Regional Center Eligibility and Services: Transition from Early Intervention to Lanterman Act
Prior to age three, children across California can receive early intervention services from Regional Centers if they have been diagnosed with, or are at risk for, developmental delays or developmental disabilities. Early intervention for children under age three is provided pursuant to the Individuals with Disabilities Education Act (IDEA), the federal law governing special education. Many children receive occupational, physical, and speech therapy from the Regional Center during this time, along with other early intervention services.
Once a child turns three, the child’s school district of residence becomes responsible for providing special education services under IDEA. The transition progress begins several months before the child turns three years old, so that an Individualized Education Plan (IEP) is in place with the school district by the child’s third birthday, which is the day the Regional Center early intervention services end.
Some children will be eligible for continued Regional Center services under the Lanterman Developmental Disabilities Act after they turn three years old, if they have been diagnosed with a developmental disability as defined by California law.
To be eligible for Regional Center services after age three, a child must have a substantial disability that begins before age 18 and is expected to continue indefinitely. Eligible disabilities include cerebral palsy, epilepsy, autism, intellectual disability, and other conditions closely related to intellectual disability or that require similar treatment. However, a diagnosis alone is insufficient for eligibility; the child’s disability must be “substantial.” A “substantial” disability is one in which the person has impairments (defined in comparison to the expectations for a typical person of the same age) in at least three of the following areas: communication skills (receptive and expressive language), learning abilities, self-care, mobility, self-direction, independent living skills, and economic self-sufficiency.1
During the transition process, the Regional Center will determine whether your child is eligible to remain a consumer under the Lanterman Act. If you disagree with the Regional Center’s determination, you have the right to file a request for a hearing to appeal their decision.
The scope of Regional Center services after age three is significantly different from what is provided through early intervention. Below is a summary of some of the services and resources that may be available via the Regional Center once a child has transitioned out of early intervention, depending on your child’s needs as outlined in the Individualized Program Plan (IPP). Each Regional Center is operated independently, and the type and extent of services vary from center to center, depending on the service and whether the Lanterman Act requires or merely allows each Regional Center to provide it. Every Regional Center has on its website a document that outlines the Purchase of Service (POS) Standards for each service that it provides. For specific information about your Regional Center, please consult their service standards guide.
Some things to keep in mind:
- Any other available sources of funding (“generic resources”), including private health insurance, Medi-Cal, and California Children’s Services (CCS), must be exhausted before the Regional Center will fund services.
- The Regional Center will not fund educational services, as the school district bears primary responsibility for those services.
- The Regional Center must provide translation/interpretation services so that in-person and phone meetings, written IPPs, and other documents (including appeal materials) are accessible to clients and parents/guardians who do not feel comfortable communicating and/or receiving information in English. You should notify the service coordinator in advance if you will require translation/interpretation services during a meeting.
- Children who are anticipated to age out of early intervention services during the COVID-19 pandemic may be eligible for continuation of services during the transition process.2
Through California’s Medi-Cal institutional deeming waiver for individuals with developmental disabilities, many Regional Center clients are able to enroll in full-scope Medi-Cal (i.e., Medi-Cal that includes the full range of covered benefits and not just emergency services) without regard to parental income, so long as the child’s personal income and resource levels fall below program thresholds.
To be eligible for the institutional deeming waiver, a consumer under the age of 18 must:
- live at home with their family;
- have a valid Social Security number;
- be ineligible for Medi-Cal due to family income;
- be diagnosed with a developmental disability;
- have two or more qualifying conditions in the areas of self-help, motor functioning, social/emotional functioning, special health care conditions, or extensive medical needs; and
- receive at least one funded Regional Center service and utilize that service at least once per year. Many families fulfill this requirement via respite hours.
Most Medi-Cal recipients will enroll in a county-managed care plan. However, recipients who have private health insurance as their primary plan are usually (with some exceptions) required to opt out of managed care and enroll instead in fee-for-service Medi-Cal (sometimes referred to as “straight Medi-Cal”). Fee-for-service Medi-Cal operates outside of the managed care system, and is always the secondary payer. Many families use this to fund medical, dental, and pharmacy copayments if the private insurance provider accepts fee-for-service Medi-Cal. Additionally, parents may be able to get certain supplies funded that the private insurance will not cover, e.g., diapers and other incontinence supplies, as well as services and equipment that may be excluded or limited by the private plan.
Many large hospitals accept fee-for-service Medi-Cal, including UCLA, many children’s hospitals, and Cedars Sinai. If you have primary insurance and hope to use Medi-Cal as a secondary coverage, you should ensure that your providers accept fee-for-service Medi-Cal.
Many families receiving Medi-Cal (whether managed care or fee-for-service) apply for In-Home Supportive Services (IHSS) for their child. IHSS is a Medi-Cal service that provides limited funding for caregiving to the extent a child’s care needs are above and beyond those of a typical child. A parent may be funded as the child’s IHSS provider if they are the only available parent and are unable to work full time because of the child’s extraordinary needs. We are happy to provide more information about IHSS at your request.
Once the Regional Center refers your child for the Medi-Cal waiver, you will receive in the mail a thick packet of paperwork to fill out. This is the application for Medi-Cal. Ordinarily, families filling out this paperwork need to establish that their income falls below a certain threshold in order to qualify for the program. However, because only families with excess income may qualify for the waiver, the main purpose of this application for families above the income threshold is to establish that the child doesn’t qualify for Medi-Cal on an income basis.
Therefore, it is usually not necessary to provide a detailed list of all your assets; a copy of your most recent tax return will establish income levels, and if you have more than $3,000 in savings, documentation of that balance that should be sufficient to demonstrate that you don’t meet the resource threshold. If your child has personal earnings or savings held in their name, you might want to consult with a financial planner to determine the most appropriate course of action.
Some Regional Centers have a designated Medi-Cal specialist who can set up an appointment with you to assist in filling out this paperwork. You can ask your child’s service coordinator whether this option is available to you.
The waiver enrollment must be renewed each year, and along with any requested financial paperwork, you will need to obtain and submit a form letter from your Regional Center coordinator establishing that your child remains a Regional Center client and continues to receive waiver-eligible services.
The Regional Center will assist with copays for services that are required to meet the goals in the IPP (including therapies) for families with income under 400% of the federal poverty level.
For 2020, those numbers are below.3 Limited exceptions may apply in cases of extenuating circumstances or significant unreimbursed medical expenses for the child. For families/households with more than 8 persons, add $4,480 for each additional person.
|Persons in Family/Household||Federal Poverty Level (FPL)||400% FPL|
*** Do not include income from IHSS in your calculation if you are a parent provider for your child. **
A Regional Center may consider funding for behavioral supports when a child’s behaviors pose a health or safety threat to themselves or others, when they jeopardize a child’s ability to be maintained in the least restrictive setting (e.g., the behaviors put a child at risk of institutionalization or preclude them from participating in typical day programs), and when they interfere with the acquisition of developmentally appropriate adaptive or functional skills that are “fundamental to the attainment of social inclusion and increased independence.”4
The Regional Center may refer parents to community resources, fund educational sessions or workshops to aid parents in addressing their children’s behaviors at home, or fund in-home consultation with a credentialed behaviorist, who aids the parents in setting up an individualized behavior intervention program to be implemented by the parent. Some Regional Centers offer a toilet-training program as one of their behavioral services. For children with higher behavioral needs, the Regional Center may fund in-home Applied Behavioral Analysis (ABA) services or other behavioral therapy programs, such as Floortime.
Per recent changes in the law, children who receive Medi-Cal through a managed care plan will receive ABA through Medi-Cal rather than the Regional Center. The Regional Center is still the funding source for children with fee-for-service Medi-Cal.
A Regional Center may fund in-home respite services for the purpose of providing parents with relief from the ongoing care and supervision of their child with developmental disabilities. The number of respite hours provided is based largely on the extent of the child’s care needs, as well as extenuating family circumstances. Additional respite hours may be available on an emergency basis, e.g., due to a family health emergency or due to shutdowns during the COVID-19 pandemic, or for parents to attend training or conferences related to the child’s disability.
Social skills therapy is “structured programming in either an individual or group format that primarily addresses significant deficits” in engagement and awareness of other people, play skills, social communication skills, and social interaction skills.5 Some Regional Centers will provide social skills classes if they are necessary to aid the consumer in meeting social goals articulated in the IPP.
Generally speaking, the Regional Center is precluded by statute from funding recreational and social activities. However, when a child needs additional supports to participate in community group activities with non-disabled peers, some Regional Centers may fund a temporary inclusion aide who “works directly with the staff members, teaching them how to support the disabled individual and encourage others in the program to engage and accept the individual with disabilities.”6 The specialist is expected to “fade” within a reasonable amount of time, so the program must be willing to accept the assistance and then assume responsibility for the child once the inclusion specialist has fulfilled their role. In limited circumstances, the Regional Center may fund a 1:1 aide when the program is unable to develop the capacity to support the child on its own.
The cost of the program itself remains the parents’ responsibility, as it would for the parents of a typical child.
Child Care Services
Regional Centers may be able to fund specialized child care services (sometimes referred to as day care, child care, or specialized supervision) for parents who work full-time or are enrolled in job training or education programs that will lead to employment and can only take place beyond the child’s school day. The child’s care and supervision needs must exceed that of a non-disabled child of the same age, such that they cannot participate in regular childcare resources in the community (such as day care centers, after school programs, YMCA programs, and others). Child care is generally funded to the extent the cost exceeds childcare costs for a typical child; in other words, only the portion in excess of typical childcare costs will be funded.
Often, additional child care/specialized supervision/personal assistance funding may be available for older children and young adults, as their typically developing peers usually do not require 1:1 day care services.
During the COVID-19 pandemic, parents who are working full-time (whether in or out of the home) may be able to request specialized supervision hours if their child’s school is closed and the child requires close supervision so that parents may continue to work. Additional exceptions/allowances may be made on a case-by-case basis.
Incontinence Supplies and Medical Supplies/Equipment
Most of the time, incontinence supplies (diapers, moisture barrier creams, incontinence pads, etc.) for children over the age of three will be funded either by private insurance or by Medi-Cal. However, sometimes a child will be unable to use the brands provided by Medi-Cal due to allergic reactions or other sensitivities. In the event that Medi-Cal is unable to provide an acceptable alternate brand of diaper, the Regional Center may be able to fund the diapers even for a child covered by Medi-Cal, as long as adequate documentation is provided showing that the diapers are medically necessary (including the change in brand) and cannot be obtained from another funding source.
The same may be true of certain medical supplies and equipment that are medically necessary but cannot be funded by private insurance, Medi-Cal, or California Children’s Services. We are happy to provide more information about this service on request.
Other Miscellaneous Services
Some Regional Centers may also provide family resource centers, support groups, IEP advocacy, and funding for educational training and conferences related to your child’s disability (typically only the registration fee is funded and not travel, food, or lodging). For specific information on what services may be available at your Regional Center, you should consult its standards guide.
For a user-friendly but comprehensive discussion of consumers’ rights under the Lanterman Act, please take a look at Disability Rights California’s publication, “Rights Under the Lanterman Act.”
2 On June 15, 2020, the Department of Developmental Services issued Department Directive 01-061520, which waives for 30 days the requirement that early intervention services cease on the recipient’s third birthday. An additional 30-day extension was granted on July 15, 2020 by DDS Department Directive 01-071520, which brings the deadline to August 14, 2020. This waiver applies only to children already receiving early intervention services whose third birthday took place during the COVID-19 closures. Regional Centers are still required to continue to work with school districts to facilitate transition from early intervention to district services, but early intervention services may continue during that time.
Lisa Concoff Kronbeck
Public Benefits Specialist