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 ProgramThis 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 2012, approximately 228,000 individuals diagnosed with developmental disabilities of all ages and approximately 28,000 infants and toddlers with a developmental delay or an established risk condition that has a high probability of leading to a developmental delay received services through this system. 

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. The UCLA Center for Health Policy Research reported that between 2000 and 2011, the number of consumers in the system increased 57 percent, while, in comparison, California’s general population grew by 14 percent. Specifically, the population of children under the age of three receiving early start services in the community increased by 62 percent, and the population of individuals over age three who are served in the community increased by 53 percent.

One significant component of this growth is the number of individuals diagnosed with autism. In California, the number 
of individuals with autism who are served by the developmental disabilities service system has grown 283 percent since 2000. (www.theSCANfoundation.org. "California’s Developmental Disabilities Service System")
 
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.