Audit Finds Billing Program for Disabled Children Is “Woefully Inefficient”

Tuesday, January 20, 2015

California state government took responsibility for providing services and support to people with developmental disabilities, like autism and cerebral palsy, in 1969 with the landmark Lanterman Developmental Disabilities Services Act.

The state created a network of regional centers and over the years, like most underfunded, half-neglected public social service efforts, has struggled mightily to fulfill its mission. Last week, the State Auditor took the Department of Developmental Services (DDS) to task for yet another failing, although this one is only indirectly related to the delivery of services and support to already burdened individuals and their families.   

The Auditor reported (pdf) that the department fails to bill and collect all the money it could be collecting through the “Parental Fee Program,” which considers ability to pay as a factor. The department collects only about 60% of assessed fees and it doesn’t do a very good job assessing those fees in the first place, the report said. The fees are only a small part of the department’s $5-billion budget.

The department doesn’t collect all the income, family size and age information they should. The department lets regional centers get away with not submitting monthly reports on children newly placed in out-of-home care, so opportunities to bill are lost. The department does not annually reassess parental fee accounts. Its assessment process does not have a standardized fee schedule, and the appeal process relies heavily on face-to-face meetings.

Overall, the Auditor deemed it a pretty shoddy operation, but didn’t speculate what the department was doing when it was supposed to be collecting money.  

Director Santi J. Rogers, in his response to the audit, agreed with the general assessment that things are pretty messed up in the program, but tried to give some context to what might be perceived as lax enforcement:

“The Department has historically acted to benefit the family whenever possible in determining ability to pay. . . . Program staff are keenly aware of the impact assessing these fees can have on a household budget, and therefore, have routinely given as much consideration as possible to each family, even when staff reasoning was not adequately documented.”  

No dollar figure was placed on the money lost—or the money inadvertently gained. Ninety-five percent of the people who appealed their assessments from fiscal year 2011-12 through 2013-14 got them reduced.

The Auditor’s report echoed many of the observations made by the Sacramento Bee in a series of stories about the department. Both noted that parents with the resources to advocate most strongly for themselves received the most benefits. But even strong parental participation doesn’t guarantee a fair and consistent outcome.

In August 2013, the newspaper wrote about George McElroy, a Tracy resident, who paid $50 a month for his autistic son living at a treatment center in Los Angeles. In 2012, he was informed that would be increased to $1,005. He appealed and got it reduced to $400 in 2013. The next year the department kicked it back up to $750. They are now in litigation.

–Ken Broder


To Learn More:

California State Audit Blasts Parental Fee Program for Disabled Child Care (by David Siders, Sacramento Bee)

California Shows Inconsistency in Fee for Parents of Disabled Children (by David Siders, Sacramento Bee)

Developmentally Disabled Center Closes as State Embarks on Precarious New Care Path (by Ken Broder, AllGov California)

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