Medi-Cal Services Targeted to People with Developmental Disabilities

The California Department of Developmental Services administers several programs targeted specifically to individuals with developmental disabilities (DD). A developmental disability is a severe and chronic disability originating before the 18th birthday that stems from mental retardation, cerebral palsy, epilepsy, autism, or a disabling condition found to be closely related to mental retardation." In addition to qualifying for the programs described below, people with DD may also qualify for other long-term care services described in this report.

Services
Services for people with developmental disabilities are offered both in institutions and in the community. Institutions, including privately operated Intermediate Care Facilities for the Developmentally Disabled (ICF/DDs) and state-run Developmental Centers, provide medical care, nursing, and developmental training to individuals who require 24-hour supervision in a structured environment. ICF/DDs are a type of nursing home for individuals with developmental disabilities, and Developmental Centers are state-administered programs that are certified as ICF/DDs.

Community-based services are provided through Regional Centers and include assessments, case management, counseling, education, monitoring of care programs, and a full spectrum of treatment and habilitation services that are purchased by Regional Centers from community providers.

Funding and Administration
The Developmental Center program is funded through Medi-Cal, out-of-pocket payments, Medicare, and the State General Fund. Medi-Cal payments constitute 91 percent of total program funding. Developmental Centers are overseen by the Developmental Centers Program in the California Department of Developmental Services. Private ICF/DDs are funded through Medi-Cal and licensed and certified by the Licensing and Certification Division of the California Department of Health Services.

Regional Centers are funded through Medi-Cal, the State General Fund, and other state agencies. Medi-Cal funding is provided primarily through a home and community-based services (HCBS) waiver program. In addition, case management is provided through the Department of Health Services' Medi-Cal Targeted Case Management program, and Medi-Cal general funds are used for other Regional Center services. The Regional Centers are under contract with the California Department of Developmental Services and are operated by community boards of directors.

* The expenditures presented in this table represent only a portion of DDS’s total expenditures.
† Source: California Department of Health Services. Medi-Cal Services and Expenditures Month of Payment Report (Sacramento, CA: 1998).
‡ Source: Charlene Harrington et al., The Role of Medi-Cal in California’s Long-Term Care System (Oakland :Medi-Cal Policy Institute, 2000).
§ FY 1999 data.

Key Issues

• Despite a recent effort to de-institutionalize individuals with developmental disabilities, approximately 10,842 people currently live in Developmental Centers and ICF/DD facilities. At an average cost of $116,000 per participant per year, the Developmental Center program consumes 24 percent of the state's total spending on DD programs to support less than 2 percent of California's DD population.
  
• In 1998, HCFA placed an enrollment freeze on the Medi-Cal HCBS waiver for Regional Centers due to quality and management problems. However, by the year 2000, HCFA removed 12 Regional Centers from the enrollment freeze and granted partial removal for the remaining centers. One lingering concern is that there may not be sufficient funds and services to ensure high quality of care in the waiver program, which spent $12,402 per beneficiary in FY 1998 compared with an average of $72,731 for individuals with DD who were living in institutions.