All Californians should be able to afford food, yet many struggle to meet this basic need. CalFresh, or SNAP as it’s known federally, provides around 5 million Californians with low incomes monthly benefits to purchase food. Since the beginning of the COVID-19 pandemic, CalFresh benefits were increased with emergency allotments (EA) of federal funds. In January alone, over $521 million additional dollars went out across California to CalFresh recipients. For reference, the total CalFresh issuance was about $1.36 billion in the same month. Emergency allotments accounted for nearly 40% of that amount.
Increased safety net supports, in particular EA, played an important role in reducing child poverty across California in recent years. However, this additional funding came to an end in March, which reduced families’ monthly CalFresh assistance by at least $95, and up to $258 in some cases, amid rising food prices. Already, 1 in 4 families nationwide are reporting increased levels of food insufficiency, according to recent Census data. This figure is on par with states that ended their participation in the EA program before the benefits expired federally. The loss of these additional food benefits is expected to undermine the recent decline in child poverty. With the federal Farm Bill up for reauthorization this year, federal policymakers should improve benefit adequacy in order to keep up the progress made in recent years. In addition, state leaders should take steps to raise the CalFresh monthly benefits and broaden eligibility to currently excluded Californians to avoid pushing millions of families over the hunger cliff.
Millions of Californians Receiving CalFresh Benefited from Emergency Allotments, January 2023
Congressional District
Representative
Party
Estimated Average Number of Participants, 2022*
CalFresh Participants as a Share of the District Population
Estimated EA CalFresh Benefits in January 2023**
Rank (Highest to Lowest EA Benefit)
California
N/A
N/A
4,896,000
12.5%
$521,115,000
N/A
1
Doug LaMalfa
Republican
119,000
15.5%
$13,865,000
5
2
Jared Huffman
Democratic
76,000
9.9%
$8,949,000
34
3
Kevin Kiley
Republican
49,000
6.3%
$6,716,000
48
4
Mike Thompson
Democratic
66,000
8.7%
$8,074,000
37
5
Tom McClintock
Republican
82,000
10.6%
$11,274,000
25
6
Ami Bera
Democratic
116,000
15.4%
$11,492,000
22
7
Doris Matsui
Democratic
117,000
15.4%
$11,276,000
24
8
John Garamendi
Democratic
89,000
11.9%
$7,090,000
45
9
Josh Harder
Democratic
107,000
13.9%
$11,352,000
23
10
Mark DeSaulnier
Democratic
37,000
4.9%
$6,234,000
49
11
Nancy Pelosi
Democratic
80,000
11.3%
$10,288,000
27
12
Barbara Lee
Democratic
92,000
12.5%
$7,499,000
41
13
John Duarte
Republican
146,000
18.7%
$14,458,000
4
14
Eric Swalwell
Democratic
50,000
6.7%
$7,507,000
40
15
Kevin Mullin
Democratic
42,000
5.7%
$4,404,000
52
16
Anna Eshoo
Democratic
33,000
4.5%
$4,755,000
51
17
Ro Khanna
Democratic
35,000
4.7%
$5,374,000
50
18
Zoe Lofgren
Democratic
89,000
12.2%
$6,794,000
47
19
Jimmy Panetta
Democratic
50,000
6.5%
$7,012,000
46
20
Kevin McCarthy
Republican
116,000
15.1%
$16,011,000
3
21
Jim Costa
Democratic
199,000
26.3%
$16,958,000
1
22
David G. Valadao
Republican
188,000
23.6%
$16,318,000
2
23
Jay Obernolte
Republican
150,000
19.7%
$11,905,000
7
24
Salud Carbajal
Democratic
69,000
9.1%
$8,378,000
36
25
Raul Ruiz
Democratic
149,000
19.4%
$12,351,000
6
26
Julia Brownley
Democratic
61,000
8.1%
$7,273,000
42
27
Mike Garcia
Republican
117,000
15.6%
$11,639,000
9
28
Judy Chu
Democratic
66,000
8.9%
$11,613,000
11
29
Tony Cárdenas
Democratic
121,000
16.4%
$11,593,000
17
30
Adam Schiff
Democratic
101,000
13.9%
$11,608,000
12
31
Grace Napolitano
Democratic
100,000
13.6%
$11,593,000
17
32
Brad Sherman
Democratic
69,000
9.1%
$11,595,000
16
33
Pete Aguilar
Democratic
126,000
16.5%
$11,724,000
8
34
Jimmy Gomez
Democratic
137,000
18.2%
$11,608,000
12
35
Norma Torres
Democratic
95,000
12.3%
$11,635,000
10
36
Ted Lieu
Democratic
44,000
6.0%
$11,608,000
12
37
Sydney Kamlager
Democratic
165,000
21.9%
$11,562,000
20
38
Linda Sánchez
Democratic
81,000
10.9%
$11,239,000
26
39
Mark Takano
Democratic
99,000
13.0%
$9,561,000
29
40
Young Kim
Republican
37,000
4.9%
$7,562,000
39
41
Ken Calvert
Republican
71,000
9.0%
$9,629,000
28
42
Robert Garcia
Democratic
121,000
16.3%
$11,593,000
17
43
Maxine Waters
Democratic
166,000
22.5%
$11,562,000
20
44
Nanette Barragán
Democratic
116,000
15.4%
$11,608,000
12
45
Michelle Steel
Republican
84,000
11.2%
$7,665,000
38
46
Lou Correa
Democratic
103,000
13.6%
$7,171,000
44
47
Katie Porter
Democratic
40,000
5.3%
$7,186,000
43
48
Darrell Issa
Republican
68,000
9.1%
$9,244,000
30
49
Mike Levin
Democratic
40,000
5.3%
$8,469,000
35
50
Scott Peters
Democratic
51,000
6.8%
$9,077,000
32
51
Sara Jacobs
Democratic
87,000
11.4%
$9,065,000
33
52
Juan Vargas
Democratic
125,000
16.5%
$9,101,000
31
* Figures are rounded to the nearest 100. Estimates do not sum to total due to rounding and excluded zip code data.
** Figures are rounded to the nearest 1,000. Estimates do not sum to total due to rounding and excluded zip code data.
Note: Values for California reflect the actual number of CalFresh participants from January to December 2022 and the total value of SNAP Emergency Allotment spent in January 2023. District-level estimates are based on zip code-level data for CalFresh recipients in December 2022. About 1% of zip code-level data are excluded due to hidden totals for de-identification purposes and special classifications of zip codes. Therefore, participation for some congressional districts may be underestimated. Data are for individuals receiving federal SNAP benefits and do not reflect individuals receiving state-funded assistance through the California Food Assistance Program.
Source: California Budget & Policy Center analysis of data from the Department of Social Services and US Census Bureau, American Community Survey
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Health care should be accessible and affordable to all Californians. No one should ever have to skip or delay health care due to the cost. Forgoing preventive care or treatment for health conditions is harmful to health and well-being.
Unfortunately, many Californians lack access to affordable health care. For some, monthly health insurance premiums are too high, and so they go without coverage. But even when people have health insurance, steep out-of-pocket costs — such as copays and deductibles — often deter individuals from obtaining the care they need. The impact of unaffordable care falls disproportionately on Californians of color due to a legacy of racist policies and practices:
Latinx Californians are most likely to experience problems paying medical bills, followed by Black, white, and Asian Californians.
Latinx and Black Californians are more likely to report having medical debt.
Black and Latinx Californians are most likely to skip health care services due to the cost.
Ensuring that all Californians have access to affordable health coverage and that they can access care when they need it will require additional state investments. In fact, funds are already available to make coverage more affordable for hundreds of thousands of Californians. Yet, Governor Newsom has blocked efforts to use these funds to boost affordability assistance.
California’s Individual Mandate Penalty: A Funding Source to Help Make Health Coverage More Affordable
In 2019, state policymakers created a penalty that applies, with certain exceptions, to people who lack minimum essential health coverage. This penalty is formally called the “Individual Shared Responsibility Penalty,” but is more commonly known as the “individual mandate penalty.”
The individual mandate penalty has two primary purposes:
Encourage young and healthy people — who might be inclined to go without health insurance — to enroll in coverage in order to ensure a more balanced “risk pool” and prevent premiums from spiraling upward.
Provide a funding source to reduce the cost of health insurance for people who buy coverage through Covered California, our state’s health insurance marketplace.
The individual mandate penalty can be costly. An adult who lacks coverage for an entire year and doesn’t qualify for an exemption must pay at least $850 plus $425 per dependent child under 18 in the household. This means that a family with two adults and two children could face a penalty of at least $2,550.
Many Californians with low-to-moderate incomes are penalized for lacking health coverage. Specifically, nearly 2 in 5 households who reported that they owed the penalty for tax year 2020 had incomes at or below 266% of the federal poverty level (FPL). In 2020, 266% FPL reflected an annual income of around $34,000; for a family of four, it was about $69,700.
Individual Mandate Penalty Revenue Has Not Been Used for Its Intended Purpose
California is expected to raise a total of $1.4 billion in individual mandate penalty revenue across four state fiscal years: 2020-21 through 2023-24, which begins on July 1, 2023. (The penalty revenue is deposited into the state’s General Fund.) However, none of these dollars have been specifically budgeted to reduce the cost of insurance purchased through Covered California. Instead, some penalty revenue appears to have been absorbed by the state’s General Fund and used to support other public systems and services.
Notably, state leaders did agree in 2021 to deposit $334 million in penalty revenue into a new Health Care Affordability Reserve Fund. These dollars were explicitly set aside to fund affordability assistance for Covered California enrollees.
However, last year the governor halted implementation of an affordability assistance program that would have been supported with the penalty reserve funds. This program would have eliminated deductibles and reduced copays for hundreds of thousands of Californians who purchase health insurance through Covered California — including people with low-to-moderate incomes.
Moreover, the governor now proposes to transfer all $334 million in penalty revenue from the Health Care Affordability Reserve Fund to the state’s General Fund in order to help address the projected budget shortfall. With this proposal, the governor makes clear that he does not prioritize using the penalty revenue for its intended purpose: further reducing the cost of health coverage for Californians who are struggling to afford the cost of care.
The governor also has failed to outline a plan for how to use the hundreds of millions of dollars in penalty revenue that the state will continue to receive each year from Californians who lack minimum essential health coverage. Without a plan, penalty dollars will end up supporting general state budget costs rather than being targeted to assist Californians struggling with the high cost of health care.
Penalizing Californians with Low-to-Moderate Incomes Without Addressing Health Care Affordability Is an Injustice
Penalizing Californians with low-to-moderate incomes for not obtaining health coverage and then failing to use the penalty revenue to address the high cost of coverage and care is an injustice. Additional financial assistance is critical for Californians who are uninsured and struggling to purchase coverage as well as for those who are insured but can’t afford to access the care they need. Governor Newsom should ensure that dollars raised from the state’s individual mandate penalty help people afford health insurance through Covered California, as was intended when the penalty was established.
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The Supplemental Nutrition Assistance Program (SNAP) — known as CalFresh in California — is the largest federal food assistance program for families with low incomes. On average, nearly 5 million Californians received CalFresh benefits each month in 2022. While CalFresh participation varied across the state, around one-quarter of the population in three congressional districts depended on this program to put food on their tables.
CalFresh has been instrumental in recent years in combating poverty and feeding families as the effects of the COVID-19 pandemic continue to be felt throughout the state. This year, the program is due for reauthorization at the federal level, with the Farm Bill set to expire in September. With much of the COVID-19 pandemic relief ending or being rolled back, including SNAP emergency allotments and Pandemic EBT, many CalFresh recipients will see their benefits decrease.1See report by the Center on Budget and Policy Priorities for additional information on temporary pandemic-related SNAP benefits. Food insecurity across California may be exacerbated without this additional support that many families have come to rely on. Federal and state leaders should protect and strengthen CalFresh.
Almost 5 Million Californians Benefited from CalFresh Every Month in 2022
Congressional District
Representative
Party
Estimated Average Number of Participants, 2022*
CalFresh Participants as a Share of the District Population
Rank (Highest to Lowest Percentage)
Estimated Annual CalFresh Benefits**
California
4,896,000
12.5%
N/A
$14,167,234,000
1
Doug LaMalfa
Republican
119,000
15.5%
14
$343,478,000
2
Jared Huffman
Democratic
76,000
9.9%
33
$219,919,000
3
Kevin Kiley
Republican
49,000
6.3%
44
$140,823,000
4
Mike Thompson
Democratic
66,000
8.7%
39
$190,732,000
5
Tom McClintock
Republican
82,000
10.6%
32
$236,896,000
6
Ami Bera
Democratic
116,000
15.4%
17
$336,949,000
7
Doris Matsui
Democratic
117,000
15.4%
16
$338,716,000
8
John Garamendi
Democratic
89,000
11.9%
27
$257,694,000
9
Josh Harder
Democratic
107,000
13.9%
19
$310,064,000
10
Mark DeSaulnier
Democratic
37,000
4.9%
50
$107,334,000
11
Nancy Pelosi
Democratic
80,000
11.3%
29
$230,125,000
12
Barbara Lee
Democratic
92,000
12.5%
24
$266,687,000
13
John Duarte
Republican
146,000
18.7%
7
$423,842,000
14
Eric Swalwell
Democratic
50,000
6.7%
42
$145,099,000
15
Kevin Mullin
Democratic
42,000
5.7%
46
$122,618,000
16
Anna Eshoo
Democratic
33,000
4.5%
52
$96,740,000
17
Ro Khanna
Democratic
35,000
4.7%
51
$100,676,000
18
Zoe Lofgren
Democratic
89,000
12.2%
26
$258,159,000
19
Jimmy Panetta
Democratic
50,000
6.5%
43
$144,907,000
20
Kevin McCarthy
Republican
116,000
15.1%
18
$334,899,000
21
Jim Costa
Democratic
199,000
26.3%
1
$575,427,000
22
David G. Valadao
Republican
188,000
23.6%
2
$543,496,000
23
Jay Obernolte
Republican
150,000
19.7%
5
$434,598,000
24
Salud Carbajal
Democratic
69,000
9.1%
34
$201,017,000
25
Raul Ruiz
Democratic
149,000
19.4%
6
$430,416,000
26
Julia Brownley
Democratic
61,000
8.1%
40
$176,388,000
27
Mike Garcia
Republican
117,000
15.6%
13
$338,138,000
28
Judy Chu
Democratic
66,000
8.9%
38
$190,214,000
29
Tony Cárdenas
Democratic
121,000
16.4%
11
$351,133,000
30
Adam Schiff
Democratic
101,000
13.9%
20
$293,270,000
31
Grace Napolitano
Democratic
100,000
13.6%
22
$290,362,000
32
Brad Sherman
Democratic
69,000
9.1%
36
$200,042,000
33
Pete Aguilar
Democratic
126,000
16.5%
9
$363,765,000
34
Jimmy Gomez
Democratic
137,000
18.2%
8
$395,248,000
35
Norma Torres
Democratic
95,000
12.3%
25
$276,276,000
36
Ted Lieu
Democratic
44,000
6.0%
45
$126,011,000
37
Sydney Kamlager
Democratic
165,000
21.9%
4
$476,158,000
38
Linda Sánchez
Democratic
81,000
10.9%
31
$234,789,000
39
Mark Takano
Democratic
99,000
13.0%
23
$287,857,000
40
Young Kim
Republican
37,000
4.9%
49
$106,302,000
41
Ken Calvert
Republican
71,000
9.0%
37
$204,736,000
42
Robert Garcia
Democratic
121,000
16.3%
12
$349,609,000
43
Maxine Waters
Democratic
166,000
22.5%
3
$479,267,000
44
Nanette Barragán
Democratic
116,000
15.4%
15
$336,596,000
45
Michelle Steel
Republican
84,000
11.2%
30
$242,049,000
46
Lou Correa
Democratic
103,000
13.6%
21
$299,049,000
47
Katie Porter
Democratic
40,000
5.3%
48
$115,231,000
48
Darrell Issa
Republican
68,000
9.1%
35
$197,230,000
49
Mike Levin
Democratic
40,000
5.3%
47
$116,891,000
50
Scott Peters
Democratic
51,000
6.8%
41
$147,559,000
51
Sara Jacobs
Democratic
87,000
11.4%
28
$252,617,000
52
Juan Vargas
Democratic
125,000
16.5%
10
$361,732,000
* Figures are rounded to the nearest 100. Estimates do not sum to total due to rounding and excluded zip code data. ** Figures are rounded to the nearest 1,000. Estimates do not sum to total due to rounding and excluded zip code data.
Note: Values for California reflect the actual number of CalFresh participants and the total value of CalFresh benefits for January through December. District-level estimates are based on zip code-level data for CalFresh recipients in December 2022. About 1% of zip code-level data are excluded due to hidden totals for de-identification purposes and special classifications of zip codes. Therefore, participation for some congressional districts may be underestimated. Data are for individuals receiving federal SNAP benefits and do not reflect individuals receiving state-funded assistance through the California Food Assistance Program.
Source: California Budget & Policy Center analysis of data from the Department of Social Services and US Census Bureau, American Community Survey
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All California children deserve to grow up in a state that provides their basic needs. CalWORKs is a key part of the California safety net designed to provide families with low incomes financial support to meet their basic needs. However, state policies that reinforce counterproductive federal work requirements limit families’ access to this program. These policies include penalizing CalWORKs parents who are not meeting program requirements by imposing unnecessarily harsh sanctions that reduce their monthly grants.
On average, the families of 60,000 children are affected by sanctions each month.1Based on Budget Center analysis of Department of Social Services data for August 2022, the most recent month with available statewide data. For typical CalWORKs single-parent families, sanctions can cut monthly grants by about $120, and a single-parent family with two children can lose up to a maximum of $235 each month. If the family’s grant is reduced by sanctions for an entire year, they can lose up to $2,820 annually — or about one-fifth of the total income they would otherwise receive from CalWORKs to pay for their basic needs.
Research shows that sanctioned recipients are often those who face the most barriers to employment and do not fully understand the sanctions process due to limited education, learning disabilities, or mental health problems.2Rachel Kirzner, TANF Sanctions: Their Impact on Earnings, Employment, and Health (Center for Hunger-Free Communities, Drexel University, March 23, 2015). As California moves to reimagine the CalWORKs program to better support participants, building on recent state reforms including CalWORKs 2.0 and Cal-OAR, and reconsidering the penalty pass-on structure related to the Work Participation Rate (WPR), it must also consider the negative impact of sanctions on families. California should strive to lift families up through its safety net programs by offering support and can take steps to minimize the amount or length of sanctions to reduce harm to families.
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All parents should have the support they need to ensure economic security for their children and themselves. CalWORKs is California’s primary program to help families with children that are struggling to secure a basic income to meet their needs. Recent state reforms to CalWORKs are designed to improve the program’s capacity to effectively focus on supporting parents to identify goals, address barriers, and secure durable improvements in economic stability and family well-being.
However, state CalWORKs policy continues to threaten counties with financial penalties tied to the federally-defined Work Participation Rate (WPR), incentivizing counties and caseworkers to direct CalWORKs participants away from supportive activities to address barriers that do not fully count toward meeting the federal WPR.
Removing this threat of financial penalty could better align state policy with the CalWORKs program’s current focus, facilitating full implementation of strategies designed to effectively support parents and families in securing long-term stability and well-being. Policymakers also have options to build on these reforms to further support families participating in CalWORKs.
CalWORKs Participants Face Multiple Challenges to Securing Economic Security
CalWORKs is California’s version of the federal Temporary Assistance for Needy Families (TANF) program and supports more than 300,000 families throughout the state, providing modest monthly cash grants while helping stabilize families and supporting parents in addressing barriers to employment and finding jobs.1For additional discussion of the CalWORKs program, recent reforms, work requirements, and the federal WPR, see also Esi Hutchful, Undercutting the Needs of California Families: The Harm of Racist, Sexist Work Requirements & Penalties in CalWORKs (California Budget & Policy Center, 2022). CalWORKs parents face a labor market in which gender- and race-based discrimination are ongoing, as well as workplace expectations and practices that make it difficult for parents to balance work with caregiving responsibilities. These dynamics significantly affect CalWORKs parents, who are predominantly women, people of color, and parents of young children.
CalWORKs parents also face an economy where a postsecondary credential is increasingly required to access all but the lowest-paying jobs. Yet nearly half of CalWORKs household heads do not have a high school degree or equivalent, reflecting structural barriers to education that many have encountered, again pointing to the effects of racism and sexism embodied by past and ongoing policies and practices across a variety of domains.2Adriana Ramos-Yamamoto and Monica Davalos, Confronting Racism, Overcoming COVID-19, & Advancing Health Equity (California Budget & Policy Center, 2021).
In addition, many CalWORKs parents also experience significant health challenges. Among parents completing appraisals of strengths and barriers at program entry, 28% faced mental health challenges, 5% struggled with substance abuse, and 18% had faced domestic abuse.3Data reflect the share of CalWORKs participants recommended for services to address mental health, substance abuse, or domestic abuse among those completing Online CalWORKs Appraisal Tool (OCAT) assessments during fiscal year 2019-20. Source: Budget Center analysis of Department of Social Services data from Department of Social Services, CalWORKs Annual Summary (November 2022). These additional barriers can negatively affect both parents’ employment prospects and their families’ broader well-being.
Supporting Parents to Address Barriers Can Improve Long-Term Employment and Child and Family Well-Being
There are multiple reasons for the CalWORKs program to prioritize supporting parents in addressing the barriers they face:
Challenges related to limited education and mental health, substance use, and domestic abuse barriers limit parents’ capacity to work at all and limit the quality of jobs parents can secure. Addressing these barriers improves parents’ likelihood of success in securing and retaining jobs and improves parents’ access to jobs with higher pay and more job security over the short-term and the long-term.
Addressing these challenges also promotes child well-being and family stability. Parental struggles with mental health, substance use, and domestic abuse are risk factors linked to child neglect leading to child welfare involvement.4Lindsey Palmer, et al. “What Does Child Protective Services Investigate as Neglect? A Population-Based Study.” Child Maltreatment (July 13, 2022), doi: 10.1177/10775595221114144. Supporting parents to address these challenges can help families stabilize and safely remain intact, facilitating prevention of child maltreatment and the need for child removal and foster care placement.
Recent State Reforms to CalWORKs Recognize that Effective and Respectful Services Should Focus on Supporting Families…
Recognizing the significant challenges facing CalWORKs families – and the importance of respectfully addressing these challenges to enable families to secure long-term stability – in recent years state policymakers have made several changes to CalWORKs policy intended to improve support for participants.
Through Senate Bill 1041 of 2012, California established its own CalWORKs participation standards that are distinct from federal standards.5Senate Bill 1041 (Committee on Budget and Fiscal Review, Chapter 47, Statutes of 2012). These state standards include no rigid time limits on activities to address barriers or advance education, treating these activities as equal to employment activities for demonstrating engaged program participation.
The state has also adopted an evidence-based behavioral approach to guide families in setting goals (CalWORKs 2.0) and created more holistic outcome measures to evaluate the program (the California CalWORKs Outcome and Accountability Review or Cal-OAR). California also implemented a voluntary home visiting program to support family health and engaged parenting.
… But Continued Threat of County Penalties Linked to the Federal Work Participation Rate Hinders Full Implementation of Reforms
These recent constructive CalWORKs reforms are hindered from full implementation, however, because state policy continues to threaten counties with potential financial penalties linked to the Workforce Participation Rate as defined by federal TANF rules.
The federal government defines success for state TANF programs not based on how well the programs meet families’ needs, but only based on whether programs meet specific WPR targets, determined by the percentage of parents receiving assistance that are engaged in a narrowly-defined set of welfare-to-work activities. These federal activities focus on getting parents into paid employment as quickly as possible, despite the fact that such work requirements have racist and sexist roots and research suggests they do not lead to meaningful long-term improvements in employment and are linked to increases in deep poverty.6Elisa Minoff, The Racist Roots of Work Requirements (Center for the Study of Social Policy, February 2020); LaDonna Pavetti, TANF Studies Show Work Requirement Proposals for Other Programs Would Harm Millions, Do Little to Increase Work(Center on Budget and Policy Priorities, November 2018). Like many other states, California has sometimes struggled to meet its federal WPR targets. The state has at times been required to submit appeals and corrective plans, but has never had to pay a WPR penalty.
Current state policy would require counties that miss federal WPR targets to pay half of any financial penalty the state received for not meeting targets. This policy incentivizes counties and caseworkers to direct CalWORKs participants into the narrowly-defined activities that count toward meeting the federal WPR. However, the federal WPR does not acknowledge the value of fully supporting parents to address education and health barriers. Many activities to address barriers faced by large shares of CalWORKs participants – that the state approves without time limits for participants to meet state CalWORKs participation expectations – do not fully count toward meeting the federal WPR.
The Federal WPR Does Not Fully Count Activities That Address Barriers Faced by Many CalWORKs Participants
State-Approved Barrier Removal That Does Not Fully Count for Federal WPR
Share of CalWORKs Participants Assessed With Need for Barrier Removal
Adult basic education or secondary education (e.g., high school or GED), for participants without a high school or equivalent degree
Nearly 1 in 2 heads of household lack a high school or equivalent degree
Mental health services
More than 1 in 4 participants recommended for mental health services
Substance abuse services
About 1 in 20 participants recommended for substance abuse services
Domestic abuse services
More than 1 in 6 participants recommended for domestic abuse services
*Note: Federal rules limit countable participation in listed education activities to no more than 10 hours per week, and limit countable participation in mental health, substance abuse, and domestic abuse services to no more than four consecutive weeks, not to exceed six weeks in a 12-month period. CalWORKs participant data reflect the share of CalWORKs participants recommended for services to address mental health, substance abuse, or domestic abuse among those completing Online CalWORKs Appraisal Tool (OCAT) assessments during fiscal year 2019-20. Source: Budget Center analysis of Department of Social Services data, Congressional Research Service
Removing County Liability for Federal WPR Targets Could Better Align State Policy with Recent CalWORKs Reforms
Threatening to penalize counties financially for not meeting federal WPR targets creates an incentive for counties to direct parents away from activities to address barriers that may be their best investments to improve stability and long-term employment prospects – and toward more narrowly-defined “work-first” activities that may not be in families’ best long-term interests but will meet rigid federal WPR criteria. This financial penalty policy therefore works at cross-purposes with extensive recent CalWORKs reform efforts. Repealing this policy could better align state policy with the CalWORKs program’s current focus, facilitating full implementation of strategies designed to effectively support parents and families in securing long-term stability and well-being.
State Policymakers Have Options to Further Build on Recent Reforms to Support CalWORKs Parents and Families
Additional state changes to CalWORKs program rules could extend recent reforms to further bolster support for parents and children. Examples include:
Continuing to increase the size of cash grants to enable families to cover their costs to meet basic needs,
Expanding policies and practices that help parents avoid and quickly resolve sanctions that reduce access to cash grants,
Reducing sanction penalties in order to minimize negative impacts on child and parent basic needs and well-being, and
Recognizing county performance that demonstrates strong participant engagement and effectively identifies and addresses participant barriers.
As California’s primary program to help families that are struggling to secure a basic income to meet their needs, CalWORKs provides a unique opportunity to support thousands of children and parents in addressing the challenges of poverty and the barriers put before them. Continuing to align state policy and build on recent reforms can help CalWORKs reach its potential to help ensure that every California child and family can thrive.
Support for this report was provided by the Conrad N. Hilton Foundation.
Data reflect the share of CalWORKs participants recommended for services to address mental health, substance abuse, or domestic abuse among those completing Online CalWORKs Appraisal Tool (OCAT) assessments during fiscal year 2019-20. Source: Budget Center analysis of Department of Social Services data from Department of Social Services, CalWORKs Annual Summary (November 2022).
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.8Evaluating 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.
Assistive technology device and service, such as switch-operated toys, specialized drinking cups, and adapted spoons.11“Assistive Technology,” Early Childhood Technical Assistance Center (webpage), accessed September 19, 2022, https://ectacenter.org/topics/atech/atech.asp. For more information on assistive technology, see PACER Center, Assistive Technology for Infants, Toddlers, and Young Children with Disabilities (2014),https://www.pacer.org/parent/php/PHP-c212.pdf.
Audiology services
Audiology services (i.e., hearing services).
Family training, counseling, and home visits
Family training, counseling, and home visits to help the family of an infant or a toddler with a disability understand the special needs of the child.
Health services
Health services, defined as services that are “necessary to enable an otherwise eligible child to benefit from the other early intervention services.” This term does not include services that are surgical or purely medical in nature.
Medical services
Medical services, which are provided by a licensed physician for diagnostic or evaluation purposes to determine a child’s developmental status and need for early intervention services.
Nursing services
Nursing services, such as the identification of patterns of human response to actual or potential health problems.
Nutrition services
Nutrition services, such as developing and monitoring plans to address a child’s nutritional needs.
Occupational therapy
Occupational therapy to address needs related to adaptive development, adaptive behavior, and play as well as sensory, motor, and postural development.
Physical therapy, such as treatment to prevent or alleviate a movement disorder.12For information about movement disorders, see “ What are movement disorders,” Boston Children’s Hospital (webpage), accessed September 20, 2022, https://www.childrenshospital.org/conditions/movement-disorders.
Psychological services
Psychological services, which include psychological counseling for children and caregivers, consultation on child development, and parent training.
Service coordination
Service coordination to assist caregivers of infants and toddlers with disabilities in accessing early intervention services.
Sign language and cued language services
Sign language and cued language services.
Social work services
Social work services, such as making a home visit to evaluate a child’s living conditions.
Special instruction
Special instruction, such as designing learning environments and activities that promote the infant’s or toddler’s acquisition of skills in a variety of developmental areas.
Speech-language pathology services
Speech-language pathology services to address or prevent communication or language disorders.
Transportation costs
Transportation costs, which allow infants or toddlers and the child’s family to receive early intervention services.
Vision services
Vision services, such as the diagnosis of a specific visual impairment.
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:
Assign a service coordinator to help the family with evaluation and assessment procedures.
Obtain parental consent
Obtain parental consent for the evaluation.
Schedule and complete evaluations and assessments
Schedule and complete evaluations and assessments of the child’s development to determine eligibility.
Develop an Individualized Family Service Plan (IFSP)
Develop an Individualized Family Service Plan (IFSP) for eligible children. This is a plan for providing early intervention services to an infant or toddler and their families. A family has a right to disagree with the regional center’s IFSP proposal and request a due process hearing.
Identify early intervention services
Identify early intervention services that are provided in the family home or other community settings.
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.
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/.
7
“Regional Center Listings,” California Department of Developmental Services (webpage), accessed September 20, 2022, https://www.dds.ca.gov/rc/listings/.
“Regional Center Eligibility & Services,” California Department of Developmental Services (webpage), accessed September 20, 2022, https://www.dds.ca.gov/general/eligibility/.
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.
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§ionNum=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.
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§ionNum=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.
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.
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:
Improve data collection and reporting. The state should implement a uniform data collection system across all regional centers that ensures accurate and comparable demographic and spending data. Data reporting should also track barriers to accessing services by race and ethnicity.
Develop a unified system across all regional centers to monitor and report child progress and outcomes.
Leverage technology to improve care coordination. Parents and caregivers should have access to information about their child’s development or the status of a referral. For instance, the state should improve support systems such as Help Me Grow, which provides care coordination for families and children who need more assistance for the eligibility and intake process.
Evaluate the effectiveness of remote services. During the COVID-19 pandemic, early intervention services were available remotely, which removed some access barriers for both providers and families. However, the state currently does not have a clear assessment on the effectiveness of remote service delivery.
Strengthen the service provider workforce
Increase provider rates to a level that ensures there are enough trained providers to serve infants and toddlers with disabilities or developmental delays. The rates regional centers are able to pay should reflect the market cost of providing services to allow service providers to attract and retain needed staff.
Support and diversify the service provider workforce pipeline. Efforts to improve the provider pipeline should target areas of need such as therapists and early intervention specialists. Any policy actions should also prioritize increasing the racial, ethnic, and linguistic diversity of service providers to reflect the diversity of communities across the state.
Invest in early intervention services and implement payment reform
Federal policymakers should fully fund the Individuals with Disabilities Education Act (IDEA). When federal policymakers passed IDEA, they committed to fund 40% of the costs associated with providing special education services, including early intervention services, and state and local funding would cover the rest. However, Congress has not fulfilled this promise.
Implement a more equitable allocation methodology for regional center budgets. Currently, funding for regional centers is based on prior year expenditures as well as caseload growth and service utilization. A more targeted allocation methodology would provide additional funding to regional centers, which would allow them to improve access to services. This is especially important for families who are less likely to use all the services available to them due multiple barriers that block them from the support they need.
Address payment issues. Regional centers are “payors of last resort.” As a result, payment for services can be a challenging and burdensome process for both regional center staff and families and also can hinder timely access to services. One step the state can take to address this issue is to better hold managed care plans accountable for paying for services.
Continue to invest in education and outreach to increase awareness about early intervention services. The state should strengthen connections between pediatric providers and regional centers. Doing so would help to expand and improve access to developmental supports for all infants and toddlers.
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.
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%.
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.
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.
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.
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.
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.
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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.
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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