How California pays for disability services

Waiver inventory

Excluded as not primarily IDD: Assisted Living Waiver (0431), Home and Community Based Alternatives Waiver (0139, medically fragile), Medi-Cal Waiver Program for people with HIV/AIDS (0183), Multipurpose Senior Services Program (0141). Source for the full list: Medicaid.gov CA waiver factsheet.

State-only funded programs

California's structure is unusual: services are a state entitlement under the Lanterman Developmental Disabilities Services Act, and federal Medicaid dollars are claimed after the fact against a General Fund-financed entitlement. The state-only share is therefore very large and is visible in the budget as "GF Other," meaning General Fund spending that draws no federal match.

• General Fund Other (unmatched state spending in the regional center program): $5,607,224,000 in FY2025-26, rising to $6,398,081,000 in FY2026-27. This funds services for people who are not Medi-Cal eligible, services that are not federally reimbursable, and the Lanterman entitlement's coverage beyond federal HCBS scope. Administering agency: Department of Developmental Services through 21 regional centers. DDS 2026-27 Governor's Budget Highlights
• State Operated Services (developmental centers and state-operated community facilities): $304,605,000 in FY2025-26 ($274,363,000 General Fund) and $293,282,000 proposed for FY2026-27 ($263,784,000 General Fund), supporting 302 people. Administering agency: DDS. Same source.
• Early Start (Part C): $1,334,405,000 of purchase of services in FY2025-26 for early intervention, plus $19,424,000 in Early Start Part C and other agency costs and $2,003,000 in Early Start Family Resource Services, financed by a blend of General Fund and a $55,482,000 Federal Trust Fund appropriation. Same source.
• Program Development Fund and Developmental Disabilities Services Account: small dedicated state accounts, $895,000 and $150,000 respectively in FY2025-26. The Program Development Fund (parental fees) is zeroed out in FY2026-27. Same source.

County / regional / local funding

• 21 regional centers. These are private nonprofit corporations under contract to DDS, each with a defined geographic catchment, and they are the operative sub-state allocation mechanism. They hold two separate allocations: Operations (case management staffing, quality assurance, projects) and Purchase of Services (POS), the money used to buy services on behalf of consumers. FY2025-26: Operations $1,650,677,000 and POS $16,523,975,000. FY2026-27 proposed: Operations $1,782,689,000 and POS $18,827,975,000. Regional centers set their own vendor rates within the DDS rate models, which is why published rates differ by regional center. DDS 2026-27 Governor's Budget Highlights, Regional center listings
• Regional center POS transparency data. Each regional center must post its own POS expenditure data by December 31 each year, broken out by age band, race or ethnicity, primary language, disability type, and residence type. This is the only public dataset of allocation at the sub-state level. DDS Purchase of Service Data
• County property tax levies for IDD: none identified. California funds this population through the state entitlement, not county levies. Counties do administer IHSS with a county share of cost, but IHSS is not IDD-specific.

Funding scale

• Total DDS spending all funds: $18,674,853,000 in FY2025-26 (updated current year) and $21,108,525,000 proposed for FY2026-27, a 13% increase. Governor's Budget Highlights
• General Fund: $11,932,318,000 in FY2025-26 and $13,536,934,000 in FY2026-27. Same source.
• Medicaid reimbursements (federal financial participation) FY2025-26 totaling $6,592,595,000: HCBS waiver $4,420,602,000; 1915(i) SPA $994,107,000; TCM $456,367,000; SDP waiver $337,373,000; Title XX block grant $213,421,000 (Social Services $136,264,000, TANF $77,157,000); ICF/DD SPA $77,406,000; Medicaid administration $28,055,000; HCBS waiver administration $25,690,000; EPSDT $21,640,000; ICF/DD Quality Assurance Fees $12,019,000; behavioral health treatment fee-for-service $5,915,000. Rising to $7,420,929,000 in FY2026-27. Same source.
• State versus federal share: the FY2026-27 GF Match line is $6,756,704,000 against reimbursements of $7,420,929,000, with an additional $6,398,081,000 of unmatched GF Other. Roughly 36% of the regional center program is federally reimbursed.
• FMAP: 50.00% for FY2026 and FY2027, the statutory floor. CRS R43847, KFF FMAP
• Caseload: 489,254 in FY2025-26 (Lanterman 418,361; Early Start 56,020; Provisional Eligibility 14,873), projected to reach 526,848 in FY2026-27 (Lanterman 452,615; Early Start 56,073; Provisional 18,160). Plus 302 people in state-operated services. Same source.
• Spending per participant (computed, not published): $16,523,975,000 POS divided by 489,254 total caseload is approximately $33,772 per person for FY2025-26. Because the denominator includes Early Start infants and provisionally eligible children whose service costs are far lower, the per-person figure for Lanterman-eligible adults is substantially higher.
• POS by category, FY2025-26 caseload table (thousands): Residential Services $6,537,876; Day Services $2,468,362; Support and Training Services $2,355,318; Respite $2,008,311; Early Intervention Services $1,334,405; Transportation $690,073; Social Recreation $379,319; Medical Services $316,932; Other Services $221,859; Employment $153,392; Behavioral Services $151,530. Total POS caseload $16,617,377. Same source.
• Waiting list: None. Services are an entitlement under the Lanterman Act. Regional centers must provide services identified in the Individual Program Plan. There is no statewide DD waiver waiting list. The corresponding access problem in California is documented as service access and equity disparity in POS spending by race, ethnicity, and language, tracked at DDS Service Access and Equity.

Residential funding detail

California funds a wider spectrum of residential arrangements than most states, and the rate structure changed fundamentally with rate reform.

What is funded.

• Community Care Facilities (group homes), staff-operated: licensed adult residential facilities and group homes for children. Paid a monthly rate that varies by four dimensions: adults versus children, staff-operated versus owner-operated, 4 or fewer beds versus 5 or more beds, and Service Level 2 through Level 7. Levels reflect the intensity of care and supervision. Level 7 rates are individually negotiated and are not on the published schedule.
• Community Care Facilities, owner-operated: the same level structure, at lower rates for Levels 2 and 3 and identical rates for Levels 4 through 6.
• Adult Residential Facility for Persons with Special Health Care Needs (ARFPSHN): monthly, service code 113, rate individually determined.
• Supported Living Services (service code 896): hourly, purchased in the person's own leased or owned home. Includes an excess mileage component.
• Independent Living Program (520) and Independent Living Specialist (635): hourly.
• Parent Coordinated Supported Living (073): hourly, with a separate overtime rate.
• Family Home Agency and specialized homes: DDS was, as of April 2026, still developing rates and models for Family Home Agencies, GRFPSHN homes, and other specialized residential facilities. These fall outside the standard published schedule for now. Rate Reform Post-Implementation Timeline, Apr 6, 2026
• ICF/DD, ICF/DD-H, ICF/DD-N: licensed intermediate care facilities, paid by DHCS under Medi-Cal long-term care rate methodology, not by the DDS rate schedule. Regional centers pay day program and transportation add-ons for ICF/DD residents through the ICF/DD State Plan Amendment ($77,406,000 in FY2025-26).
• Developmental centers and state-operated community facilities: 302 people, $304,605,000 in FY2025-26. Fairview Developmental Center is in cold shutdown with a General Fund decrease of $8.1 million proposed in FY2026-27 while the property disposition proceeds.

Payment structure. Residential is monthly with acuity levels. Supported living, independent living, and personal assistance are hourly with staffing-ratio tiers (1:1, 1:2, 1:3). Day services are hourly or daily with ratio tiers from 1:2 to 1:10, where the daily rate is defined as six hours at the applicable hourly rate. Every rate is split into a base rate at 90% of the full rate and a Quality Incentive Program (QIP) payment at 10%, a two-component structure required by statute and fully implemented January 1, 2025.

Room and board. The published residential rates are inclusive: the DDS rate files state that "Full rates and base rates include SSI/SSP amount. QIP amount is calculated based on full rates without SSI/SSP amount." In practice the resident's SSI/SSP non-medical out-of-home care payment covers room and board and the regional center pays the balance of the published monthly rate. On January 15, 2026 DDS corrected residential base and QIP rates to recalculate using the updated 2026 SSI/SSP rate, which confirms the mechanical linkage. Room and board is therefore not separately state-funded; it flows through the resident's SSI/SSP grant, with the state's SSP supplement being the state contribution.

Rate structure link: Rates Only Files Updated April 27, 2026

Comparable service rates

All figures below are Alta California Regional Center (ACRC), effective January 1, 2026 unless noted, from the DDS Rates Only file. Rates differ by regional center; a per-center file exists for all 21. "Full Rate" is shown; the base rate is 90% and QIP is 10%.

Additional professional rates at ACRC, 1:1, effective Jan 1, 2026: Behavior Analyst $145.20/hour; Associate Behavior Analyst $74.50; Behavior Technician-Paraprofessional $71.35; Behavior Management Consultant $88.86; Adaptive Skills Training Professional $143.38, Specialist $106.01; Specialized Therapeutic Services Professional, home and community-based, $143.38. Transportation was re-methodologized effective March 1, 2026 to a per-vehicle AM/PM rate of $166.94 plus reduced per-mile rates.

Official rate schedule links

• Rates Only files for all 21 regional centers, updated April 27, 2026: dds.ca.gov
• Complete Rate Models by Regional Center, 2026: dds.ca.gov
• Complete Rate Models, January 2026 to June 2026: dds.ca.gov
• ACRC Rates Only, effective Jan 1, 2026: dds.ca.gov
• ACRC Complete Rate Models, Feb 10, 2026: dds.ca.gov
• Rate Reform program page: dds.ca.gov
• Rate Reform Post-Implementation Timeline, Apr 6, 2026: dds.ca.gov
• Directive D-2026-Rate Reform-004, day program length of day and billing, June 16, 2026: dds.ca.gov
• Directive D-2026-Rate Reform-002, behavior day program requirements: dds.ca.gov
• ICF/DD and other Medi-Cal long-term care rates: mcweb.apps.prd.cammis.medi-cal.ca.gov
• FY2025-26 Enacted Budget funding summary: dds.ca.gov
• FY2026-27 Governor's Budget Highlights: dds.ca.gov

Notable features and flags

• Jan 1, 2025: the final phase of service provider rate reform took effect, moving all services to fully funded rate models with the statutory 90% base plus 10% Quality Incentive Program split. The Legislative Analyst's Office attributed roughly $500 million of the budget increase to annualizing fully funded models. LAO Report 5008
• Feb 28, 2026: the Rate Reform Hold Harmless provision ended, a 2025 Budget Act solution scored as a reduction of $113 million ($75 million General Fund). Providers whose legacy rates exceeded the new model rates lost that protection. The same budget carried a $22.5 million General Fund reduction to Self-Determination Program Protections. Governor's Budget Highlights, Rate Reform Timeline
• June 30, 2026: enrollment in the DDS Provider Directory stopped being sufficient to qualify for the QIP portion of the rate model. Real quality metrics now gate 10% of every provider's rate. LAO Report 5008
• Mar 1, 2026: transportation company reimbursement was re-methodologized from purely per-mile to a per-vehicle AM/PM rate of $166.94 plus much lower per-mile rates, and the Transportation Broker monthly rate rose from $56.92 to $80.80 effective Feb 1, 2026 after a full re-review of the model components.
• FY2026-27 proposed: $2.4 billion net increase driven by a projected 37,594-person caseload increase, plus $2.4 million and 9 positions specifically to meet the federal HCBS Access Rule, and $14.6 million for the Life Outcomes Improvement System IT project. Fairview Developmental Center moves to cold shutdown.
• December 2024: all consumers were transitioned off subminimum wage employment, meeting the statutory January 2025 phase-out deadline. Work Activity Program rates remain on the schedule at $2.83 to $12.95 per hour by ratio. LAO Report 5008
• Ongoing 2026: DDS is still building rate models for Family Home Agencies, GRFPSHN homes, and other specialized residential settings, and continues to amend Title 17 regulations. Residential providers serving the highest-acuity people (Level 7) remain on individually negotiated rates rather than a published schedule.

Confidence

Solid: budget totals, fund splits, caseload, POS by category, the Medicaid reimbursement breakdown, the rate reform structure and its dated milestones, and the ACRC rate table, which I read directly from the DDS-published spreadsheet rather than from a summary. Also solid: the absence of a waiting list, which follows from the Lanterman entitlement and is confirmed by the budget's caseload-driven appropriation structure. Estimated: the per-participant figure is my arithmetic on published totals and DDS does not publish it. Could not find: a current published participant count for the Self-Determination Program (the DDS SDP page does not state one, so I used the $337.4 million reimbursement line as the scale indicator); the exact 2026 SSI/SSP non-medical out-of-home care payment standard, which CDSS references but does not display on its landing pages, so I described the mechanism without a dollar figure; current ICF/DD, ICF/DD-H, and ICF/DD-N per diems, which live behind the Medi-Cal rates application rather than in a static PDF; and per-regional-center POS allocation totals, which are posted individually on 21 separate regional center websites.