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All infants and toddlers and their families should have access to a comprehensive set of services that support their health and development. This is especially important for children who experience delays in their development, which can be a cause for concern.

In California, children with disabilities or developmental delays can receive early intervention services through the Early Start program. Early intervention services promote a child’s growth and development and support their families. This report provides a high-level overview of California’s early intervention system with a focus on the Early Start program.

What Are Early Intervention Services and Why Are They Important?

The early years of a child’s life are a significant period of growth.1“Early Brain Development,” US Department of Health & Human Services (webpage), accessed September 19, 2022, https://www.cdc.gov/ncbddd/childdevelopment/early-brain-development.html. While all children grow and develop at their own rate, some infants and toddlers experience delays in their development, such as when they’re not playing, learning, speaking, eating, or moving when expected in their early years, which can be a cause for concern. Early intervention services help to enhance the growth and development of a child and are delivered through a partnership between families and professionals. These services can change a child’s development and improve outcomes for children, families, and communities.2 “Why Act Early,” US Department of Health & Human Services (webpage), accessed September 19, 2022, https://www.cdc.gov/ncbddd/actearly/whyActEarly.html.

California’s early intervention program is called Early Start.3 “Early Start,” California Department of Developmental Services (webpage), accessed September 19, 2022, https://www.dds.ca.gov/services/early-start/. It was established in response to federal legislation, the Individuals with Disabilities Education Act (IDEA), which guarantees a free appropriate public education to eligible children with disabilities and ensures special education and related services are provided to those children.4“About IDEA,” US Department of Education (webpage), accessed September 19, 2022, https://sites.ed.gov/idea/about-idea/; “Early Start Laws and Regulations” California Department of Developmental Services (webpage), accessed September 19, 2022,https://www.dds.ca.gov/services/early-start/laws-and-regulations/. The Early Intervention Program for Infants and Toddlers with Disabilities, which is part of IDEA, supports states in providing services and supports for children from birth through age 2. These children and their families receive early intervention services under a component of the federal law known as  IDEA Part C, whereas children and youth ages 3 to 21 receive special education and related services under another piece of the federal law known as IDEA Part B.

Who Provides Early Intervention Services?

Early intervention services in California are provided by two agencies: regional centers and schools (school districts and county offices of education).5 Legislative Analyst’s Office, Evaluating California’s System for Serving Infants and Toddlers With Special Needs (January 4, 2018), https://lao.ca.gov/Publications/Report/3728#Introduction. Regional centers are community-based non-profit agencies that provide or arrange for services to Californians of all ages who meet eligibility criteria, including infants and toddlers with developmental delays or disabilities.6 To be eligible for services, a person must have a disability that begins before the individual’s 18th birthday that is expected to continue indefinitely and present a substantial disability. See “Information About Regional Centers,” California Department of Developmental Services (webpage), accessed September 20, 2022, https://www.dds.ca.gov/rc/information-about-regional-centers/. There are 21 regional centers across California and they serve the majority of infants and toddlers who are eligible for early intervention services.7 “Regional Center Listings,” California Department of Developmental Services (webpage), accessed September 20, 2022, https://www.dds.ca.gov/rc/listings/. Regional centers are overseen by the Department of Developmental Services.

Schools are responsible for providing services to infants and toddlers whose disabilities are solely due to vision, hearing, or orthopedic impairments.8 Evaluating California’s System. There are also some school districts and county offices of education across California that provide services to all eligible children.9Evaluating California’s System These schools have a long history of providing early intervention services to infants and toddlers.

What Types of Early Intervention Services Can Infants and Toddlers Receive?

Early intervention services in California are designed to meet the developmental needs of each eligible infant or toddler and the needs of the family related to the infant’s or toddler’s development.10 “IDEA Sec. 303.13 Early intervention services,” US Department of Education (webpage), accessed September 19, 2022, https://sites.ed.gov/idea/regs/c/a/303.13. Services must be provided in a child’s natural environment, such as their home or in a group setting among their peers.

Types of early intervention services include:

more in this series

See our companion report, California Can Better Support Infants and Toddlers with Disabilities or Developmental Delays, to learn more about California’s early intervention system and steps policymakers can take to better support children and their families.

Who Is Eligible to Receive Early Intervention Services?

Regional centers determine eligibility through diagnosis and assessment.13“Regional Center Eligibility & Services,” California Department of Developmental Services (webpage), accessed September 20, 2022, https://www.dds.ca.gov/general/eligibility/. Infants and toddlers from birth through age 2 may be eligible for early intervention services through California’s Early Start program if they meet one of the following criteria:14“What is Early Start,” California Department of Developmental Services (webpage), accessed September 19, 2022, https://www.dds.ca.gov/services/early-start/what-is-early-start/.

  • The child has a developmental delay of at least 25% in one or more areas of cognitive, communication, social or emotional, adaptive, or physical and motor development including vision and hearing.
  • The child has an established risk condition with a high probability of resulting in delayed development.
  • The child is considered to be at a high risk of having a substantial developmental disability.

What Are the Steps to Receiving Early Intervention Services?

A child must be referred to California’s Early Start Program to receive early intervention services.15 “Early Start.” Referrals can be made by health care providers, family members, child care providers, and neighbors.

Within 45 calendar days of the referral date, the regional center or school is required to:

Who Pays for Early Intervention Services?

If a child is deemed eligible to receive services through California’s Early Start program, regional centers arrange and/or purchase services, but they are technically funders of last resort.16“IDEA Part C,” University of California, San Francisco (webpage), accessed September 20, 2022, https://odpc.ucsf.edu/communications-paper/idea-part-c. This means that regional centers require families to obtain certain services through Medi-Cal (California’s Medicaid program) or through their private insurance plan. However, there is no charge for regional centers to determine a child’s eligibility or to provide service coordination. The regional center will also pay for services while families wait for their insurance plan or Medi-Cal to approve the service.

Payment for early intervention services can be a challenging and burdensome process for families.17First 5 Center for Children’s Policy, Early Identification and Intervention for California’s Infants and Toddlers: 6 Key Takeaways (September 8, 2020),https://first5center.org/publications/early-identification-and-intervention-for-californias-infants-and-toddlers-6-key-takeaways. The process often hinders timely access to services.18To learn more about families’ experience accessing early intervention services in California, see First 5 Center for Children’s Policy, A Family’s Journey Through the Early Identification and Intervention System (September 8, 2020),https://first5center.org/publications/briannas-journey-through-the-early-identification-and-intervention-system.

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All infants and toddlers and their families should have access to a comprehensive set of services that support their health and development. This is especially important for children who experience delays in their development, such as when they’re not playing, learning, speaking, eating, or moving when expected in their early years, which can be a cause for concern.

When families have timely access to early intervention services, they can better meet their children’s needs during their earliest years and throughout their lives. Access to quality health and developmental services promotes a child’s growth and development and supports their families as they learn and live across California communities.

This report provides 5 key facts about the Early Start program, California’s early intervention system, and outlines steps policymakers can take to better support children and their families.

More in this series

For a high-level overview of California’s early intervention system, see Understanding How Infants and Toddlers with Disabilities or Developmental Delays Receive Support.

1. California Provides Early Intervention Services to Thousands of Children Through a Network of Regional Centers

California’s Early Start program serves a diverse population of infants and toddlers with developmental disabilities throughout the state. In 2020-21, more than 75,000 children from birth through age 2 with developmental delays and disabilities were determined eligible for early intervention services by regional centers.1 Regional centers are nonprofit agencies that coordinate services for infants and toddlers as well as for school-aged children and adults. Fiscal year 2020-21 is the most recent year for which data on the infant and toddler population are available. Data include all eligible infants and toddlers, regardless of whether the regional center paid for intervention services or not. Additionally, these data may include duplicate counts if consumers received services from more than one regional center during the fiscal year.

Regional centers serve a racially and ethnically diverse population of infants and toddlers. The largest group of eligible children are Latinx, making up nearly half (46%) of all eligible infants and toddlers. Families with children who identify as multi-race or a race or ethnicity considered “other” on administrative forms are the second largest group of eligible children (21%), and white children make up the third largest group (20%). American Indian or Alaska Native, Asian, Black, and Native Hawaiian/other Pacific Islander children, together, represent approximately 14% of all infants and toddlers served by regional centers.2Counts and percentages for race and ethnicity groups exclude Inland Regional Center (IRC) because IRC was unable to provide valid data by race and ethnicity. Moreover, the percentages shown in this paragraph do not sum to 100 due to rounding.

The largest group of eligible children are Latinx, making up nearly half (46%) of all eligible infants and toddlers.

Families served by regional centers speak many languages. Across all regional centers, the most common languages that families speak are English, Spanish, and Vietnamese. English and Spanish are by far the two most-spoken languages, but the third most common language varies depending on the regional center. For example, in San Diego, the top three languages are English, Spanish, and Arabic.

Given the cultural and linguistic diversity among California families, regional centers should be equipped with the staff and other resources that respond to the unique needs of the state’s diverse population.

2. Spending to Support Infants and Toddlers with Disabilities or Developmental Delays Has Been Relatively Flat

Funding to support early intervention services through California’s Early Start program comes from the state and the federal government. In 2022-23, the state funded about 90% of services.3“Services” refers to the “purchase of service” authorization, utilization, and expenditure for infants and toddlers, which excludes infants and toddlers who are deemed eligible but do not receive services. Welfare and Institutions Code, Division 4.5, sec. 4519.5, https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC&sectionNum=4519.5. This is mainly because the federal government, which provides funding through the Individuals with Disabilities Education Act (IDEA), has historically underfunded these services.4The Education Trust, Increasing Equity in Early Intervention (May 2021),  https://edtrust.org/increasing-equity-in-early-intervention/. When federal policymakers passed IDEA in 1975, they committed to fund 40% of the costs associated with providing special education services, including early intervention services, with state and local funding covering the rest. However, Congress has not fulfilled this promise.

Per capita spending to support California’s infants and toddlers with disabilities or developmental delays has been relatively flat since 2017-18.5Expenditure data reflect a Budget Center analysis of data from the Department of Developmental Services for fiscal years 2017-18 to 2022-23. State funds come from the General Fund, and federal funds come from IDEA and the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. In 2020-21, per capita expenditures temporarily dropped as both the Early Start caseload and overall program spending declined with the onset of the COVID-19 pandemic.6 In 2020-21, Early Start expenditures fell by 22% compared to the previous fiscal year, whereas the number of infants and toddlers enrolled in the program declined by a more modest 13%. In addition to the impacts of COVID-19 on families seeking services, the pandemic affected service coordination and delivery due to a sudden switch to remote services as well as staffing shortages.7US Department of Education, State Performance Plan/Annual Performance Report: Part C (February 1, 2022), 7, https://www.dds.ca.gov/wp-content/uploads/2022/07/2020_Early_Start_Part_C_Annual_Performance_Report.pdf.

A column chart showing inflation-adjusted per capita expenditures for the Early State Program for the fiscal years 2017-2018 to 2022-2023, where spending to support California's infants and toddlers with disabilities or developmental delays has been roughly flat.

Current funding to support California’s infants and toddlers with disabilities or developmental delays is not enough.8California State Auditor, Department of Developmental Services: It Has Not Ensured That Regional Centers Have the Necessary Resources to Effectively Serve Californians with Intellectual and Developmental Disabilities (June 2022), https://www.auditor.ca.gov/reports/2021-107/index.html#QL1. Given that funding for regional centers is based on prior year expenditures as well as caseload growth and service utilization, regional centers may not receive the funding necessary to improve service access and delivery. State and federal policymakers should continue to invest in early intervention services and do so equitably.

3. Per Capita Spending for Black and Native Hawaiian/Other Pacific Islander Families Is the Lowest Compared to Other Groups

Regional centers pay for services for eligible California infants and toddlers who do not receive funding from Medi-Cal or private insurance. State law requires regional centers and the Department of Developmental Services to annually report expenditures broken out by age, race and ethnicity, language, and disability.9California Welfare and Institutions Code, division 4.5, sec. 4519.5.https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC&sectionNum=4519.5.

Regional center support for infants and toddlers across California varies by race and ethnicity. In 2020-21, regional center spending to support Black and Native Hawaiian/other Pacific Islander infants and toddlers with disabilities or developmental delays was the lowest compared to other races and ethnicities, $4,360 and $4,210, respectively.10Inland Regional Center is excluded from this analysis because they were unable to provide valid data by race and ethnicity. As a result, only 20 out of the state’s 21 regional centers are included. To provide more accurate per capita spending by regional centers, the consumer population in this analysis does not include consumers with no purchase of services. Moreover, consumer counts used to calculate per capita spending figures include all consumers who received a regional center-funded service any time during the 2020-21 fiscal year. All consumers are included in this count regardless of their status with the regional center, including those that closed their case, transferred, or are inactive. Per capita spending for other race and ethnicity groups ranged from $4,550 and $5,350, with spending being the highest among Asian infants and toddlers.

A column chart showing per capita expenditures by race and ethnicity across 20 California regional center during the 2022 to 2021 fiscal year, where spending on Native Hawaiian or other Pacific Islander children (ages 0-2) with disabilities or developmental delays is the lowest.

At the regional center level, spending by race and ethnicity varies substantially compared to statewide patterns. For example, per capita spending at North Los Angeles Regional Center ranges between $2,340 and $11,810, where spending for American Indian or Alaska Native children is the lowest.11 Budget Center analysis of California regional center data. The state has invested dollars to implement strategies to advance equity and reduce spending disparities, but improvement is unclear.12Public Counsel, Examining Racial and Ethnic Inequities Among Children Served Under California’s Developmental Services System: Where Things Currently Stand (May 2022), 10, https://www.lpfch.org/sites/default/files/field/publications/2022-disparity-report_californai-developmental-services_regional-centers.pdf. Fully understanding and addressing spending disparities is crucial, and at the same time, the state should also investigate what funding levels are adequate to ensure children with the greatest needs receive the support services they need.

4. California Lags Behind Many Other States in Supporting Infants and Toddlers

An estimated 1 in 6 children in the US have a developmental disability.13Benjamin Zablotsky et al., “Prevalence and Trends of Developmental Disabilities Among Children in the United States: 2009–2017,” Pediatrics 144, no. 4 (October 2019): https://doi.org/10.1542/peds.2019-0811. Yet, in California, only 3% of infants and toddlers receive early intervention services.14“IDEA Section 618 Data Products: Static Tables,” US Department of Education (webpage), accessed September 19, 2022, https://data.ed.gov/dataset/idea-section-618-data-products-static-tables-part-c-child-count-and-settings-table-1/resources. In comparison, 10% of infants and toddlers in Massachusetts receive services.

The low rate of infants and toddlers receiving early intervention services in California is due to myriad factors. One major issue is that not enough children receive developmental screenings, even though all children enrolled in Medi-Cal are entitled to developmental screenings under the Early Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.15Alexandra Parma, Early Identification and Intervention for California’s Infants and Toddlers: 6 Key Takeaways (First 5 Center for Children’s Policy, September 2020),  https://first5center.org/publications/early-identification-and-intervention-for-californias-infants-and-toddlers-6-key-takeaways. Research suggests that California’s developmental screening rate is one of the lowest in the country (26%), which is problematic because screening is the critical first step in connecting children with early intervention services.16A developmental screening is the use of a standardized set of questions to see if a child’s motor, language, cognitive, social, and emotional development are on track for their age. Developmental screenings assess a child’s development and can be done by a doctor or nurse as well as by professionals in health care, early childhood education, community, or school settings. To learn more, see ​​​​​​”Proposition 56 ​Developmental Screenings,​” California Department of Health Care Services (webpage), accessed September 19, 2022, https://www.dhcs.ca.gov/provgovpart/Prop-56/Pages/Prop56-Screenings-Developmental.aspx; “Developmental Monitoring and Screening,” US Department of Health and Human Services (webpage), accessed September 19, 2022,https://www.cdc.gov/ncbddd/childdevelopment/screening.html.

A bar chart showing the percentage of infants and toddlers (ages 0-2) receiving early intervention services in 2020 where California lags behind may other states in serving infants and toddlers with disabilities or developmental delays.

Making matters worse, when infants and toddlers become eligible for early intervention services, the services often are not provided in a timely manner. In fact, California does not meet the requirements for implementing a component of the federal Individuals with Disabilities Education Act known as Part C.17US Department of Education, 43rd Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act, 2021 (January 2022), 222, https://sites.ed.gov/idea/files/43rd-arc-for-idea.pdf. This determination is based on a number of criteria, including if children receive services in a timely manner, receive services in the home or community-based settings, and demonstrate improved outcomes.

California should follow the example set by other states to ensure that all children with a developmental delay have access to early intervention services as early in their lives as possible. Serving more children with disabilities or developmental delays can improve outcomes for children, families, and communities.

5. California’s Early Intervention System Needs Improvement to Ensure Children and Families Receive Access to Services

California’s early intervention system seeks to support children with developmental delays or disabilities, but multiple barriers block children and families from the support they need. Regional center data show significant gaps in families’ access to available dollars for services.18The statewide utilization rate — the share of services that families actually receive based on the amount authorized in their Individualized Family Service Plan — is only 58% for children 0-2. The utilization rate is a common measure of barriers to receiving services because it shows families are only able to access a portion of available dollars for services. Budget Center analysis of California regional center data. Some research suggests that barriers can be attributed to the complexity of navigating services and workforce shortages that impact service delivery.19First 5 Center for Children’s Policy,Systems Interactions: Medi-Cal Managed Care and Other Health Care Delivery for Children on Medi-Cal (May 2021), 3, https://first5center.org/assets/files/FINAL-MMC-Cross-Systems.pdf, and Burns & Associates, Inc., DDS Vendor Rate Study and Models (May 15, 2019), 2, https://www.burnshealthpolicy.com/wp-content/uploads/2019/03/DDS-Vendor-Rate-Study-Report.pdf.

The early intervention system is convoluted and creates barriers for families. For example, children may need services from more than one provider network, and given the current payment structures, determining who pays for what may cause interruptions.20 First 5 Center for Children’s Policy, Systems Interactions, 3. Families served by regional centers also identify other systemic barriers such as the lack of outreach, information, and services in their home languages.21State law requires regional centers to hold annual public meetings to present and discuss service expenditure data and identify strategies for improvement. Parents and other advocates at several regional centers identified ways that service access and equity could improve, including targeted outreach and more inclusion of languages other than English. For an example, see Alta Regional Regional Center’s 2020-21 report on page 11: https://www.altaregional.org/sites/main/files/file-attachments/dds_letter_2022_pos_data_meetings.pdf?1662735412.

“Payment rates, which are set by the state, are not sufficient to promote a stable service provider workforce.”

Payment rates, which are set by the state, are not sufficient to promote a stable service provider workforce.22 Burns & Associates, Inc., DDS Vendor Rate Study, 2. Historically, rates have not kept pace with policy changes aimed at improving services and have not been adjusted to account for inflation.23 Association of Regional Center Agencies, Inadequate Rates for Service Provision in California (January 2014), 12, 26, https://www.dds.ca.gov/wp-content/uploads/2019/02/DSTF_Jan2014ARCA_20190212.pdf Moreover, rates have been subject to freezes or reductions due to budget crises.24Burns & Associates, Inc., DDS Vendor Rate Study and Models, 3. Although the state has reversed budget cuts, rates are still not high enough to support a stable supply of providers, which directly impacts service delivery.25 Burns & Associates, Inc., DDS Vendor Rate Study and Models, 6.

All in all, there are many factors that block California children and families from accessing early intervention services in a timely manner. California policymakers should remove all barriers that prevent families from the support services their children need to develop and thrive during their early years and beyond.

Policy Recommendations for Improving California’s Early Start Program

California can take steps to ensure all infants and toddlers and their families have access to a comprehensive set of services through the Early Start program that support their health and development, which is especially important for children who have disabilities or experience delays in their development.

Recent action by California policymakers to improve intervention services for infants and toddlers include investments in: reducing regional center service coordinator caseloads, providing technical support for service coordinators, expanding eligibility for early intervention services, and taking initial steps to reform provider rates.  

State leaders can build on these policy changes by taking action on the following recommendations:

  • 1
     Regional centers are nonprofit agencies that coordinate services for infants and toddlers as well as for school-aged children and adults. Fiscal year 2020-21 is the most recent year for which data on the infant and toddler population are available. Data include all eligible infants and toddlers, regardless of whether the regional center paid for intervention services or not. Additionally, these data may include duplicate counts if consumers received services from more than one regional center during the fiscal year.
  • 2
    Counts and percentages for race and ethnicity groups exclude Inland Regional Center (IRC) because IRC was unable to provide valid data by race and ethnicity. Moreover, the percentages shown in this paragraph do not sum to 100 due to rounding.
  • 3
    “Services” refers to the “purchase of service” authorization, utilization, and expenditure for infants and toddlers, which excludes infants and toddlers who are deemed eligible but do not receive services. Welfare and Institutions Code, Division 4.5, sec. 4519.5, https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC&sectionNum=4519.5.
  • 4
    The Education Trust, Increasing Equity in Early Intervention (May 2021),  https://edtrust.org/increasing-equity-in-early-intervention/.
  • 5
    Expenditure data reflect a Budget Center analysis of data from the Department of Developmental Services for fiscal years 2017-18 to 2022-23. State funds come from the General Fund, and federal funds come from IDEA and the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.
  • 6
     In 2020-21, Early Start expenditures fell by 22% compared to the previous fiscal year, whereas the number of infants and toddlers enrolled in the program declined by a more modest 13%.
  • 7
    US Department of Education, State Performance Plan/Annual Performance Report: Part C (February 1, 2022), 7, https://www.dds.ca.gov/wp-content/uploads/2022/07/2020_Early_Start_Part_C_Annual_Performance_Report.pdf.
  • 8
    California State Auditor, Department of Developmental Services: It Has Not Ensured That Regional Centers Have the Necessary Resources to Effectively Serve Californians with Intellectual and Developmental Disabilities (June 2022), https://www.auditor.ca.gov/reports/2021-107/index.html#QL1.
  • 9
    California Welfare and Institutions Code, division 4.5, sec. 4519.5.https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC&sectionNum=4519.5.
  • 10
    Inland Regional Center is excluded from this analysis because they were unable to provide valid data by race and ethnicity. As a result, only 20 out of the state’s 21 regional centers are included. To provide more accurate per capita spending by regional centers, the consumer population in this analysis does not include consumers with no purchase of services. Moreover, consumer counts used to calculate per capita spending figures include all consumers who received a regional center-funded service any time during the 2020-21 fiscal year. All consumers are included in this count regardless of their status with the regional center, including those that closed their case, transferred, or are inactive.
  • 11
     Budget Center analysis of California regional center data.
  • 12
    Public Counsel, Examining Racial and Ethnic Inequities Among Children Served Under California’s Developmental Services System: Where Things Currently Stand (May 2022), 10, https://www.lpfch.org/sites/default/files/field/publications/2022-disparity-report_californai-developmental-services_regional-centers.pdf.
  • 13
    Benjamin Zablotsky et al., “Prevalence and Trends of Developmental Disabilities Among Children in the United States: 2009–2017,” Pediatrics 144, no. 4 (October 2019): https://doi.org/10.1542/peds.2019-0811.
  • 14
    “IDEA Section 618 Data Products: Static Tables,” US Department of Education (webpage), accessed September 19, 2022, https://data.ed.gov/dataset/idea-section-618-data-products-static-tables-part-c-child-count-and-settings-table-1/resources.
  • 15
    Alexandra Parma, Early Identification and Intervention for California’s Infants and Toddlers: 6 Key Takeaways (First 5 Center for Children’s Policy, September 2020),  https://first5center.org/publications/early-identification-and-intervention-for-californias-infants-and-toddlers-6-key-takeaways.
  • 16
    A developmental screening is the use of a standardized set of questions to see if a child’s motor, language, cognitive, social, and emotional development are on track for their age. Developmental screenings assess a child’s development and can be done by a doctor or nurse as well as by professionals in health care, early childhood education, community, or school settings. To learn more, see ​​​​​​”Proposition 56 ​Developmental Screenings,​” California Department of Health Care Services (webpage), accessed September 19, 2022, https://www.dhcs.ca.gov/provgovpart/Prop-56/Pages/Prop56-Screenings-Developmental.aspx; “Developmental Monitoring and Screening,” US Department of Health and Human Services (webpage), accessed September 19, 2022,https://www.cdc.gov/ncbddd/childdevelopment/screening.html.
  • 17
    US Department of Education, 43rd Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act, 2021 (January 2022), 222, https://sites.ed.gov/idea/files/43rd-arc-for-idea.pdf.
  • 18
    The statewide utilization rate — the share of services that families actually receive based on the amount authorized in their Individualized Family Service Plan — is only 58% for children 0-2. The utilization rate is a common measure of barriers to receiving services because it shows families are only able to access a portion of available dollars for services. Budget Center analysis of California regional center data.
  • 19
    First 5 Center for Children’s Policy,Systems Interactions: Medi-Cal Managed Care and Other Health Care Delivery for Children on Medi-Cal (May 2021), 3, https://first5center.org/assets/files/FINAL-MMC-Cross-Systems.pdf, and Burns & Associates, Inc., DDS Vendor Rate Study and Models (May 15, 2019), 2, https://www.burnshealthpolicy.com/wp-content/uploads/2019/03/DDS-Vendor-Rate-Study-Report.pdf.
  • 20
     First 5 Center for Children’s Policy, Systems Interactions, 3.
  • 21
    State law requires regional centers to hold annual public meetings to present and discuss service expenditure data and identify strategies for improvement. Parents and other advocates at several regional centers identified ways that service access and equity could improve, including targeted outreach and more inclusion of languages other than English. For an example, see Alta Regional Regional Center’s 2020-21 report on page 11: https://www.altaregional.org/sites/main/files/file-attachments/dds_letter_2022_pos_data_meetings.pdf?1662735412.
  • 22
     Burns & Associates, Inc., DDS Vendor Rate Study, 2.
  • 23
     Association of Regional Center Agencies, Inadequate Rates for Service Provision in California (January 2014), 12, 26, https://www.dds.ca.gov/wp-content/uploads/2019/02/DSTF_Jan2014ARCA_20190212.pdf
  • 24
    Burns & Associates, Inc., DDS Vendor Rate Study and Models, 3.
  • 25
     Burns & Associates, Inc., DDS Vendor Rate Study and Models, 6.

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All Californians deserve to be able to put food on the table, pay the rent, and meet their basic needs. In short, no Californian should ever live in poverty.

Our state should aspire to be a place where no child or adult struggles to afford their basic needs, and there’s proof that it can be a reality. Recent data released by the US Census Bureau show that poverty — especially for children — significantly dropped nationally and in California in 2021, and would have been much higher if not for public supports.

That’s good news that may be unexpected as the effects of the pandemic and inflation are still very real for California children, adults, and families struggling to make ends meet. So many may be wondering: How did poverty rates drop across the US and California? And amid the pandemic no less.

The answer is simple: Poverty is a policy choice. When we choose to provide the basic support families and individuals need to thrive — as policymakers did via tax credits and other support — it really works.

What is the Supplemental Poverty Measure? And why is it important?

Public policies work best when they are crafted with reliable data and provide positive and measurable results at both the macro level and personal level for our communities.

To measure poverty in California and the success of poverty reduction strategies, we rely on data from the US Census Bureau which routinely surveys households across the country. Each September the Census releases new data that show what share of the population experienced poverty in the prior year — under the official poverty measure and the Supplemental Poverty Measure — for California and states across the country, as well as the United States as a whole.

The Supplemental Poverty Measure (SPM) is vital because it provides a more accurate picture of poverty by accounting for local differences in the cost of housing and accounting for expenses that families must pay like health care and child care. The SPM also accounts for a wide variety of safety net supports, including those that are not direct cash payments — including tax credits, food assistance, and housing subsidies. The official poverty measure does not adjust for differences in the costs of living and ignores non-cash benefits. This makes the official poverty measure less useful to evaluate poverty in California as well as the effectiveness of poverty reduction measures.

Bottom line: The SPM captures how much it costs to pay for basic needs and the resources people have available to pay for them.

Want to learn more about poverty measures?

Check out the Budget Center’s guide to understanding poverty measures in California.

Poverty dropped from 2020 to 2021 nationally and in California — what’s behind the drop in poverty, especially for kids?

Multiple factors likely contributed to the drop in poverty year over year, including the improving job market. Data show too that strong public policies played an especially key role in the low poverty rates seen in 2021. To combat the uncertainties of the pandemic and our economy, state and federal governments provided additional support directly to people, and this made the difference for many families in having the resources to pay for food, housing, diapers, and other basic necessities.

Refundable tax credits were especially effective in boosting family resources in 2021, particularly because of temporary expansions of federal credits last year. Without these credits, overall poverty would have been significantly higher in 2021.

Unfortunately, the temporary expansion to the federal Child Tax Credit that lifted nearly 3 million children out of poverty nationally last year has now expired due to Congress’ failure to permanently expand the credit. The temporary expansion of the federal Earned Income Tax Credit (EITC) for workers without dependent children has also expired. But the evidence is clear — federal policymakers can significantly lower poverty by permanently expanding the Child Tax Credit and the EITC and state policymakers can build on the success of California’s refundable tax credits, the CalEITC and Young Child Tax Credit.

How did housing costs affect California’s poverty rate?

There is no question safe, stable housing is the foundation to families’ basic needs being met, yet the cost of housing is a challenge in many parts of the state — and high housing costs directly affect California’s SPM poverty rate.

California’s poverty rate in 2021 was higher under the Supplemental Poverty Measure than under the official poverty measure — and this has been true in every year that SPM poverty data have been available, going back more than 10 years. This is mainly because, as previously noted, the SPM accounts for local differences in housing costs, so that families need more resources to be categorized as above the SPM poverty threshold (and not experiencing poverty) in places where housing is expensive, which include many parts of California. These data point to another way policymakers can effectively reduce poverty — by addressing California’s housing affordability challenges, through boosting the supply of affordable housing, protecting tenants, and providing direct support to help people afford housing costs.

Why does it matter for everyday Californians that the poverty rate dropped?

The lower 2021 poverty rate shows that our economy and safety net can work better for everyday Californians when good policy and investment come together to help people meet their basic needs. It reveals how many people can meet basic expenses like housing, food, child care, and other necessities — and it also reveals where our public policies are sorely failing.

A lower poverty rate under the Supplemental Poverty Measure means fewer families worrying about where their next meal comes from or wondering if they can keep the lights on. And while the encouraging Census data does not diminish the fact that the high cost of housing and recent high inflation have made it even more difficult for families to flourish in California communities, it does help us understand how we can build on public policies that work to help families now and in the future.

Poverty data from 2021 show that when increased state and federal support was provided, more people were able to count on having enough resources to make ends meet.

What were the primary forms of assistance people received to help meet their basic needs?

Safety net programs that help people pay for food, health care, housing, child care, and other basic needs are essential to the well-being of our people and state.

Current safety net programs — including those used to successfully lower poverty rates in 2021 — are a combination of state and federal supports aimed at helping individuals and families pay for basic needs. These programs can be divided into three categories including cash supports, tax credits, and non-cash benefits.

  • Cash support through tax credits: Federal Child Tax Credit and EITC, state CalEITC and Young Child Tax Credit, as well as child and dependent care tax credits and pandemic stimulus payments.
  • Other cash supports: Social Security, TANF (known as CalWORKs in California), Supplemental Security Income/State Supplementary Payment (SSI/SSP), Unemployment Insurance.
  • Non-cash benefits: SNAP food assistance (known as CalFresh in California), Supplemental Nutrition Program for Women, Infants, and Children (WIC), school meals, energy assistance, and housing subsidies like federal Housing Choice Vouchers.

Together, these programs significantly reduced poverty, particularly child poverty, in California in 2021.

Additional programs that help reduce the out-of-pocket costs people must pay for necessary expenses — particularly Medi-Cal health coverage and subsidized child care — also reduced the number of Californians experiencing poverty last year.

It’s important to remember that each program has unique and sometimes burdensome processes to receive assistance. Moving forward, policymakers should streamline and strengthen existing programs in order to further reduce poverty every year.

What can policymakers learn from the latest poverty data?

First and foremost, the latest Census data show us that poverty is a policy choice — we can choose to provide support needed so that families and individuals can thrive.

Federal and state governments have effective tools — like refundable tax credits — for getting cash to people and rapidly reducing poverty. When we prioritize the health and well-being of everyday people regardless of their race, age, or immigration status the result will be a country where far fewer people experience poverty and its devastating consequences.

State and federal policymakers should boost investment in the policies and tools we know are effective in helping families and individuals meet their basic needs to end poverty in California and across the country.

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Mental health is an essential part of overall health and well-being for Californians no matter one’s age, zip code, gender identity, or sexual orientation. Everyone should have the opportunity to be healthy and thrive, yet LGBTQ+ people disproportionately experience mental health challenges compared to non-LGBTQ+ people.1The acronym “LGBTQ+” is a collective acronym for lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender identities. The addition of the “+” indicates inclusion of other identities not encompassed by “LGBTQ,” including but not limited to those who identify as intersex, nonbinary, and asexual. For more information about terminology used in this report, see GLAAD Media Reference Guide, https://www.glaad.org/reference/terms. This was true even before the pandemic, when many Californians experienced stress, grief, isolation, depression, and other hardships.

Many LGBTQ+ Californians Reported Poor Mental Health During the Pandemic

Over the past several months, LGBTQ+ Californians have experienced more mental health hardship than cisgender and straight Californians, according to data from the US Census Bureau Household Pulse Survey collected between July 2021 and March 2022.2A cisgender person is a person whose gender identity aligns with the sex they were assigned at birth. Data reflect the period between July 21, 2021 and March 14, 2022. While the US Census Bureau began administering the Household Pulse Survey in April 2020, it only began including questions about sexual orientation and gender identity in July 2021. Overall, about half of LGBTQ+ Californians reported poor mental health during the pandemic, which is defined as symptoms of depression, anxiety, or both. Mental health hardship was particularly pronounced among transgender Californians, with about two-thirds experiencing symptoms of poor mental health. In addition, about 6 in 10 bisexual Californians and more than 4 in 10 gay or lesbian Californians experienced poor mental health, compared to less than one-third of straight Californians.

Bar Chart: Transgender Californians have experienced more mental health hardship compared to cisgender people.

The Household Pulse Survey includes relatively detailed information on gender identity and sexual orientation, which is significant because US Census Bureau surveys generally fail to capture this information, making it impossible to compare outcomes between LGBTQ+ and non-LGBTQ+ communities. However, the Household Pulse Survey data still do not fully reflect the complexity, nuance, and full spectrum of identities.

Bar Chart: Bisexual, gay, and lesbian Californians have experienced more mental health hardship compared to straight people.

Many LGBTQ+ Californians Did Not Receive Mental Health Care When Needed

More than 1 in 5 LGBTQ+ Californians reported that they needed mental health services but did not receive them, compared to about 1 in 10 straight, cisgender people. LGBTQ+ people have unique barriers in accessing care, such as discrimination or fears of discrimination as well as a lack of competent providers and gender-affirming care.3Susan H. Babey et al., Gaps in Health Care Access and Health Insurance Among LGBT Populations in California (UCLA Center for Health Policy Research, February 2022) https://healthpolicy.ucla.edu/publications/Documents/PDF/2022/Health-Care-Access-Insurance-LGBT-policybrief-feb2022.pdf. See also Jennifer Kates et el., Health and Access to Care and Coverage for Lesbian, Gay, Bisexual, and Transgender (LGBT) Individuals in the U.S. (Kaiser Family Foundation, May 3, 2018) https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-and-access-to-care-and-coverage-for-lesbian-gay-bisexual-and-transgender-individuals-in-the-u-s/. For example, providers may refuse to use the names and pronouns that correspond with an individual’s gender identity, question an individual’s stated sexual orientation, or fail to acknowledge someone’s relationship as legitimate.4Rory P. O’Brien et al., Mapping the Road to Equity: The Annual State of LGBTQ Communities (#Out4MentalHealth Project, 2018), 70-82, https://californialgbtqhealth.org/wp-content/uploads/2018/12/O4MH-Mapping-the-Road-to-Equity.pdf.

LGBTQ+ People Face Multiple Stressors That Are Harmful to Health

Even before the pandemic, Californians who reported their gender as transgender or gender nonconforming as well as those who identified as gay, lesbian, or bisexual were much more likely to report serious psychological distress compared to cisgender and straight Californians, respectively.5Serious psychological distress is an estimate of adults who have serious, diagnosable mental health disorders that warrant mental health treatment. See D. Imelda Padilla-Frausto et al., Serious Psychological Distress on the Rise Among Adults in California (UCLA Center for Health Policy Research, September 2020), 4-5, https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/SPD-policybrief-sep2020.pdf. Experiences with discrimination, family or social rejection, and internalized oppression that many LGBTQ+ people face likely contribute to these higher rates of distress. For example, in a nationally representative sample of adults, including 489 adults identifying as LGBTQ, more than half of the LGBTQ respondents reported having experienced or having a LGBTQ friend or family member who had experienced personal discrimination such as slurs, harassment, violence, or threats of violence.6Harvard T.H. Chan School of Public Health, Robert Wood Johnson Foundation, and National Public Radio, Discrimination in America: Experiences and Views of LGBTQ Americans (November 2017), 1, https://cdn1.sph.harvard.edu/wp-content/uploads/sites/94/2017/11/NPR-RWJF-HSPH-Discrimination-LGBTQ-Final-Report.pdf. For more background on the factors that may contribute to higher rates of mental health challenges for specific LGBTQ+ populations, including LGBTQ+ people of color, see Pasha Mikalson Walker et al., Surveying the Road to Equity: The Annual State of LGBTQ Communities (#Out4MentalHealth Project, 2019), https://californialgbtqhealth.org/wp-content/uploads/2020/11/Surveying-the-Road-to-Equity-2019-State-of-LGBTQ-Communities-Report.pdf. About 1 in 5 reported having experienced discrimination in employment or housing.7Discrimination in America.

Economic Challenges May Worsen Mental Health for LGBTQ+ Communities

In addition to creating psychological distress, discrimination faced by LGBTQ+ individuals may lead to economic challenges such as poverty and homelessness, putting them at further risk of experiencing poor mental health outcomes. Between July 2021 and October 2021, people who identify as LGBT nationally were more likely to report difficulty paying for household expenses, such as food, rent, mortgage, and car payments than non-LGBT people, according to a report from the Williams Institute.8Kerith J. Conron et al., Food Insufficiency Among LGBT Adults During the COVID-19 Pandemic (The Williams Institute, April 2022), 4, https://williamsinstitute.law.ucla.edu/wp-content/uploads/LGBT-Food-Insufficiency-Apr-2022.pdf.

Californians who are LGBTQ+ and have low incomes have experienced an especially high rate of poor mental health during the pandemic. About 6 in 10 LGBTQ+ Californians in households with incomes less than $50,000 experienced poor mental health between July 2021 and March 2022, according to the Household Pulse Survey data. In contrast, about 4 in 10 non-LGBTQ+ Californians in households with incomes under $50,000 had poor mental health symptoms.

Income, cost of living, and socioeconomic status all impact people’s health. Research shows that low levels of household income and mental health conditions are related.9Jitender Sareen et al., “Relationship Between Household Income and Mental Disorders: Findings From a Population-Based Longitudinal Study,” Archives of General Psychiatry 68 (April 2011): 419–427, doi:10.1001/archgenpsychiatry.2011.15. Adults living in poverty are about three times more likely to report feeling nervous all or most of the time and four times more likely to report feeling sad all or most of the time compared to adults with higher incomes.10“Adults living in poverty” refers to adults who live in families with incomes below the poverty threshold. “Adults with higher incomes” refers to adults who live in families with incomes that are 200% of the poverty threshold or greater. “Interactive Summary Health Statistics for Adults,” National Center for Health Statistics (webpage), 2018 National Health Interview Survey, accessed April 18, 2022, https://www.cdc.gov/nchs/nhis/ADULTS/www/index.htm. Having a low income makes it difficult to afford health care, quality housing, and retirement savings — all of these stressors negatively impact both physical and mental health.

LGBTQ+ people with low incomes must navigate multiple and compounding stressors related to their economic situation as well as their gender identity and/or sexual orientation, which can be especially harmful to their mental health.

State Leaders Should Address the Mental Health Needs of LGBTQ+ Californians

State policymakers should address the unique needs of LGBTQ+ Californians as they work to increase access to mental health services and bolster the state’s mental health workforce. For instance, state leaders can promote LGBTQ+-affirming training for behavioral health providers to better serve Californians receiving health services through Medi-Cal, as some advocates have proposed. Policymakers can also invest in efforts to make sure that the behavioral health workforce better reflects the diversity of all Californians, including their gender identities and sexual orientations.

Information About the US Census Bureau Household Pulse Survey Data:

The US Census Bureau Household Pulse Survey measures how the COVID-19 pandemic has impacted households across the country from a social and economic perspective. In July 2021, the survey began collecting information on current gender identity, sex assigned at birth, and sexual orientation. For the gender identity dimension, the possible responses are 1) male, 2) female, 3) transgender, and 4) none of these. The possible responses for the sexual orientation question are 1) gay or lesbian, 2) straight, that is not gay or lesbian, 3) bisexual, 4) something else, and 5) I don’t know.

Because some transgender individuals select male or female as their primary gender identity, the data presented for transgender Californians in this report also include respondents identifying as male or female whose current gender identity is different than their sex assigned at birth.

Data Displayed in this Report:

This report does not display results for respondents who selected “none of these” on the gender identity question or those who selected “something else” or “I don’t know” to the sexual orientation question — unless the respondents were categorized as gay or lesbian, bisexual, or transgender based on other survey responses. Previous research suggests that people selecting these options may or may not identify as LGBTQ+.11Conron et al., Food Insufficiency, 17. Given the inconclusiveness of these data, it may not be appropriate to assume that people selecting these responses are LGBTQ+. However, excluding these responses means that the data do not fully represent the experiences of some groups of LGBTQ+ Californians. These groups include but are not limited to: those who identify as nonbinary, genderqueer, gender fluid, two-spirit, or another gender identity; those identifying as pansexual, asexual, or another sexual orientation; and those questioning their sexual orientation or gender identity.

Why Inclusive Information Matters for California Policy:

In order to better understand the experiences and needs of various LGBTQ+ populations, it is crucial that future federal, state, local, and nongovernmental surveys both include questions about gender identity and sexual orientation and also refine these questions to more accurately reflect the diversity of LGBTQ+ communities. Policymakers can advance health and economic equity for LGBTQ+ individuals by ensuring that publicly funded data efforts include comprehensive and inclusive information about gender identities and sexual orientations.

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