system so that they are with other state departments and programs on sufficiently empowered to provide meaningful the Master Plan for Developmental Services, it has feedback? Would meetings be structured to allow not yet released any details on its vision for this stakeholders sufficient time to voice their concerns type of collaboration. Individuals with intellectual and suggestions? and developmental disabilities often receive Legislature Will Likely Need to Give Fiscal services outside of DDS, including those overseen Considerations a Key Focus. In the context by the California Department of Education, the of likely budget deficits through 2027-28, Department of Rehabilitation, the Department of understanding the potential fiscal impacts of Health Care Services, and the Department of Social the proposed Master Plan would be critical. Services. We recommend that the Legislature ask To understand these potential impacts, the DDS to provide more information about its plans Legislature could ask the administration how it for collaboration across state agencies. Questions proposes to estimate the implementation costs to ask the administration could include: Which of the Master Plan and fund any costs above state agencies and departments would be involved current baselines. The Legislature may want to in the development and implementation of the consider the potential future cost pressures of Master Plan? How would DDS ensure successful the administration’s proposal as it evaluates the and efficient interagency coordination? Would DDS proposal and weighs it against other legislative seek to create a Cabinet Work Group, similar to the funding priorities. group created for the Master Plan for Aging? Proposal Does Not Address Ongoing More Details Needed on Stakeholder Legislative Oversight of Plan Implementation. Engagement. While the department stated that At the time this analysis was prepared, DDS has it plans to convene a workgroup of stakeholders not indicated whether the Legislature would have to inform the development of the Master Plan, any role in overseeing the ongoing implementation it has not released details on the stakeholder of the Master Plan once it is developed. We note engagement process. Chapter 742—concerning the that Chapter 742 required the Department of Aging Master Plan for Aging—specified requirements for to submit annual reports to the Legislature on 6 LEGISLATIVE ANALYST’S OFFICE 2024-25 BUDGET the implementation of the Master Plan for Aging. DELAY PRESCHOOL The Legislature could consider codifying a similar INCLUSION GRANTS requirement for the Master Plan for Developmental Proposal Is in Addition to Previous Services. The information from such reporting Two-Year Delay. The 2022-23 budget package could assist the Legislature in exercising ongoing included $10 million General Fund of ongoing oversight through its appropriations authority funding for grants to enable preschool programs and review of administration spending plans. The to include more children with exceptional Legislature could also ask DDS to elaborate on its needs. The Governor proposes delaying the plan to track ongoing implementation. Questions implementation of this program until 2026-27. In could include: How would DDS plan to define last year’s analysis, we raised several issues with success and track progress under the Master the design of these grants; all of these concerns still Plan? How would DDS plan to record and analyze apply. Given that the Governor’s budget projects data under the Master Plan? What role would multiyear deficits (in addition to the current budget stakeholders play in Master Plan implementation? problem), the Legislature may wish to consider How would the department ensure its goals are eliminating this program (which has not yet sufficiently specific to be tied to measurable been implemented). outcomes? How would the department ensure financial transparency in its ongoing implementation tracking and reporting? DDS OVERSIGHT ISSUES In recent years, the DDS system has undergone Issues some significant changes that warrant continued Compliance With Compensation Increases legislative oversight. Below, we highlight three areas for Direct Care Staff. While DDS issued guidance of particular interest for the Legislature. For each, to remind providers about the compliance we provide background and updates on the requirement, the department indicated that it has implementation of recent initiatives. We also raise not yet initiated any provider audits. This is in part issues for legislative consideration. because expenditures for 2022-23 are not yet finalized. DDS stated that providers’ compliance DIRECT CARE STAFF with this requirement is a potential candidate for COMPENSATION INCREASES future audits. Given the significant amount of funding provided for rate reform implementation to Background date, these types of audits could help ensure that Rate Reform Acceleration Intended to Benefit any funding allocated to rate reform implementation Direct Care Staff. When the 2022-23 budget aligns with legislative intent. The Legislature could accelerated the phase in of service provider rate therefore ask DDS when it plans to conduct this reform implementation, the associated trailer type of audit and request a briefing on the findings legislation required providers to use a specified once complete. The Legislature could also ask DDS percentage of the upcoming rate increases to raise to elaborate on how it coordinates with regional the wages, salaries, or benefits of direct care staff centers on this issue. starting on January 1, 2023 (Chapter 49 of 2022 [SB 188, Committee on Budget]). The percentage of the rate adjustment that must be allocated to the direct care staff varies by service code. The phase-in plan also requires providers who receive a rate increase to maintain documentation demonstrating compliance with this requirement. www.lao.ca.gov 7 2024-25 BUDGET SERVICE PROVIDER RATE slow pace of progress in reaching consensus on quality measures and the need for more urgency REFORM: QUALITY INCENTIVES within the department. Although the department Background indicated that it expects to receive support from regional centers and provider associations in Quality Incentives Will Ultimately Comprise communicating its quality measures before they 10 Percent of Provider Rates. Once service take effect, limited time now remains before the provider rate reform is fully implemented, quality measures must be finalized and published. statute requires that 10 percent of each service provider rate is reserved for a quality incentive Second, the department requires an information payment. These quality incentive payments will technology (IT) system that will enable all be tied to performance metrics specific to each 21 regional centers to consistently track whether category of service provider. By tying payments providers have satisfied the quality criteria to to performance, the department aims to improve earn the final 10 percent of the rate model. consumer outcomes. DDS convened a Quality DDS has initiated a project with the California Incentive Program Stakeholder Workgroup Department of Technology that would modernize to help develop the methodology for quality case management and financial recordkeeping incentive payments. (We provided additional throughout the state. Once fully operational, this background on and assessment of the status of the project would allow DDS and regional centers to development of the quality incentive program in a leverage outcome measurements when calculating previous analysis.) rates. At the time this analysis was prepared, whether this project would be completed in time Department Has Initiated Provider Directory. for DDS to implement quality incentive payments The department has started the process to create is unclear. a statewide database containing contact details for all service providers authorized to serve DDS In light of these potential challenges, the consumers. Prior to this, the department did Legislature could ask DDS to provide more not maintain comprehensive contact details for information at budget hearings about the providers. The department indicated that the anticipated time line for finalizing quality measures directory will help facilitate the quality incentive and upgrading the department’s IT systems as process by providing access to current and both of these components would be required to complete provider data. As of December 2023, implement the measures. the department is engaging with regional centers SERVICE DISPARITIES AND and service provider focus groups, as well as a contractor, to support provider directory rollout COORDINATED FAMILY SUPPORT and training. SERVICES Issues Background Infrastructure Needed to Support Quality Longstanding Interest in Spending Disparities Incentive Program Still Under Development. Among Racial/Ethnic Groups. Starting in 2011-12, Although the administration views the provider state law requires all regional centers to periodically directory as a valuable and necessary starting point publish data on the amount spent on services for for quality incentives, we have heard concerns consumers disaggregated by the race/ethnicity of from stakeholders that two other components of these consumers. These data consistently have the infrastructure needed to fully implement quality shown large disparities in the average amounts incentive payments by 2025-26 is lagging. spent among these groups. In particular, spending First, DDS needs to define the quality measures for Hispanic/Latino consumers is about half that for that providers must satisfy in order to earn the final white consumers on average. (We raised concerns 10 percent of the fully implemented rate model. about spending disparities in a previous analysis, Stakeholders have expressed concerns with the which provides additional context on this topic.) 8 LEGISLATIVE ANALYST’S OFFICE 2024-25 BUDGET Coordinated Family Support Pilot Intended Issues to Help Identify and Address Disparities. DDS Evaluation Would Reveal Outcomes From the reports that adult Hispanic/Latino consumers are Pilot and Provide Opportunities for Legislative more likely than white consumers to live at home Oversight. Once the pilot concludes, a program and thus consume fewer residential services. evaluation would be warranted to assess whether While this could be one contributing factor to lower the pilot sheds light on the service disparities spending levels for Hispanic/Latino consumers, for Hispanic/Latino consumers and potential the circumstances of living at home could mask opportunities to reduce them. The department service needs that are not being met. In response has not yet announced an end date for the pilot. to this spending disparity, DDS created a pilot For now, the department indicates that it is still program for Coordinated Family Support targeted implementing the pilot and approving service at the population of consumers 18 years and older providers to provide Coordinated Family Support who choose to live in their family homes. Services services. To assess whether additional General provided through the Coordinated Family Support Fund spending on these services—or other policy pilot are intended to be tailored to each family’s actions—could be warranted in future budgets, unique needs and to respect the language and we recommend that the Legislature ask DDS to culture of each family. The department utilized provide more details on its plan to evaluate the funding for HCBS under the American Rescue Plan pilot. Based on the evaluation, the Legislature could Act (ARPA) to help fund the pilot. The expenditure consider whether the pilot merits continuation and deadline for all HCBS ARPA activities is any potential modifications to improve efficacy. December 31, 2024. Questions the evaluation could include are: Did the Department Stated Intent to Collect Data pilot identify gaps in consumers’ service needs? on Pilot. The department stated in 2023 that Did participants consume more services as a regional center service coordinators are responsible result? Do the department’s findings suggest for distributing an experience questionnaire to that spending disparities are driven by barriers consumers and families receiving Coordinated consumers have faced in the developmental Family Support. Service coordinators must then services system? Were there a sufficient number submit questionnaire responses to the department. of providers approved to provide Coordinated Additionally, the department stated that regional Family Supports? centers must submit quarterly reports on pilot implementation. www.lao.ca.gov 9 2024-25 BUDGET 10 LEGISLATIVE ANALYST’S OFFICE 2024-25 BUDGET www.lao.ca.gov 11 2024-25 BUDGET LAO PUBLICATIONS This report was prepared by Karina Hendren, 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