California's Department of Developmental Services

A developmental disability is defined as a disability, related to certain mental or neurological impairments, that originates before a person's eighteenth birthday, constitutes a substantial handicap, and is expected to continue indefinitely. The state Lanterman Developmental Disabilities Services Act of 1969 entitles individuals with developmental disabilities to a variety of services, which are overseen by the state Department of Developmental Services (DDS). Individuals with developmental disabilities have a number of residential options. While most live with their parents or other relatives, thousands live in their own apartments or in group homes that are designed to meet their medical and behavioral needs.

Community Services Program. This program provides community-based services to clients through the regional centers (RCs). The RCs are responsible for client assessment and diagnosis, the development of an individualized program plan, case management, and the coordination and purchase of various services, such as residential, supported living, and day program services. Day program services include early intervention services for infants and young children and daytime activity programs for adults. The department contracts with 21 RCs to provide services to more than 170,000 clients each year.

Developmental Centers Program. The department operates five developmental centers (DCs), and two smaller facilities, which provide 24-hour care and supervision to approximately 3,700 individuals.

Background

The state's Lanterman Developmental Disabilities Services Act ("Lanterman Act"), first passed in 1969 and significantly amended in 1977, provides the basis for the state's commitments to fund community services for persons with developmental disabilities. The Lanterman Act establishes the state's responsibility for ensuring that persons with developmental disabilities, regardless of age or degree of disability, have access to services that sufficiently meet their needs and goals in the least restrictive setting.

In order to deliver services to persons with developmental disabilities, the Lanterman Act specifies that the state contract with RCs, which are nonprofit agencies that coordinate and develop services within their community. The state opted to contract with RCs, rather than use state or county agencies for service delivery, due to the complex service coordination needs of persons with developmental disabilities and their families. That coordination requires RCs to address social, medical, economic, legal, and other challenges that persons with developmental disabilities face.

The state now contracts through the Department of Developmental Services (DDS) with 21 RCs whose catchment areas cover the entire state. The RCs must serve all persons who meet the state's definition of a developmental disability and all children under age three who have or are at risk of developmental delays. In 2000-01, the RCs served more than 165,000 persons, including nearly 63,000 children and 86,000 adults with developmental disabilities and 16,000 children under age three who have or are at risk of developmental delays.

Eligibility. The RCs provide services to individuals who have been diagnosed with mental retardation, cerebral palsy, epilepsy, autism, or a disabling condition requiring treatment similar to that required for mental retardation. To qualify for services, individuals' disabilities must have originated before the age of 18, and they must constitute what is considered a substantial handicap.

Unlike most health and social services provided by the state, eligibility to receive both case management and community services does not depend on a "means" test or determination of financial need that is based on income level or assets. Further, with a few minor exceptions, services are provided without any requirement that those benefiting from the services, and who have the ability to contribute, pay a share of cost. For that reason, RCs generally do not collect data on the income or means of the clients or the families whom they serve.

Caseloads. Unlike other states, which have waiting lists for services, California does not place limits on the number of people who can receive services. Caseloads, therefore, have grown steadily according to demand, as shown in Figure 3. Between 1995-96 and 2002-03, the RC caseload is expected to increase from 128,000 to 182,000 clients. That amounts to more than 5 percent growth per year.

One significant component of this growth is the number of individuals diagnosed with autism. Autism caseloads have grown at an average rate of about 16 percent per year.

Individual Program Plans Determine Services. Under the Lanterman Act, RCs must assist each client in developing an individual program plan (IPP), which identifies a person's needs and goals, and the services necessary to meet those needs. The IPP becomes the general basis for determining the community services to which an individual is then entitled. The RCs have the responsibility of ensuring that services identified in the IPP are actually provided.

Although individuals are entitled to the services identified in their IPPs, those services nevertheless must be delivered within annual budgetary appropriations. However, the annual appropriations in support of the entitlement for caseload growth and the cost and utilization of services are generally adjusted each year based on historical spending patterns.