Purchase of Services (POS) Disparity Data

The Department of Developmental Services (DDS)

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Welfare and Institutions Code Section 4519.5-4519.6

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Introduction

Governor’s Office

California Health and Human Services Agency

Department of Developmental Services contracts with 21 Regional Centers

Local case management

Developmental Services System Structure

Introduction

• DDS contracts with 21 regional centers (RC) across California to serve individuals with developmental disabilities (consumers).

• DDS is committed to supporting access to services and supports for families of diverse cultural and linguistic backgrounds.

• DDS and RCs collaborate annually to compile and analyze data to identify possible disparities in purchase of services (POS) among different consumer groups.

• RCs hold public meetings annually and provide DDS with their plans and recommendations to reduce POS disparities.

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Changes in Law• AB 1472 (2012) requires RCs to annually compile data on POS

authorization, utilization and expenditures and discuss the data with stakeholders in public meetings.

• SB 555 (2013) requires RCs to make reasonable efforts to communicate in the consumer’s native language when developing Individualized Family Service Plans and Individual Program Plans.

• SB 82 (2015) requires DDS to review POS data with stakeholders, including consumers and families; identify barriers to equitable access; and develop recommendations to reduce disparities.

• ABX2 1 (2016) allocates $11 million for RCs’ efforts to address POS disparities.

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Meeting Purpose• Present key consumer characteristics such as ethnicity, language,

residence type, age, and diagnosis as of January 1, 2016.

• Present statewide data on funding differences among consumer groups.

• Review authorized and actual consumer expenditures and utilization rates based on certain key characteristics in multiple fiscal years.

• Identify potential barriers to equitable access to services and supports.

• Identify best practices to reduce disparity.

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Description of Data

• Data includes total service authorization amounts, per capita

expenditures and utilization rate (the share of authorized amounts

that were expended).

• Cost for services received or funded outside the DDS system are not

included; for example: education-funded services, In-Home Support

Services, etc.

• Contract expenditures that cannot be tied to specific consumers are

not included (approximately 5% of total expenditures).

• There has been a 42% increase in consumer population between 2006 and 2016.

• These numbers include consumers, of all ages, who receive services from regional centers.

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Who we serve

203,583

289,855

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

2006 2016

Autism, 26%

Intellectual Disability, 45%

Cerebral Palsy, 3%

Epilepsy, 1%

Category 5, 4%

Other, 21%

Consumers by Diagnosis

FY 14/15.

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Consumers by Age - 2016

As of January 1, 2016.

13%

36%

9%

33%

10%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Infants (0 to 2) Children (3 to 17) Young Adults (18 to 21) Adults (22 to 51) Seniors (52 and older)

Consumers by Language

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As of January 1, 2016.

English75%

Spanish20%

All Other Languages5%

• “All Other Languages” include languages, such as: Vietnamese, Cantonese Chinese, Mandarin Chinese, Tagalog, Korean, Hmong, and ASL.

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Consumers by Ethnicity/Race - 2006 and 2016

As of January 1, 2006, and 2016.

5.6%

10.6%

2.1%

31.0%

0.4% 0.5%

43.2%

6.8%6.5%

9.0%

2.3%

37.3%

0.3% 0.2%

32.8%

11.5%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

Asian Black/AfricanAmerican

Filipino Hispanic Native American Polynesian White Other

2006 Percentage 2016 Percentage

Consumers Ages by Ethnicity

For FY 14/15.

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AsianBlack/African

AmericanFilipino Hispanic Native American Other Polynesian White

0 to 2 18.0% 10.0% 8.9% 19.9% 10.0% 37.0% 12.3% 10.4%

3 to 21 48.3% 38.3% 49.5% 50.9% 40.2% 45.5% 46.4% 34.4%

22 and older 33.7% 51.7% 41.6% 29.1% 49.7% 17.5% 41.3% 55.2%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Consumers by Residence Type

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Home of Parent/Guardian79%

Community Care10%

Independent Living/Supported Living

8%

ICF2%

Institution<1%

SNF<1% Other

1%

As of January 1, 2016.

Review of Authorizations and Expenditures for Services

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Comparison of Expenditures by Residence Type, All Ages – FY04/05 and FY14/15

Residence Type FY04/05 FY14/15

Home of Parent/Guardian $4,811 $6,945

ILS $8,769 $11,299

SLS $45,261 $59,001

Residential Care $29,007 $46,826

Medical/Rehabilitation or Psychiatric Facility $11,132 $23,066

Other $2,037 $2,334

Home ofParent/Guardian

ILS SLS Residential CareMedical/Rehabilitationor Psychiatric Facility

Other

FY04/05 $4,811 $8,769 $45,261 $29,007 $11,132 $2,037

FY14/15 $6,945 $11,299 $59,001 $46,826 $23,066 $2,334

$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

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Share of Consumers by Residence Type and Ethnicity, All Ages – FY14/15

EthnicityHome of

Parent/Guardian ILS SLS Residential CareMedical/Rehabilitation

or Psychiatric Facility Other

Asian 7% 3% 2% 4% 3% 4%Black/African-American 8% 17% 14% 11% 12% 17%

Filipino 2% 1% 1% 2% 1% 1%

Hispanic 42% 19% 14% 17% 22% 24%

Native American <1% 1% 1% <1% 1% 9%

Other 14% 5% 4% 5% 5% 9%

Polynesian <1% <1% <1% <1% <1% <1%

White 26% 54% 64% 61% 55% 37%

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Comparison of Per Capita Expenditures by Residence Type and Ethnicity – FY14/15

EthnicityHome of

Parent/Guardian ILS SLS Residential CareMedical/Rehabilitation

or Psychiatric Facility Other

Asian $7,628 $10,252 $63,932 $50,326 $22,582 $32,263

Black/African-American $7,458 $11,284 $43,749 $50,859 $23,693 $19,126

Filipino $7,598 $10,506 $60,024 $48,748 $8,308 $15,763

Hispanic $6,209 $10,608 $46,114 $49,001 $23,595 $15,659

Native American $6,679 $7,813 $59,444 $43,688 $29,773 $2,021

Other $5,955 $12,764 $67,899 $50,362 $41,883 $11,490

Polynesian $5,323 $7,656 $41,253 $51,873 $9,372 $77,838

White $8,267 $11,531 $64,234 $44,970 $21,271 $16,902

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Comparison of Per Capita Expenditures by Ethnicity/Race, All Ages – FY 04/05 and FY 14/15

$7,288

$9,585

$7,965

$5,783

$8,419

$6,288$6,898

$12,337

$10,711

$14,479

$11,326

$8,452

$14,740

$7,940

$10,458

$18,412

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

$18,000

$20,000

Asian Black/AfricanAmerican

Filipino Hispanic Native American Other Polynesian White

FY04/05

FY14/15

Ethnicity FY04/05% of Total Expenditures,

FY04/05 FY14/15% of Total Expenditures,

FY14/15

Asian $7,288 4% $10,711 6%Black/African American $9,585 11% $14,479 10%Filipino $7,965 2% $11,326 2%Hispanic $5,783 21% $8,452 26%Native American $8,419 <1% $14,740 <1%

Other $6,288 6% $7,940 8%Polynesian $6,898 <1% $10,458 <1%

White $12,337 56% $18,412 48%

Comparison of Authorizations and Expenditures by Ethnicity/Race, All Ages – FY14/15

Ethnicity% of Consumer

Population Per Capita Authorized Services Per Capita Expenditures Utilized

Asian 6% $13,340 $10,711 80%

Black/African American 9% $17,282 $14,479 84%

Filipino 2% $13,610 $11,326 83%

Hispanic 38% $10,770 $8,452 78%

Native American <1% $17,945 $14,740 82%

Other 12% $10,037 $7,940 79%

Polynesian <1% $12,732 $10,458 82%

White 32% $21,610 $18,412 85%19

$13,340

$17,282

$13,610

$10,770

$17,945

$10,037

$12,732

$21,610

$10,711

$14,479

$11,326

$8,452

$14,740

$7,940

$10,458

$18,412

$0

$5,000

$10,000

$15,000

$20,000

$25,000

Asian Black/AfricanAmerican

Filipino Hispanic Native American Other Polynesian White

Comparison of Expenditures by Ethnicity/Race –FY14/15 (without consumers living in residential care)

Ethnicity Consumer total Per Capita Expenditures% of Total Consumer

Population

Asian 19,268 $8,154 7%Black/African American 25,037 $9,606 9%Filipino 6,262 $7,978 2%

Hispanic 115,062 $6,539 40%Native American 942 $10,315 <1%

Other 38,304 $6,307 13%Polynesian 608 $5,894 <1%White 83,234 $12,244 29%

20Note: Authorization data without consumers living in residential care by ethnicity/race was not available.

AsianBlack/African

AmericanFilipino Hispanic

NativeAmerican

Other Polynesian White

All Consumers $10,711 $14,479 $11,326 $8,452 $14,740 $7,940 $10,458 $18,412

Without Consumers Living in Residential Care $8,154 $9,606 $7,978 $6,539 $10,315 $6,307 $5,894 $12,244

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

$18,000

$20,000

Comparison of Authorizations and Expenditures by Ethnicity/Race, Birth to 36 Months – FY14/15

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Ethnicity

% of Total Consumers, Birth to

36 months Per Capita Authorized Per Capita Expenditures Utilized

Asian 7% $8,288 $5,385 65%Black/African American 5% $7,446 $4,197 56%Filipino 1% $9,084 $5,684 63%Hispanic 42% $7,257 $4,402 61%Native American <1% $7,606 $4,183 55%Other 26% $5,840 $3,990 68%Polynesian <1% $6,947 $3,482 50%White 19% $7,819 $4,635 59%

AsianBlack/African

AmericanFilipino Hispanic

NativeAmerican

Other Polynesian White

Utilized 65% 56% 63% 61% 55% 68% 50% 59%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Comparison of Authorizations and Expenditures by Ethnicity/Race, Ages 3 to 21 – FY14/15

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Ethnicity

% Of Total Consumers, Ages 3

to 21 Per Capita AuthorizedPer Capita

Expenditures Utilized

Asian 7% $9,592 $6,824 71%Black/African American 8% $8,237 $5,722 69%Filipino 2% $8,476 $6,109 72%Hispanic 44% $7,006 $4,855 69%Native American <1% $9,550 $6,417 67%Other 13% $8,170 $5,851 72%Polynesian <1% $6,788 $4,849 71%White 25% $10,076 $6,774 67%

AsianBlack/African

AmericanFilipino Hispanic

NativeAmerican

Other Polynesian White

Utilized 71% 69% 72% 69% 67% 72% 71% 67%

64%

65%

66%

67%

68%

69%

70%

71%

72%

73%

Comparison of Authorizations and Expenditures by Ethnicity/Race, Ages 22 and Older – FY14/15

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Ages 22 and Older % of TotalPer Capita Authorized

Per Capita Expenditures Utilized

Asian 6% $19,568 $19,144 98%Black/African American 12% $26,815 $22,943 86%Filipino 2% $21,754 $18,749 86%Hispanic 28% $20,852 $17,522 84%Native American <1% $27,881 $23,606 85%Other 6% $25,391 $21,762 86%Polynesian <1% $22,351 $18,825 84%White 46% $32,733 $28,252 86%

AsianBlack/African

AmericanFilipino Hispanic

NativeAmerican

Other Polynesian White

Utilized 98% 86% 86% 84% 85% 86% 84% 86%

75%

80%

85%

90%

95%

100%

Comparison of Authorizations and Expenditures by Language, All Ages – FY14/15

Language Per Capita Authorized Per Capita Expenditures Utilized

English $17,018 $13,652 80%Spanish $9,830 $7,630 78%Vietnamese $12,114 $9,652 80%Cantonese Chinese $14,309 $12,346 86%Tagalog $15,005 $12,498 83%

Mandarin Chinese $13,271 $10,730 81%Korean $19,270 $15,598 81%

ASL (Amer. Sign Language) $35,556 $29,088 82%Other Languages $17,573 $11,237 64%

English Spanish VietnameseCantonese

ChineseTagalog

MandarinChinese

KoreanASL (Amer. Sign

Language)Other

Languages

Per Capita Expenditures $13,652 $7,630 $9,652 $12,346 $12,498 $10,730 $15,598 $29,088 $11,237

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

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Comparison of Consumers with no POS by Ethnicity – FY14/15

AsianBlack/African

AmericanFilipino Hispanic Native American Other Polynesian White

14/15 21% 20% 24% 22% 23% 16% 26% 17%

0%

5%

10%

15%

20%

25%

30%

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• Consumer demographics have changed over the past 10 years.

• Between 2006 and 2016, there has been a 42% increase in consumer population.

• In 2006, Whites made up 43% of the consumer population, representing the largest ethnic group. By 2016, Hispanics became the largest ethnic group, representing 37%, of total consumers served by regional centers.

• 75% of consumers/families indicate English is their primary language.

Themes

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• Residence types impact POS per capita expenditures.• Out of home care has the highest per capita expenditures.• Consumers ages 22 and older have significantly higher per capita expenditures.

• Data reflects variances in POS expenditures by ethnicity and language.• Hispanics have the second lowest per capita expenditures; however, they are the

largest ethnic group served by regional centers. • Spanish have the lowest per capita expenditures by language.• Asian consumers, ages 22 and older, had the highest utilization rate.• Cantonese Chinese had the highest utilization rate by language.• Per capita, authorized services and expenditures are higher for Whites than all other

ethnic groups.

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Themes, continued

Public input and feedback are encouraged and may be provided via the web at: www.surveymonkey.com/r/dds-pos

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