ADSD warns rapid caseload growth, federal assessment mandate will strain regional centers

The Aging and Disability Services Division (ADSD) told the Joint Subcommittee on Human Services on Tuesday that regional centers statewide are projecting unusually high caseload growth and must implement a federally required standardized functional needs assessment for many waiver recipients.

ADSD Director Dina Schmidt said the division operates three regional centers and is planning for caseload growth that the agency described as historically large. The division is seeking decision units to fund projected caseload increases and to implement a standardized assessment tool that, ADSD told the committee, will be required by federal rules and is intended to improve accuracy in predicting service costs.

Why it matters: Committee members pressed ADSD about whether staffing and provider capacity can meet the projected increases. ADSD officials said hiring limits and provider ramp-up time mean the division prioritized realistic enrollment expectations for the next biennium rather than automatically funding wait lists that would be unlikely to be used.

ADSD’s presentation identified caseload-growth projections of about 3% for the Rural Regional Center, 13% for Desert Regional Center and 15% for Sierra Regional Center in the upcoming biennium. Jessica Adams, ADSD deputy administrator, told the panel that roughly 35% of people served by the division are on a Medicaid waiver and that the standardized assessment will apply to most waiver recipients under a federal rule change.

Adams said the federal change will require ADSD to perform the standardized assessment on a high percentage of waiver participants each year; the agency told the committee it expects to meet a federal requirement to assess roughly 90% of waiver enrollees annually by the implementation date in 2027. ADSD said the assessment is intended to be an independent, standardized instrument rather than the case-management social assessment currently used, and that it should help the state predict the service costs associated with individuals more consistently.

ADSD also flagged an administrative correction: staff identified a double-counting error that placed the cost of a prior rate increase in two different decision units and will amend the budget to correct it. The division is also requesting additional positions in some regional centers to support assessment implementation and to address supervisory ratios in the Desert Regional Center’s intermediate care facility (ICF).

Committee members repeatedly asked whether providers could hire to meet the caseload growth. Adams said providers told the division they can hire more staff, but ADSD remains concerned that caseload projections would push service costs much higher than historical levels and could lead to reverting funds if spending outpaced appropriation. Dina Schmidt said ADSD has been operating under an enrollment freeze during the current fiscal year and that providers have not been building capacity during that period.

Ending note: ADSD said it will continue to prioritize enrollment based on need and to focus limited hiring and provider capacity on avoiding institutionalization. The committee asked ADSD staff to provide follow-up details on hiring assumptions, the scope of the assessment rollout and corrected budget figures.