INTRODUCTION
In 2003, the Legislature adopted a statute (W&I §4620.2) calling on the Department of Developmental
Services (DDS) to develop a system of
co-payments and/or enrollment fees to be assessed against parents of regional
center consumers ages 3 to 17 who live with
their parents and are “not otherwise eligible to receive services
provided under the Medi-Cal program.” The assessments are to be applied only
to parents whose adjusted gross family income is more than 200% of the federal poverty level.
Already, regional centers can charge a fee to parents of children under 18
who receive 24-hour out-of-home care.[1]
A “detailed plan” is to be developed by DDS
“after consultation with stakeholder groups” and is to be submitted to the
Legislature by April 1, 2004,
but “may be subsequently modified during the legislative review process.” Section
4620.2(e) outlines a number of components that must be included in the plan,
such as issues of privacy, potential safeguards regarding family income, cost
sharing, hardship exemptions, appeal process, implementation timeframe and
costs, etc.
Two bills have already been introduced this session, AB
1821 (Cohn) and AB 2775 (Richman), addressing the implementation date of the
assessment system. AB 1821 calls for a plan to be implemented in FY 2004-05 (July 1, 2004) and AB 2775 calls for
a January 1, 2005 start-up
date.
This memo proposes a framework of general guidelines that
PAI can apply to any co-payment plan that DDS
develops and presents to the Legislature. At this stage, there have been a
few public hearings, but no formal consultation. We understand that DDS
will unveil a plan in early March, but there is no indication whether the
Department will propose regulations to implement the plan; section 4620.2 is
silent on that point. Note that PAI has already adopted principles calling
for the maintenance and strengthening of due process protections for
Lanterman Act recipients of supports and services[2]
(attached).
PRINCIPLES REGARDING PARENTAL CO-PAYMENTS
A Co-payment System Must Include Mandated Protections
A co-payment system will cause substantial harm to those
families it will affect. While no fees or co-payments would be best, if a
co-payment system[3]
is required, it must be implemented consistent with the principles of the
Lanterman Act. The Legislature and/or DDS
must set clear parameters that ensure a family’s financial stability,
privacy, right to the least restrictive environment, right to choose needed
services, right to appeal a fee decision, and petition for an exemption. We
suggest six specific principles regarding mandated protections. Many of these
principles are included within the existing law.
First, any parental co-payment system must impose less
of a burden on children living at home, than any fee system imposed on
families with children in out-of-home living arrangements and institutions.
Second, a parental co-payment system should be on a
sliding scale, based on family income and family size. The system needs to
have, at a minimum, all of the income deductions that the institutional
parental fee system currently allows. (See
17 Cal.CodeRegs.
§§50231-50235).
Third, any parental co-payment system must contain
safeguards that protect the privacy of the families’ income records and the
children’s regional center clinical records, and otherwise considers and
protects related privacy matters, including assurance that information will
not be shared with other governmental entities.
Fourth, a parental co-payment system must have an
exemption process for families who are experiencing financial hardships and
may need to defer or waive co-payments.
Fifth, a parental co-payment system must have an appeal
process for families who may dispute the co-payment or assessment amount. The
hearing process in the Lanterman Act, (§4700 et seq.) should be the hearing
process available to families, including adequate written notice and
provisions that a co-payment will not be imposed during the pendency of the
hearing.
Sixth, a parental co-payment system should have
sufficient protections to minimize the disruption of services when
implemented. Among other things, a co-payment’s implementation should not
adversely affect the health and safety of an individual, or the person’s
right to the least restrictive environment within the context of any regional
center services or supports.
Given the High Cost of Living in California,
a Co-Payment System Must Be Equitable and Cannot Financially Burden Working
Families
A co-payment system is equitable only if the State
collects greater payments from families with substantially more disposable
income than those families who are at or close to 200% of the federal poverty
level.
The 200% of the federal poverty level established in
Welf. & Inst. Code section 4620.2() is too low and will adversely affect
working class families. Any co-pay system must operate in a way to ensure
that families will not forego regional center services, consider institutionalization
as an alternative, or suffer significant reductions in the family’s financial
well-being just to obtain regional center services.
In deciding on the co-pay floor (the income amount at
which families would first be required to pay), the Legislature should
require DDS to consider family size and
the receipt or non-receipt of a true living wage for the geographic area
where the family lives. A living wage is a wage amount that realistically
meets the cost of living in a given area. For example, California
families living in urban centers require a significantly higher wage than
those living in communities that are more rural. Instead of minimum wage, a
person in Los Angeles
realistically needs to earn somewhere between 10 to 15 dollars per hour to
adequately meet his/her cost of living needs. A co-payment system must
therefore consider what a family’s income is in direct relation to its
expenditures. Therefore, a family’s income is one factor that must be weighed
differently based on the geographic area.
A Co-Payment System Should Not Harm Vulnerable Populations within the
Regional
Center System
A co-payment system should protect politically
vulnerable populations within the regional center service system, such as
undocumented immigrants, who tend to withstand reductions in services with
little or no resistance, since they fear governmental intrusion.
DDS has always
excluded individuals who are eligible for Medi-Cal services from its
co-payment plan. Undocumented immigrants are not eligible for full-scope
Medi-Cal, and can only receive “emergency” Medi-Cal. Therefore, this
commendable exception must also apply to individuals who receive any Medi-Cal
benefit.
A Co-Payment System Should Be Uniform and Consistent
To eliminate the disparities in the administration of
co-pays, DDS should centrally administer
any co-payment system.
DDS should Develop a Co-Payment System
that Reduces Administration Burdens on Families and the Agency
Any co-payment system should minimize the administrative
actions necessary to process co-payments. A co-pay system can allow families
to satisfy a co-payment requirement while lessening the financial affect on
them and reducing the administrative burden it places on DDS.
For example, we understand that DDS
has proposed a flexible program that would allow families to use alternative
resources to meet their co-payment obligations. Under this proposal, a
family’s co-pay would be used to reduce the amount of services they receive
from DDS. Families could use alternative
resources (including non-vendored services) to meet this obligation. In
addition, DDS is encouraged to consider
alternative flexible programs such as allowing families to waive regional
center case management as a way of meeting their co-payment obligation. The
types of flexible systems that reduce administrative burdens and do not
require families to make “cash” payments to regional centers should be
encouraged.
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