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(6.36) Do parents have to pay fees for some regional center services?

(6.36) Do parents have to pay fees for some regional center services?

Yes.  These are fees parents may have to pay:

1. A monthly parental fee

Parents of children under 18, who receive 24-hour-a-day, out-of-home care, may have to pay for some of that care, depending on their income.  The fee is based on the current cost of caring for a child at home, using federal government information, adjusted for inflation.[1]Section 4784(e). The regional center will consider what your family has paid for medical expenses and other expenses, like how much it costs to travel to visit your child.[2]Section 4784. See also Cal. Code Regs., tit. 17 §§ 50201-50241. Disability Rights California believes there should be no parental fees when the child is a Medi-Cal recipient and is living in a … Continue reading

If you disagree with the parental fee, you can appeal.  The appeal process for parental fees is different than for services under the Lanterman Act.  You must appeal in writing within 30 days of getting the parental fee confirmation letter, to the Director of the Department of Developmental Services, with the reason(s) for the appeal.  The Director will issue a written decision within 30 days of getting all needed financial data.[3]Section 4784(h).

2. Day Care

The law says parents must pay the same amount for day care as they would pay for a child without disabilities.  The regional center pays for any costs beyond the cost of typical day care.  If the family can show they cannot afford to pay, the regional center can pay the entire cost of day care.[4]Section 4685(c)(6).

3. Family Cost Participation Program

For respite services, daycare, and camping programs, the Family Cost Participation Program may apply.  It requires families to pay a portion of the cost, depending on income.[5]Section 4783(c). It does not apply to all families.  If your child qualifies for Medi-Cal, you do not have to pay any part of the cost.[6]Section 4783(a)(1)(E).  Even if your child qualifies for Medi-Cal without considering family income (called “institutionally deemed”), you do not have to pay any part of the cost. 

You only have to pay for part of respite, daycare, and camping services if:

  • your child is between 0 and 17 years old and lives at home,
  • your child is not eligible for Medi-Cal,
  • your child receives respite, day care, and/or camping services, and
  • your family’s gross annual income is at least four times the “federal poverty level.” [7]Sections 4783(a)(1)(A)-(E) and 4783(b)(1).

If your family meets all these conditions, your share of the cost will be on a sliding scale, between 5% and 80% of the cost.  The regional center cannot ask your family to pay for other regional center services listed in your IPP and cannot deny a service you need because your family cannot pay for it. 

After you sign your completed IPP, you have 10 days to give the regional center your income information (an IRS form W-2, last year’s income tax return, payroll stubs, or other acceptable proof of income[8]Section 4783(g)(2).).  The regional center has 10 days to tell you how much you must pay.  That amount is called your “cost participation.”[9]Section 4783(g)(3). If you do not provide income information, you must pay the maximum cost participation.[10]Section 4783(g)(4).  If you have more than one child who gets regional center services, the amount you have to pay is reduced.[11]Section 4783(d).

There are exceptions.  The executive director of each regional center can adjust the family cost participation amount in two situtations:

  • When families are experiencing “unavoidable and uninsured catastrophic loss” that temporarily limits their ability to pay.  This can be natural disasters, accidents, major injuries to immediate family members, or extraordinary medical expenses.[12]Title 17, Cal. Code Regs., section 50265(a).
  • When there would be a “direct economic impact” if the cost were not lowered.  This means your family would go without basic needs like food, shelter, clothing, or medical care if you had to pay that amount.[13]Title 17, Cal. Code Regs., section 50265(b).

You can appeal the cost participation if you believe the regional center is charging you more than it should, they made a calculation mistake, or you disagree with the decision about an exception.

To appeal your cost participation, send a letter to the regional center executive director and describe your disagreement within 30 days of learning your fee amount.[14]Section 4783(k)(1). If you do not agree with the regional center’s recalculation, you can appeal to the Director of the Department of Developmental Services (DDS).  You must appeal within 15 days of receiving the regional center’s decision.[15]Section 4783(k)(1).

If you disagree with the executive director’s decision about your family suffering an unavoidable and uninsured catastrophic loss which makes your cost participation impossible, you can appeal to the DDS.  You must appeal within 15 days of receiving the regional center’s decision.[16]Section 4783(k)(2)&(3).

4. Annual Family Program Fee

Your family will have an annual fee if your family’s adjusted gross income is at or above 4 times the federal poverty level, and your child:

  • is eligible for regional center services under the Lanterman Act or Early Intervention Services Act,[17]For children age 0-2 years, the fee depends on approval by the federal government.
  • is under 18,
  • lives with you (parents),
  • gets services beyond needs assessment and service coordination,
  • does not get Medi-Cal or Medi-Cal waiver services, and
  • gets services besides the 3 under the Family Cost Participation Program (respite, day care, camping).[18]Section 4785(a); includes respite, day care, or camping costs.

If your adjusted gross income is less than 4 times the federal poverty level, there will be no fee.  If your adjusted gross income is 4 – 8 times the federal poverty level, the fee is $150 per year.[19]Section 4785(b). If your adjusted gross income is more than 8 times the federal poverty level, the fee is $200 for the year.

Keep in mind:

  1. These fees are per family, no matter the number of regional center clients in the family.
  2. Total adjusted gross family income means all income from both parents (even if living separately – unless a court order says otherwise).  It also includes the community property portion of a stepparent’s income.
  3. If regional center cannot get a noncustodial parent’s income, the income will not be included.[20]Section 4785(j).

A regional center may grant an exemption to having to pay the annual family program fee if you show:

  1. You need it to keep your child at home;
  2. You have an extraordinary event that impacts your ability to pay the fee or to meet the care and supervision needs of your child; or
  3. You have a catastrophic loss that temporarily limits your ability to pay and creates a direct economic impact on the family.  Examples: natural disasters, accidents involving or major injuries to an immediate family member, and extraordinary medical expenses.[21]Section 4785(f).

Non-payment of the Annual Family Program Fee cannot result in services being delayed or denied.[22]Section 4785(g). If fees are not paid, the regional center will send a letter requesting payment.  If fees are still not paid, DDS can pursue collections.[23]Section 4785 (d) and (e).

References
1 Section 4784(e).
2 Section 4784. See also Cal. Code Regs., tit. 17 §§ 50201-50241. Disability Rights California believes there should be no parental fees when the child is a Medi-Cal recipient and is living in a Medi-Cal-funded placement, such as a nursing facility, an intermediate care facility for people with developmental disabilities, a developmental center, or a community care facility funded under the HCBS Waiver.  This is because state and federal Medicaid laws require that the payment made by the Medicaid program – Medi-Cal in California – is to be considered as payment in full. (Cal. Welfare and Institutions Code section 14019.3(d); Title 42 Code of Fed. Regs. Section 447.15.)  Parental fees for children who need to live outside the family home to benefit from their education may also be unlawful.  Federal special education law provides that “[i]f placement in a public or private residential program is necessary to provide special education and related services to a child with disabilities, the program, including non-medical care and room and board, must be at no cost to the parents of the child.” (Title 34 Code of Fed. Regs. Section 300.104.)  If a residential placement is necessary for educational purposes, it must be provided at no cost to the parents.
3 Section 4784(h).
4 Section 4685(c)(6).
5 Section 4783(c).
6 Section 4783(a)(1)(E).
7 Sections 4783(a)(1)(A)-(E) and 4783(b)(1).
8 Section 4783(g)(2).
9 Section 4783(g)(3).
10 Section 4783(g)(4).
11 Section 4783(d).
12 Title 17, Cal. Code Regs., section 50265(a).
13 Title 17, Cal. Code Regs., section 50265(b).
14 Section 4783(k)(1).
15 Section 4783(k)(1).
16 Section 4783(k)(2)&(3).
17 For children age 0-2 years, the fee depends on approval by the federal government.
18 Section 4785(a); includes respite, day care, or camping costs.
19 Section 4785(b).
20 Section 4785(j).
21 Section 4785(f).
22 Section 4785(g).
23 Section 4785 (d) and (e).