Aaron Carruthers, Executive Director of the California State Council on Developmental Disabilities, shares how Medicaid cuts and changes implemented at the federal level are affecting California systems, and he explains how new bills affect special education, services, funding streams, and more. Key topics include:
Watch our full event in the video above, or catch a recap of the highlights here!
Hey everybody, welcome to Undivided Live.
I'm Lindsay Crain, and I head the Content and Community teams here at Undivided.
If you're new to Undivided, we're a digital platform and service that supports families raising kids with disabilities so they can access the care they need, like education, insurance, and public benefits like Medi-Cal, IHSS, Regional Center, the Self-Determination Program, and more, and we need these programs to thrive so our kids can do the same, which is why we are excited to have back with us today Aaron Carruthers, executive director of the State Council on Developmental Disabilities, who is going to school us on everything we need to know about California's revised proposed budget and how it affects our families and individuals with disabilities.
I should also mention my visual description.
I am a female with a short brown bob, glasses, and wearing a gray and white striped blazer, sitting in a green office with bookcases to my right.
Last week's revised budget announcement brought relief in many regards, but it doesn't mean the programs our children rely on are untouched.
Significant proposals and policy shifts are still on the table for all programs, both good and some potentially not. So additionally, looming over all of our state conversations are massive federal changes that are already moving forward.
H.R.1 is expected to mean billions less for California's Medi-Cal system starting in 2027.
Additionally, there's increased uncertainty in federal funding fulfillment.
Vice-President Vance recently announced that the federal government would withhold $1.3 billion in Medicaid payments to California over fraud concerns.
A bulk of those funds are meant to support IHSS.
We've also heard a wave of comments from the federal government citing fraud in parent caregiving and questioning why we pay parents to do things they used to do as family members for free.
So does the May Revise build in enough of a cushion for these federal threats in addition to changes at the state level, or are these challenges ultimately being pushed into next year for a new governor and legislature to untangle?
Well, thankfully, Aaron is here to help families understand what's happening in Sacramento, and where telling our stories in the next few weeks could help shape outcomes for our kids.
So Aaron Carruthers is the executive director for the State Council on Developmental Disabilities.
He has worked in civil rights policy and programs for over 25 years, including as an appointee of two governors, for California's attorney general, and in the state Senate and Assembly.
He is a child of parents with developmental and other disabilities, is a person with disabilities, and is the parent of a young man with disabilities.
Welcome, Aaron.
Thank you for being back with us today. Always good to see you.
Lindsay, thank you so much for the invitation.
I'm so glad to be here.
Thank you for that, very kind, warm introduction.
So important that you share my life experience and what brings me into this space because it is, I think, the most important part of of what I can bring today.
You are in the trenches with us, and we appreciate you being here and on both sides, on both sides out there fighting for us as well.
Definitely check out everything they have to offer.
Like I said, they are on the front lines every day.
And after Aaron's presentation we will take questions from the Q&A.
And lastly, a big shout out to our Undivided members.
Without you, our free resources and events like today would not be possible, so if you want to learn more about how to support events like today, you can check out the link in the chat.
And with that, Aaron, it is all yours.
Take it away.
Lindsay, thank you so much and you did such a fantastic job in framing today's conversation, and as you spoke, you really... it's almost like you had my presentation ahead of time.
Aaron, it's just what is in the mind of all of us and that we're waking up...Absolutely.
I'll speak for myself......waking up in the middle of the night.
I'm very excited to see what you share, because it's scary.
There is a lot that we hear every day, and it's hard to figure out where we need to focus so...Well, isn't it refreshing that we're all thinking the same thing, because if someone was over and thinking about something else, well, they probably catch something all of us are missing, but what I'll be doing really today is unpacking, just unpacking a lot of what you said.
So, hello everybody.
About 150 of us.
That is exciting.
Thank you for coming today.
Great to have you here.
I would say good to see you.
I can't see you just yet.
We're on this format where I can't see you, but thank you.
As my grandmother would say, “So good for you to see me again.” Grandmother...Southern charm right there.
So today's presentation is described as legislative and budget updates.
From Lindsay's introduction, really, we're talking about budget.
That's really what's happening.
There's so much going on.
The budget itself is legislation.
It's a bill.
So we're going to cover both, but really focusing on the budget as legislation.
Just a reminder, what I'm doing here today is just part of what the State Council on Developmental Disabilities has done for over 55 years under our authority under federal and state law.
If you aren't familiar with the State Council, here's a little bit about us.
Our authority... Three verbs, three action verbs in law.
We can advocate, we can build capacity, and we can change systems.
Now building capacity, that's exactly what we're doing here today.
We're building your capacity, your knowledge of what's happening in the world around the budget so that you can make informed decisions for yourself to advocate or change systems, or just work through changes in your own life.
The State Council is an independent state agency.
We're not under any other state department or Health and Human Services agency.
That gives us independence and flexibility and nimbleness to act, advocate, but also have the stability of being a state department.
Most importantly, we are led by people with developmental disabilities and their families.
The council is a council.
There's 31 council members, all appointed by the governor, and 20 of those are leaders with lived experience.
Now, what you may learn today...Lindsay, and everybody, I got to let you know as I was preparing for today I thought of a new way to talk through all the different topics, and at the end, let me know if this worked.
Let me know if it made sense.
Let me know if it worked throughout, but as I was preparing the topics, I realized they fell into a couple of quadrants.
There are things that are here, kind of Sacramento based, where I'm joining you from today, and there are things that are there, Washington DC.
So state issues in Sacramento, federal issues in Washington DC.
There are things that are happening right now, active, underway, going on, and there are things that are going to be happening in the very near future, so I structured this presentation today in those quadrants.
Let's look at what's here and now in Sacramento and active, what's here and near Sacramento and happening in the very near future.
Then we'll jump over across the continent to see what's happening there and now and then also there and in the near future.
Again, trying this out.
I know I can do it with Undivided, In the end, give me feedback.
Let me know if it worked.
Before we begin, we’ve got to talk about budgets, budgets, budgets, and if I could just make sure we're all starting with a level playing field where we're making budgeting sort of plain.
What is a budget?
It's just a spending plan.
It's a plan that the state or a household starts off with, thinking, okay, I think I know how much money I'm going to get, and I think I know the things I have to spend it on, and I've got some fixed cost, I've got some discretionary cost, I got some savings cost.
Well, the process that we have to do in our own lives to manage our own resources, state costs have same processes the state has to do.
And so budgets are plans, and sometimes reality matches the plan and sometimes it doesn't match the plan.
And through this presentation we'll be talking about some of the planning and the realities.
It's important to know that there's two different calendars. Now for you...For me, I kind of use the calendar we all know, January 1st through December 31st as a year, but the state, they use a different year.
They use July 1st through June 30th.
It's called the state fiscal year.
And it's May 20th, May 21st, which means July 1st is coming up, so we're going to talk about how the state is preparing for its next fiscal year.
The budget development process...All right, here and now. What's happening here and now?
They're working on developing the budget.
The budget process begins in January, so in January, you've probably heard a lot about the budget and the governor's proposals.
Well, January 10th is the constitutional deadline for the governor to present a budget to the legislature to begin on July 1st of that year.
Now, what happens after he introduces it? February through May, the legislature holds budget hearings on the governor's proposals, but then they're all kind of waiting.
They're all waiting and buying time until April 14th, tax day.
After the taxes are filed, the governor can actually see how much revenue the state received.
How close are the dollars actually coming in compared to the plan they had for the dollars?
How much of those dollars tell the governor about what they can project or predict for the future, for future planning.
After that, the governor has a month from April 14th to May 14th to release what's called the May Revise. Now again, tax returns coming in April, then the governor revises his January proposal.
Therefore, we get the very creative term May Revise.
That's where the term comes from.
That's what it means.
He revised his January proposal, and he did that revision in May.
Now, once it releases it, the legislature has a month till June 15th to then pass their version.
They usually take the governor's version and edit from there.
So they take the governor's as a first draft and make adjustments up or down, and then they do that by June 15th, and then the governor needs to sign it by June 30th to make sure it's all in place to begin July 1st. All right.
That's the process.
Now, where are we overall? Again, here and now issue, May Revise, as Lindsay described, and as Lindsay said, we were ready for bad.
It wasn't as bad as we expected, but it's still mixed.
It wasn't as good either.
On the good side, we saw some unexpected, welcomed increases in special education, 2.4 billion, but we also saw decreases in health care and health care supports.
I saw one calculation of about a billion.
I haven't seen...because they increase some things, they decrease some things, so the overall net I saw was $1 billion less for health care and supports.
That's the number I'm still confirming, so don't quite cite it yet, but it's the best one I have so far.
Now, based on their budgeting, they're planning for how many dollars they were going to get, revenues, dollars coming in were actually better than expected.
So cuts could have been worse, but what they saw is that $16.5 billion higher across a three year period than they thought they would have in January.
That's a really big shift in a short period of time.
What happened?
The stock market’s strong, capital gains are strong.
They're forecasting and adjusting for the expectation that the three mega artificial intelligence companies that are based in California will have their initial public offerings, and the revenues the state will likely get from that, so all of that combined, they're looking at...We think we got about $16.5 billion more across the three year period than we thought we had in January.
Now, in January, the governor thought there would be about a $2.9 billion deficit, so if they get 16.5 million more than that, it gets this budget out of a lot of jams, which is really what we see in the different proposals.
Let's go into some of those different areas of the budget.
First, looking at Department of Developmental Services and Regional Centers, big headline, big headline, no budget reductions proposed for developmental services.
There are at least no new ones, I should say.
I think at the beginning of the year we saw some reductions, about 45 million for the Self-Determination Program, but overall, what's important to see is that there actually was an increase proposed for meeting the entitlement of the Lanterman Act, but the increased and expected increase of 39,000 individuals, other cost drivers, the governor's proposing $2.9 billion increase from last year.
That's a significant amount.
If we look at the numbers, 2.9, it's more than 10%.
Next slide, we're going to take a look at that, but there’s also some other pieces.
The Department of Developmental Services is really focused on their data systems, making sure they're working well, because when the data systems are working well, their claims systems are working well, so they've made improvements and they're actually reaping it.
They expect to get $154 million in federal reimbursements and claims above what they were getting before.
It's always owed.
It was always eligible, but the data systems, weren’t keeping up and getting those reimbursements drawn down.
So with this cost pressure of $2.9 billion over a single year, the department has to look for ways to manage the cost drivers from population, and that's really what we see. Now, I have two charts here on the screen.
The one on my left hand side is average expenditures, and the one on my right hand side is case loads.
You don't need to see the details of this to be able to see the story it tells.
We see on the expenditure side a pretty fast increase from 2018, 2019 on, especially within the last few years.
We see a somewhat similar increase in caseloads.
So there's often questions about, Aaron, why does the system cost so much.
How come we're doing billion...over a billion more each year?
It used to be just a billion more.
This year was almost 3 billion more.
And the answer is because there are more people who are being identified who were not being identified before.
They're coming into services, and those services are costing more, as are services across any system.
Now, they'll accept that, but they still want to know how can we do this better.
The department's data systems to get better reimbursements is one of those efforts.
The governor also proposed some additional increases.
One is to improve the department's data system, the life outcomes improvement system, LOIS, but $14 million.
Another $15 million to update the rate model.
The rate model was something very large rolled out over the last five years or so that...The rate study said the system was underfunded by $1.8 billion just at baseline.
The legislature agreed to meet that.
They've met it.
Then we've had caseload increases, so we're raising the baseline and keeping up with growth.
It's what's the big drivers.
As they come through, they see they need to make a few adjustments here and there to the rate model, and these in particular are for early intervention services outside the home.
There is a support for... to standardize the intake process and create a standardized assessment tool, and part of the new federal regulations require a new grievance process, so there's dollars for the department to incorporate that.
Jumping over to health, generally.
There is savings.
The total health expenditures are 216.7 billion for the health...the state's public health insurance program that we all know as Medi-Cal, serving 13.9 million people.
That's more than one third of Californians.
This is their source of their health insurance.
This is a significant portion of Californian’s experience and also a significant portion of the budget.
The other thing we see in the governor's proposal is that the initial proposals to implement the early parts of H.R.1, we start to see what those specifics are.
We're going to talk a lot about H.R.1 throughout this presentation, but just a very quick statement to make sure we're all on the same page is that, when I say H.R.1, I'm talking about something...If you don't know it as H.R.1, you may have heard of it as that big something or other bill.
That one big something or other bill.
If you've heard that, it's also the same as H.R.1.
I won't say that other thing.
It's a marketing line.
They are both the formal titles of the legislation.
I'll use the technical title: H.R.1.
So looking at what the state has proposed to begin implementation of H.R.1 is they are looking at incorporating the beginnings of the work requirements, so beginning January 2027, they expect those work requirements will begin to be implemented, which will impact Medi-Cal eligibility.
They expect 44,000 people to be disenrolled for Medi-Cal in the the budget year 26/27, so that half a year of 27, from January 27th through June 27th, they expect 44,000, but then that number to be picking up in out years.
Also for H.R.1 impacts, they're going to start to see the reduction in what the federal government would pay to match for emergency room services, and emergency services, so federal government used to pay 90%.
Federal government dropped it from 50%.
Those... That results in almost 670 million in additional costs just in the out year next year and 718 the year after.
We've heard a lot about redetermination, so if you need to go through Medi-Cal redetermination for your situation, if you're one of those individuals and you have needed to do it every 12 months, you will now need to do it every six months instead of 12 months.
And this is paperwork.
This is purposeful, burdensome paperwork, because they know people can't keep up with it.
People can't keep up with it, they lose their coverage.
So we... During Q&A, we can really dig in on how the state is addressing that, but with all of the different ways they're trying to make it as easy as possible on us, on people who are served, they still expect three quarters of $1 billion be reduced because of people losing coverage to not keep up with their redetermination.
Throughout H.R.1, but also in the governor's budget last year, there has been a focus on restrictions on people with unsatisfactory immigration status, and the governor proposed some for the state budget last year. H.R.1 carries that forward, and we see some of those early implementation.
Now, back to the governor's own proposals related to health care coverage for people with unsatisfactory immigration status.
We see 1.5 billion ongoing, an increase, so... I'm sorry, reduction.
Half a billion next year and 1.5 billion ongoing reduced from Medi-Cal from people with immigration...unsatisfactory immigration status who will have to receive their Medi-Cal coverage services through fee-for-service.
There's also intention to expand access to care through the Federal Rural Health Transformation Program.
When Congress passed H.R.1, they also put in a few nickels...--They weren’t nickels, but you get my idea-- ...to say, “Don't worry, states with rural health care, here's an extra amount.
You'll be okay.
You'll be okay for your hospitals.” The amount that those areas would lose very likely does not equal the amount that the legislature...that Congress put in, but this is that program that's rolling out to help strengthen the workforce and enhance infrastructure in rural and frontier communities throughout California.
California will get about 233 million in federal funds for this.
Does not match the tens of billions of dollars we expect to lose because of H.R.1.
Very... Getting a lot of attention from people and very concerning is reinstating asset limits for seniors and adults with disabilities.
We used to not have them, and last year they popped in, and now this year for 130,000.
Now this year it's dropping from... down to 2,000 or 3,000 for couples.
Again, these are all proposals, but this is what the governor is proposing.
And then also increased premiums for adults with unsatisfactory immigration status for what they would have to pay from $30 to $50, which reduces how much the state would pay.
Over to IHSS.
Overall, that system is a $33.7 billion system, and it serves 875,000 recipients, but the first thing we gotta look at regarding IHSS is a proposal from January that still continues, which is effectively a cost shift from the state to the counties.
The proposal is that the state, we're not going to pay for increases in IHSS hours.
So county, if you approve those additional hours, then you pay for them.
You're on the hook.
You're making the decision.
Not us.
Well, it's largely seen by everybody as a shift, a cost shift from the counties, and out of any response the legislature has had firmly, the legislature has not responded to too many details concretely in the governor's proposals, but both the state assembly and state senate said we reject this idea.
Now, the other one we're still waiting to hear their determination on is those asset limits.
It's important to talk about them in Medi-Cal, but it's important that I carry them over to how they would impact IHSS recipients too, so the same asset limit for Medi-Cal also will impact IHSS eligibility.
The governor last year proposed eliminating the backup provider system for your providers doesn’t show? Let's get a system to get somebody there. Proposing to eliminate again this year and to end the state funded waiting period.
So if I apply for Medi-Cal, IHSS can kick in before my Medi-Cal is approved.
This would revert it... would change it so IHSS is only available when Medi-Cal coverage starts.
What else do we have?
I said it was a mixed bag, so that's the impacts and the challenges related to health care, but we had some good news as related to child care and education.
We saw cost of living adjustments to child care programs run by the Department of Social Services.
We saw overall $151 billion allocated for all T-K through 12 to serve 5.7 million students.
So if the first thing was child care, now we're moving to education.
Again, funding for special education increased by 2.3 billion, an increase of 43% over the current budget.
This is really a historic proposal.
Also, another historic proposal: We saw a one time increase of 25 million for grants to expand inclusive college programs for students with IDD.
Some other cost of living for many programs, which would also include special education, and we have a few other programs here.
I'm going to leave the details to you in the PowerPoint, when you get to print so that we leave enough room for questions because I want to make sure that we cover all that's happening in the federal government.
We're still only in that first quadrant, here and now.
I still got to go to here and near and there and now and there and near. Okay.
All right.
So there's a couple of really important pieces related to civil rights supports in the budget.
As we know, disability rights are civil rights.
There's some good funding and proposals for affordable housing.
This is actually a picture of an affordable housing complex built with funds from DDS that's in San Diego.
All right, so here and now, last slide for here and now.
That's the governor's proposal.
What happens now?
It's all over the legislature.
It's all over the legislature and they have a few weeks to make their decisions.
Do they accept the governor's proposals?
Do they adjust the governor's proposals?
Do they have their own proposals?
Now it's go time for them.
So that's where all of the action and the intention moves as they work on that budget bill.
But what about here and near?
Okay.
If they act by June 15th and when they have a new budget in place by July 1st, that's it, right?
It's done. Well, not exactly.
The budget is not a product.
It's a process.
There's an ongoing process that is happening at all months of the year, and sometimes over multiple years in the same month, but roughly the planning... They'll pass a budget, get it going, but the planning for the next year's budget begins in September.
Enactment is what they're doing right now, so development, enactment, administration are all happening.
After they enact this one, they do the administration, they spend it, they see if the spending and the collecting dollars match their plans, they adjust accordingly, so I just want to lay this out as a dynamic process that's constantly going, and sometimes they're looking at multiple years within the same year, so while this is May 2026, they're looking at what happened in...what was allocated in the budget in May 2025 and still closing out May 2024 items, so dynamic, ongoing....It's a process, it's never done, so it's not a product.
When we're looking to the future and what's happening in the near-term, we have to look at really the full impacts that we're expecting from H.R.1.
The number that I've seen has not been specific, but the state expects to lose tens of billions of dollars in federal funding because of H.R.1.
Now, let's pause and dig into H.R.1 a little bit and July 25th...sorry, July 2025, the federal government cut 1 trillion from their Medicaid spending, and they did that through this legislation called H.R.1 or the one big something or other bill.
Now, what's important to keep in mind about this is it was not a direct cut.
They didn't go into the Medicaid line item and say, “Let’s just decrease that by $1 trillion over ten years.” What they did though is a series of policy changes, and through those policy changes, they expect to not have to pay as much.
So for example, we talked about the work requirements. Well, if everybody can't make the work requirements, you lose your health care.
The federal government doesn't have to pay so much.
We talked about redetermination.
Well, if you can't keep up with that every six month redetermination, then you lose your health care.
The federal government doesn't have to pay so much. Now, the reverse is true too.
If everybody who's eligible can keep up with the six month redeterminations, the federal government doesn't...Their spending doesn't go down as much as they thought.
If people are able to verify that they're working or verify they have an exemption from working, or able to effectively do that, well, the federal government spending doesn't go down as much, so it's hard for the state to say a specific number of what they expect to lose in federal dollars because it's a bit dynamic, and the more the state is focused on implementing the new rules, the new policies, and the new exemptions, and the new verifications, the higher the amount of federal reimbursement they'll pull down.
So it's interesting because it wasn't just a direct cut.
We could spend an hour just talking about those steps and those processes, but I'll move on.
I geeked out a little bit.
What are they expecting?
So if there's $1 trillion in cuts across the entire country over ten years, again, it's tens of billions for California. Right now, 15 million people served by Medi-Cal, and the states estimating about 2 million could lose their health insurance benefits.
We look at ,of those 15 million, there's about 2.2 to 2.3 million Californians who are older adults, people with disabilities, but it's not clear how many of them are at risk of losing their Medi-Cal, because there's so many other exemptions that could apply, but the thing about paperwork is real.
If you can't keep up with it, you lose your coverage, so more frequent eligibility checks, and of course, those work requirements.
While I've been in many meetings where the state is being thoughtful about how they determine exemptions, that process has to work.
Now, tens of billions of dollars is a lot.
Are there any other things happening in Sacramento in the near future that could address that?
A lot of people ask, “I the state gonna raise revenues?” Well, one thing we've seen is the Senate Democrats have proposed what they're calling the fair share tax.
What this is, it would be a new tax on the state's 1 to 2% largest corporations.
They think it'll raise about 5 to 8 billion a year, and they say they would use that to pay for Medi-Cal.
Their reason for this particular approach is that they state 42% of people enrolled in Medi-Cal are full time employees, but they're on Medi-Cal because they're not getting health insurance from their employer, or their income is so low they still qualify, so their bottom line point of view is that when the public dollars are paying for the public health, for health benefits, health insurance for people who are employed, then taxpayers are basically paying for health care instead of those employers, so this is the Senate Democrats’ proposal, and their approach, if it's passed, it would be up to the governor to sign it or veto it, and that would be in the next few weeks.
We would see if they take action on it.
We've heard a lot about the Billionaires Tax Act.
I don't know if anybody was outside your grocery store collecting signatures.
I know they were out in front of mine.
And this is sponsored and sought by SEIU, Service Employee International Union, and their point... What this is would be a new one time 5% tax on personal assets over $1 billion.
They estimate this will raise $1 billion, just one time, and they say it should be used 90% for health care and 10% for food supports and education.
Why this approach?
From their point of view, the federal health care cuts are...they estimate, are going to cost California $100 billion over five years, so the federal government took away $100 billion.
They say this tax will refill it, backfill that $100 billion.
Now, SEIU says they have enough signatures to qualify for the ballot.
They submitted those signatures to the Secretary of State, and the Secretary of State is verifying those.
Now, if this gets on the ballot or if it doesn't get on the ballot, billionaires themselves have also authored other initiatives that would compete and make complex this one and the others they put forward, so we got to wait for November to see what actually gets on the ballot.
Glad to come back and explain them when those happen.
Unexpectedly, last week saw another proposal.
We had heard from the governor that he did not support increases in revenue, but yet in his proposal, he's got some revenue solutions, so there's a total of 3.6 billion solutions.
Some of those ideas include taxing digital software, limiting how many credits businesses can take and creating a new managed care organization taxes, the dollars the state uses to pay for its part, its share of Medicaid services.
They also... Governor also say we’re expecting local sales taxes to increase by a half a billion dollars, so these numbers don't add up to 3.6 billion, but this is a portion of what's in the governor's proposals. Now, any taxes would need a two thirds vote of the legislature.
That's 54 members of the Assembly and 27 members of the Senate.
The regular budget bill needs a simple majority, need 50%, but taxes need two thirds.
These all qualify as taxes, and they would... Does the Assembly and the Senate have those numbers?
Well, the majority party within each house, --and it's the Democrats are the majority party-- holds 60 seats in the Assembly, --They need 54-- and 30 seats in the Senate, --They need 27-- so I think the governor's proposing these thinking they can get the two thirds votes needed to pass taxes.
All right.
That is what's happening here.
That's what's happening here and now.
That's what's happening here and near. Now, let's go over there.
Let's go from Sacramento to Washington DC to see what's going on over there. And over there and now, what's being said in Washington?
Well, January 2026, the Center for Medicare and Medicaid Services, CMS, that's the entity that we report to for our Medicaid programs, sent a letter to California, and it gave the state three weeks to respond with a program integrity action plan.
CMS said there's rising spending in programs like IHSS, and that rising spending may be because of fraud, waste, and abuse, improper payments, or even weak oversight by the state, and they point out basically a $20 billion increase over a ten year period.
For them, these numbers are suspect.
They're sus and they want to know what's going on.
CMS questioned whether California has the program integrity controls and are they strong enough to protect federal dollars.
Well, California said that growth does not equal fraud.
It reflects California keeping up with federal policy, which encourages care in homes instead of institutions.
It reflects compliance with ADA and Supreme Court's decision in Olmstead. That growth reflects CMS' own long standing support for expansion of services like IHSS.
They say this growth, it's predictable and it's intended.
Now, by the way, we have plenty of anti-fraud systems in place.
Here's our whole list and we'll give you a whole description on how they work.
So California's core message was, “Dear federal government, you should view these increases in spending as evidence of implementing federal policy, not evidence of widespread abuse or weak oversight.
You should view this as a shift away from costly institutional care when it costs...If we're not providing care for people in the communities, we're providing for institutions, which are much more expensive, and this should be viewed as a civil rights and community integration success.” Well, there wasn't a response.
There was not a response until last week, last Wednesday, and the response came from the vice-president who said California has not taken fraud seriously, so he announced there's going to be $1.3 billion deferral in medical reimbursements, so this is money the state has already spent, has submitted for reimbursement, and has not received, and... but this is...The mechanism is a little bit interesting and a little bit different and informing a little bit of the state's response.
Now, many times when we've seen action by the federal government, we've seen the attorney general sue almost immediately, and here's the website being shared with you where you can track all of the lawsuits filed by the attorney general Bonta, but California hasn't sued on this one.
I think there's a different strategy underway, and I'm going to keep my eye on what that is.
If there was an immediate lawsuit route to...the immediate route to resolve it was through a lawsuit, I think could have been filed.
I think the state's following a different route, but I imagine they're going to fight it.
Let's keep our eye on that one.
Now that's there and now, what's happening in DC right now.
What's happening in DC in the near future?
We gotta listen in to our leaders, and hear what they are saying.
In April, last month, President Trump said, “The US can't take care of daycare.
That has to be up to the state.
We're fighting wars.
Medicaid, Medicare, they can do it on a state basis.
We have to take care of one thing: military protection.
But all these little scams that have taken place, you have to let the states take care of them.” There's a lot in this statement and it’s important we're paying attention, because we've seen a pretty good track record of this president being able to carry out things that he states.
What we see here is a priority for federal spending is on military protection.
We see it paired somehow in not a very clear way with Medicaid and Medicare and daycare.
And then we have the statement of ‘all these little scams.’ Let's listen to somebody else in the president's leadership circle to understand maybe a little bit more of where...what the president is thinking.
Also in April 2026, federal Health and Human Services Secretary Kennedy said consumer-directed personal assistance programs contribute to fraud and higher costs, specifically the waivers, meaning IHSS, Regional Center services, HCBS.
“They allow people, family members who are taking care of an elderly patient to get paid for balancing the checkbook, for picking up the groceries, for driving somebody to a doctor's appointment.
These are family members who are getting paid to do things that they used to do as family members for free, and this is rife with fraud, because we have no way to determine if they actually performed the duties or not.” Lindsay, you mentioned this quote.
It's an important one, and I'm glad...I'm glad we're unpacking it, because what we see is not really a statement of fact.
We see an attack, not only on the core of family supports, the core of family strengths, but also the core of federal law.
This is how it's designed to work.
This is how it is working.
We know that we're not fraud in doing this work. We also know we're carrying out federal law.
This is how the law is structured, but it looks like politicians have found their health care message: fraud.
Building on that, in April, the federal government told all 50 states you have ten days to commit to a swift revalidation of high risk providers.
We're seeing a rapid rise in fraud, and we need your quick action to promise us you're going to revalidate these high risk providers.
Well, who are they identifying as high risk providers?
They're identifying them as individuals paid through Medicaid dollars through home and community based services without an NPI, without a national provider identifier.
Who are those individuals?
A lot of people we know and work with: direct personal care attendants, direct support professionals, IHSS workers, people providing services through the Self-Determination Program, respite providers, supported living, independent living, transportation providers, well, that kind of a whole host of community services within Regional Center supports and IHSS.
Why don't these professionals we know and need, why don't they have an NPI, a national provider identifier?
Well, we don't have them because we're not required to have them.
Many people who don't have them just are...This number is for medical service providers, and we're not considered medical service providers.
Self-directed, self-determined programs will use consumer employed workers rather than clinical providers as is designed. It's all by design.
This is what Home and Community Based Services, HCBS, is about.
It's part of CMS rules, but suddenly there's a different message.
Dr. Oz is the administrator for CMS, and states that without this NPI, states may...providers may be integrity risks because an NPI is a standardized national identifier.
Without it, it's harder to track and screen providers, so it may take...make it harder to detect fraud. Specifically, in April, Dr. Oz said corrupt individuals and organizations masquerading as health care providers are defrauding Medicaid.
Politicians found their health care message: fraud.
We need to pay attention.
Adding to this, the president's own director of budgets described the $1 trillion cuts already made to Medicaid as a response to fraud.
The director said in July 2025 with H.R.1, he says it wouldn't lead to eligible people losing benefits.
Instead, savings would happen because ineligible people would be removed, and able-bodied people would get jobs and health care through their jobs.
Well, that sounds okay, except it's a little confusing because they cut the trillion dollars first and then they looked for the fraud afterward, not the other way around.
Find the fraud and address it, or find the fraud and cut it.
We're going to cut it, and now we're going to...Now remember, this was July 2025, so he's stating fraud.
We've already found $1 trillion in fraud.
Everything else Dr. Oz and Secretary Kennedy said is in addition to that.
So summary of the talk in Washington DC.: Politicians found their health care message: fraud.
First cut the dollars, then look for evidence of fraud to justify the dollars you cut.
The core philosophy of HCBS is being suggested as evidence of fraud.
That is parents getting paid for what they should do as a family.
And growth and services itself is being suggested as evidence of fraud.
Now, there's been a lot of focus on IHSS in this presentation, but there's been a lot of focus in autism services and ABA by Dr. Oz and others, so advocates really fear and believe this is building to another federal bill with more Medicaid cuts, and last time they did this through a mechanism called reconciliation and Speaker Johnson has signaled that he'd like to do a third reconciliation by January... July. By July.
All right.
There's a lot.
Let's take a little moment to breathe together.
Okay.
We'll get through this.
We'll get through this.
Okay. Back to my quadrants.
To summarize everything we went through.
The budget landscape right now, if we look at what's happening here and now, the budget is being developed and we got May Revise.
If we look at what's happening here and near, they got to get that new budget in place by July 1st.
We're starting to see some H.R.1 impacts, and we're wondering is the state going to take action to raise revenues to backfill the impacts of H.R.1.
And if we look over there, Washington D.C., there are now lots of claims of fraud, actions on those claims, even though they haven't been proven, and withholding 1.3 billion.
And then what can happen in the near future?
Well, this focus on direct service providers as high risk, people without NPI numbers as high risk, and possibly a third reconciliation bill.
So that's the landscape of the budget world that we are looking at.
All right.
Well, what can you do?
What can you do?
As always, if you're not signed up for SCDD’s, listserv and e-blast, please feel free to sign up.
We'll get you budget updates, we’ll get you federal updates.
Something we're pretty good about finding is when the federal government has proposed to change one of the law... change one of the rules through the regulations process, our national surveillance with the DDs, councils across the country, are pretty good at finding those and then sending you information on how you can make public comments on those.
Of course, if you sign up, we can get you information and updates on council supported bills and...sponsored and supported bills.
Now, that was kind of a rough talk.
It's strange to start off the presentation by saying, “Hey, it's not so bad, it could have been a whole lot worse,” and then I just tell you bad things, but in balance, we got some increases in education, got some decreases in health care and supports that are proposed.
We don't know exactly what the legislature will do.
They'll make their decisions in the next few weeks.
Everyone's asking, “Is the state just going to keep cutting or will they raise revenues?” Well, no, but we may see more cuts coming from the federal government.
Now remember, cuts do not end movements.
Cuts have only strengthened movements.
Change just never comes from the top down.
It's never trickled down from power.
Change rises up.
It rises up from people who know what it's like to be dismissed, to be dismissed and yet choose to speak up anyway.
Change comes from families and advocates and self-advocates who just refuse to let their silence write policy.
Our silence will not let you author policy.
From advocates, change comes from families and caregivers who just refuse to be left behind because we know what's at stake and we're still here.
We're fighting for care, we're fighting for respect, we're fighting for our lives, and we are doing it together.
Thank you so much.
I'd be glad to answer questions.
Right.
There's a lot.
I need to take a breath, Aaron.
Yeah.
Thank you so much.
And I do have a question.
I didn't ask you this before.
Do you have a hard out right at one in case we go a couple minutes over?
I can stay over if others are able to stay.
So I'll talk fast.
I can ask questions because there's a lot of these that are just clarifications and I think people heard and I think it's important for people to hear those clarifications.
So I want to start with Medicaid.
First, you talked about a lot of the tax proposals, right, that could provide a cushion against what we would be losing from the H.R.1 Medicaid cuts. Just a clarification on that: Would that be enough to cover...Would those tax proposals potentially be enough to cover for what we're losing from H.R.1?
Yeah.
Great question, because the different proposals had different amounts that they project it would raise.
I've seen a lot of tax proposals not raise what they projected.
Sometimes they raise more.
We also have what I described, an uncertainty about how much we're actually going to lose from H.R.1 because it's not a direct cut.
It's changes to policy, so it...We don't know how much we're going to lose from federal health care, and we don't know how much those tax proposals could bring in, so they could match each other, it could not be enough, or maybe it's more than we need.
And if they don't... If one or more of those tax proposals don't pass, is there anything in the budget to protect us from what's coming in 2027 from H.R.1 or is this something that the next administration is going to have to figure out in the new budget cycle?
The governor believes he has proposed a budget to address what would come from H.R.1 in next year, so it's a multi-year plan and a multi-year budget, which includes some increases.
If those increases don't happen...There were three different proposals.
It could be none of them.
It could be all of them.
It could be some of them.
So we would have to really see what gets enacted.
There could be a wild approach where they do the governor's sort of targeted taxes on different services.
They could also do the Senate's.
Let's go after these large companies.
And the voters could also pass, so it could be a windfall.
It could be more money that way, or it could be none of it, or the billionaire's other proposals can undo its dynamic.
What am I saying?
It's so in motion.
So, hard to say specifics right now, but at least we're seeing proposals.
It would be a much worse case scenario if we were not seeing proposals.
Not just... Not to scare you, but the reality, there's a DD council like ours in every state and territory.
I’ve been doing a lot of work with my colleagues in Idaho because the Idaho government just proposed to eliminate the entirety of HCBS.
That's...We're going to give another tax cut, and we're just going to completely eliminate home and community services to pay for it, so it's rough here.
We're fighting.
It's rough out there too.
All right, some quick clarification questions.
Lindsay asked...She... and we actually had a couple people ask, “Does the work requirement for Medi-Cal also apply to individuals with ID?” Yeah.
So, I... It is a great question, and what I want to do is I can... and I'm working in the background, a couple screens here.
There we go.
I would like to display the language from the federal law that we can all read together about the work requirements and who the exemptions apply to.
Moving fast.
Okay.
It's a great question about the work requirements.
Let's go directly to H.R.1 to see what H.R.1 says. So cut and paste. Who's exempt from the work requirements?
“A person who is medically frail or otherwise has special medical needs, including an individual who's blind or disabled, with a substance use disorder, with a disabling mental disorder, with a physical, intellectual, or developmental disability that significantly impairs their ability to perform one or more activities of daily living, or with a serious or complex medical condition.” I read this and I see a very broad, very inclusive definition of disability.
I mean, one ADL, significant, ongoing ADL, that's...All right. All right.
I see where you're going here.
I really like that it specifically says people with intellectual development disabilities are excluded from the work requirements.
That's about people.
How about family or caregivers?
Well, also exempt is a “person who is the parent, guardian, caretaker relative, or family caregiver of a dependent child 13 years of age or under or is a disabled individual.” So we see family caregivers also covered under this legislation.
That's what it says.
I see a broad definition.
Now what about implementation?
Under implementation, the state is taking as broad an approach as possible.
They're using every data set and computer set that they have to pull in services.
If you're receiving services that would qualify you under this exemption, they're automatically putting people forward and saying this individual is exempt, so if you're receiving Regional Center services, IHSS services, they're going to take Medicaid service codes and say, “Okay, all these individuals are receiving it, therefore they're exempt.” They want to automate it as much as possible.
They want to take the burden off of us as much as possible.
The one place I've seen... Actually, I got another slide I can show you.
I'm answering more than the question you asked, but it's such a good one.
If it's okay, Lindsay, I’ll copy this one too.
So what I'm showing you is, this is from the website of the Health and Human Services Agency.
What they are...Here's their approach to verify the exemptions for work requirements.
First, “assess if the individual meets an exemption based on being eligible for one of the categories.
Assess if the individual meets a hardship exemption that can be verified electronically.
Identify individuals who meet exemptions using data sources or cross information sharing.
Conduct data verification to identify compliance with qualifying activities based on income and hours.
Then request information from the consumer to verify compliance with qualifying activities or exemption.” For some reason, when I read these, my brain translate...interprets them into a much more plain language than when I just read them out loud.
What I see, though, is five steps.
And for us, we basically would get found in steps one through four, most likely just from the first one, but really the people that I'm concerned about are step five.
So I meet the definition for an exemption, but I'm not being served.
I'm not showing up in other systems, but yet I still meet it.
So what I don't know yet, and what I haven't seen is what's that form going to look like.
How is the state actually going to do step five, which is reaching out to individuals directly?
These slides go into some of the specifics.
What are the steps, the details, and how many people they think they're going to be able to catch.
They're going to be able to prove they have an exemption.
Same question.
Another clarification.
We had a lot of questions in the chat about the redetermination, so just confirming that...and we had some questions like, “Is this for minors as well?
Is this for adults?” So everyone is going to have to do that paperwork every six months?
If you have to do it every 12 months...Whoever you have to do it for every 12 months, it would then also move to six months.
IHSS. Another huge question.
Obviously, we're keeping our eye on the funding shift to the counties like you talked about.
Karen had a follow up question on that.
Would it also cover new cases, so eventually it would all be covered by the county?
Because I think a lot of us are a bit confused at saying increase of hours would be covered by the county, but does that mean new people coming into the IHSS system, or just existing people who are asking for an increase in hours?
It's a great question and I don't know.
I can find out.
I don't know.
I also think maybe it's not worth spending a lot of time on it, because the Senate and the Assembly have both said we reject this proposal.
So of all the many things to worry about or spend time on, do we go look at that thing that some of the assembly has basically signaled they're not going to do, so let's figure out how that thing that's not going to happen actually works.
But I will go look if you'd like me to.
No. That's great.
Let's cross our fingers.
If that's what you're hearing, that's great.
If we want to zoom out a little for the long term, obviously there's a lot of worry for all the things you were outlining talking about Home and Community Based Services so specific to IHSS, long term, if we don't...I mean, I know we just talked about the taxes, so this might be an ‘I don't know,’ but if we don't get those funds, the 1.3 billion that Vice-President Vance was talking or was it, what, the 1.3 billion, if we don't get those funds, does that mean that IHSS payments aren't going out?
What does this mean for IHSS long term and... but is that what we're trying to figure out on the California side with these tax proposals of if this all goes away, then this is how we're going to handle it in California, or what do we need to know about what's happening right now and what's at risk?
Because it feels like everything is at risk to keep our children in our...in their homes or communities.
I am very concerned by the philosophical broadside attack on the core of our function and care and compensation for it, so it's a very clear, just great question mark and suspicion about us in ways that we never even fathomed possible.
It's pretty...As I laid out from the different comments, it's pretty clear that there is a focused messaging around it and that that messaging will be used to justify cuts in the next reconciliation bill.
I think the ‘Respond within ten days, you're going to recertify all these high risk providers,’ is...Some have described it as a fishing expedition.
We're just looking for evidence to prove the statements we already want to make, and our best way to do it is just to go ask all 50 states and we're going to find some things that confirm what we already want to conclude, or we'll find states that don't respond and isn't that suspicious, and what are they hiding?
So while there is the 1.3 billion for California, we've seen the federal government withhold dollars from states, and we've seen those dollars go to the states.
So that’s just in a tussle right now, and I'm optimistic.
Really, it's really interesting to not see a lawsuit and go, oh, the state must have an even better route to go.
I'm confident the state is going to get the dollars.
They're going to fight to get those dollars.
And if there wasn't immediate lawsuit, they must have thought of other routes or options to make sure the money keeps flowing, so a part of me is trusting our leaders within California to keep working on those dollars.
So I am concerned.
I want to make sure they come.
I am much more concerned about the philosophical shift in an ongoing attack on the core of the services.
Absolutely.
Okay.
Do you have time for a couple?
Sure. Yeah.
Okay.
State questions too, because Regional Center....I mean, it seemed like things were good.
I did want to ask...There was a proposed change that disabled individuals and their family members would no longer be required for Regional Center boards.
This being a push towards more professional boards, so it just kind of makes you wonder where the ‘nothing about us without us’ mantra was sort of strangled during these discussions, but maybe we're missing something, so I just wanted to know if you could briefly talk about...Can you help us understand why this was put forward and what problem we're trying to solve?
Yeah.
Say that again in a different way.
There was a lot in that.
Yeah.
Can you can restate it?
I'm sorry. Oh, sure. Sorry.
Yes. It was just about... so the Regional Center boards, right?
There's no longer a requirement...Well, proposal, sorry.
There's a proposal that there would no longer be a requirement for family members or disabled individuals to be on Regional Center boards, which from the community feels like the ‘nothing about us without us’ has just sort of been thrown out the window, but maybe there's something we're missing.
So what problem is trying to be solved by this proposal?
Because it feels like something we've been working towards for a long time, and it felt like a bit of a door slam in the face to families.
Trusting that the...Everybody here understands what you're describing.
The administration proposed changing the...how the compensation of Regional Center boards, a move away from lived experience expertise toward professional experience expertise, and really, the only requirement for... also shrinking the size of the boards...The only requirement is for the Consumer Advisory Committee to appoint two of their members as full voting...board members with full rights.
The department's stated rationale and approach and thinking behind this is the boards are entities that are overseeing multi-million, billion dollar organizations, not advocacy entities.
That's what I've heard stated.
The State Council, along with many others, disagree and we have very firmly stated it needs to remain 50% lived experience.
And I've had many conversations saying, you know what, the State Council has got some secret sauce in effective leadership among adults with...who are served, adults with developmental disabilities, among family members, and here's...If we were to do it, here's how we do it.
So, we've proposed amendments that not only undo what the administration is proposing to revert it back to where it is now, but goes even further to strengthen the roles of leaders with lived experience, additional training, additional responsibilities, additional oversight role, so, all right, you open that one.
That's how we're going to respond to it.
Thank you.
Thank you, Aaron.
Self-Determination...Just have to ask again, one of the biggest questions that we received ahead of time, and we received several in the chat as well, because you touched on the fact that that $45 million had been reduced, but we keep hearing, right, that DDS is saying that individual budgets should not be cut, so just confirmation on that.
Should families be seeing anything different?
Should they be hearing anything different when they're doing their budgets, that anything had changed in the budget or legislatively, that that would be any reason that their budget should change?
I wish I could do a quick poll because the question would be, is anybody experiencing anything differently in their budgets.
We are hearing yes, so yeah.
We are also hearing yes, and so right there over all our cost pressures within the program, it has to be cost neutral from the traditional program, and so... but there's claims of it costs so much more, it costs so much more.
Our response is that's because this program is meeting the needs the traditional system did not, could not meet, and it's really easy to point out.
It's not hard.
It's a stretch of how I wasn't getting my needs met even though I'm entitled to them, and...because the Regional Center didn't have those vendors, but yet I can hire somebody in Self-Determination to do it.
Okay, so now we're spending dollars that I wasn't spending before.
Are those increases actual expenditure increases or increases in authorization?
In budgets, there's so many different ways to slice it, but in the end, the story is it costs so much more.
So we saw a year ago what the department described as guardrails around budgets and spending within Self-Determination, so while there is a statement of $45 million less for Self-Determination overall, it may not be a direct cut.
It's not like, okay, now go reduce everybody's budget to meet that $45 million, but we're just seeing people's experience with much more scrutiny on their budgets.
Now okay, let me add one other piece in this.
There is no line item within the Department of Developmental Services budget that says, “For Self-Determination,” so they're not going into that number and saying, “Okay, we're going to have $45 million less from that.” I think the 45 million comes from differences in projected growth in the program, projected enrollment in the program.
We think there's gonna be 45 million less than we thought, but they're not saying what the other number was, so I...So the pressures on the budget are kind of general.
The people are experiencing...They're not specifically related to this 45 million.
Okay.
There was a lot.
It was... No, because it...I know it's a little bit nebulous and we're hearing what you're hearing, what I'm sure a lot of people are experiencing on this call.
I mean, I just got something from RIF saying some of this flexibility might be changing, even when new things are coming into a budget, so I think people are just bracing again, but I think it's important for people to know that nothing has officially been done.
They might be feeling and experiencing different things, and it's really important to share those stories with you all, so you are hearing that and then you can address the root cause of what's happening.
So anything else on that, Aaron, that you want to share?
Yeah. It's like 45 million from what?
From which number?
And that's really what you're asking, because it's like is it 45 million from my budget?
Is it 45 million from the pot we call Self-Determination?
Is it 45 million off from projections?
So it's a really...it's a really fuzzy 45 million, which in my mind means we should each be going forward with our programs, with our budgets, with our spending plans as strongly as we need to.
Yeah.
Quick... Just really quick confirmation.
Someone asked about the special ed funding, that ongoing funding, that 43% increase, is that restricted funding, meaning can that only be used for special education or can that be rolled into the general fund?
It's... The governor proposed it for special education rolled into the general fund, and goodness, there are so many restrictions around education funding, around Prop 98 as dollars come in.
We usually see the opposite.
Dollars come to the general fund and it gets rolled...It gets rolled over to K through 12, but maybe this individual has experience about the reverse flow happening, but to answer the question, this is for special education.
And I did want to ask, and then I know we're over time, but early intervention.
So you talked about and we received this question ahead of time, but the funding increase of $15 million to update the rate models for early intervention services, and I think you had mentioned there have been some issues and I wanted to specifically ask about center based early intervention, because some center based programs have reported that the DDS rate reform changes that went into effect March 2026 have resulted in funding reductions of up to 40% for certain center based care, threatening their sustainability, obviously, despite their critical role in child development, school readiness, and family support.
So is that what... Is that $15 million supposed to balance those losses?
Is that something totally different?
Is there anything in there to protect that critical care for our youngest?
Yeah, if you could actually email me that question, I think there's enough there that I need to dig into...Okay.
...to look at it from a couple of different angles to come back with a good answer.
Yeah.
Aaron, I actually received five really detailed questions about this specific, and I would love...I will definitely share that one because obviously, look, I am a...We are a proud family that had critical early intervention services, right, so you're either somebody where you got them or someone where it came too late and you didn't, and you recognize what a huge loss that was, and so I just want to...We definitely need to look at if things are intentionally or unintentionally threatening those programs, so...If you got five detailed questions, either send them all or you go through them and synthesize and say, okay, here are the questions we asked or here are the dynamics that are happening.
I want to make sure I do them justice and get the right information for it.
Great.
And really quickly, because we received several questions specifically about Denti-Cal or Medi-Cal Dental.
Is there anything...Smebody asked...Melanie asked, “Any news on the elimination of Prop 56 tobacco tax supplemental incentive programs to dental providers?” Effectively, July 1st the reimbursement rates will go back up, back to what they were in the ‘80s, which we'll call...which will cause Medi-Cal dental offices to close throughout the state.
I need to look into that one too.
Okay, great.
And then lastly, Aaron, is there anything...We've talked about what's in the budget.
Is there anything that's not in there that you guys were pushing for? Is there anything that we need to know?
Because we have a month to be going out and talking, which obviously we're not going to probably throw anything new in there, but I don't know, is there anything lastly that you want to throw out?
We've just talked...largely talked about the dollars.
We have not talked about these things called trailer bills.
So trailer bills are pieces of legislation that go along with the budget.
They trail along behind them and they change policy.
They're supposed to have fiscal impacts and are related to fiscal proposals.
We're seeing a trend sort of away from that, and so the department and other parts of the state administration have proposed interesting significant trailer bills that we're digging through.
You mentioned one related to Regional Center board oversight.
That's one.
There's one related to Self-Determination Program and reprioritizing the local volunteer advisory.
Well, the federal reimbursement dollars that are available and given to local volunteer advisory committees for grants to reprioritize them to state administration, so there's a lot of policy pieces that are happening too, so we could have a whole conversation just about trailer bills.
Yeah. All right.
So I'm going to do a really probably bad quick highlight of what Aaron said with...and I really liked the here and now, the here and there, the near... I liked it.
To me, it brought a good visual for me.
So we could talk to you all day for sure, and I can't wait for you to come back and tell us what settles, but really quickly, here and now proposals. Again, Aaron said it.
The headline: no new budget reductions for developmental services, historic increase in sped funding, 43% ongoing, --This is huge-- one time funding for college programs for students with IDD, considerations of H.R.1 impacts on state budget starting in 2027, which are significant both socially and economically, asset limit reductions, IHSS cost shift to counties for increased hours.
Again, proposals. Here and now proposals, Aaron stressed, --and I love this quote-- the budget isn't a product, it is a process, and it's not done yet.
So there's $1 trillion of Medicaid spending reductions in H.R.1, various tax proposals, which he outlined very neatly, including one to the top 1% to 2% of the corporations and that proposed billionaire tax.
There and now: Urge the feds not to claim widespread fraud.
If you're doing outreach, consider talking about that this isn't fraud when our growth means that we are actually reaching more people in their homes and communities.
That is what California has been trying to do that we are still trying to do, and we don't want to stop doing, obviously, but we have not yet sued the feds.
I thought this was important too.
We have not yet filed suit for those withheld Medicaid funds, so hopefully more to come on that.
There and near: Fraud is a trending health care message from the feds, like we've talked about, directly focusing on HCBS services, but cuts were made before they talked about fraud.
Requiring NPI numbers for providers...--This is my words, not Aaron's-- ...threatens family providers.
I think that's something that we need to look at very closely.
More Medicaid cuts could be coming via reconciliation bill.
That was a really quick summary.
Aaron, did I misspeak?
--We covered all that?
That was...This was a dense and fortified hour that we had together.
It was. It was.
I know and now I'm going to have to unpack like I'm sure everyone else will, and so just...I also want to echo the advocacy, the...that Aaron always talks about and encourages everyone to get out there and speak up because like Aaron explained, we have about a month before this budget is finalized.
Much of what we talked about today, again, not guaranteed for good or for bad.
Legislators hear from lobbyists all the time.
They hear from big money, they hear from labor, and too often they do not hear directly from families.
They don't understand what your everyday life is like.
They don't meet our children.
They don't know the actual consequences of what these proposed changes could do to your life in real time, and to your child's, so tell them.
Make it impossible to look away.
And I know every day you might be hearing, “Reach out to your legislators.
This is important,” and that might start to become noise in the back of your head.
Aaron and I get it.
It is a lot.
Life is a lot, and there's also a lot on the line, which obviously everyone here knows, so we don't have the privilege of assuming that things will work out or that California will automatically protect our kids.
We need every voice, and yours is just as important as every other.
Make sure you follow the State Council on Developmental Disabilities and Undivided.
We want to make it as easy as possible for you to know what is important, so make sure and follow us for the latest.
Thank you again, Aaron, for explaining what is on the line.
We know there is so much to dig into, but thank you for laying it all out, what could be coming and what we can do about it, and we know the State Council is fighting for our community every day, and we're grateful for you, so we need to do our part too, and at Undivided, our mission is to support you so your children can thrive, and we want you to thrive too.
We'll see you out there.
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