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BEFORE THE Powered By Docstoc
					                                BEFORE THE
                            STATE OF CALIFORNIA

In the Matter of:


                            Claimant,                  OAH No. N 2004090008



                            Service Agency.


       This matter was heard before Michael C. Cohn, Administrative Law Judge, State
of California, Office of Administrative Hearings, in Oakland, California on October 14,

       Claimant Stephanie M. was represented by her parents, Jeff and Lisa M.

       Regional Center of the East Bay was represented by Pam Higgins, Fair Hearing

       The matter was submitted for decision on October 14, 2004.


       The issue is whether the service agency is obligated to reimburse claimant’s
parents for personal expenditures made on behalf of their daughter, who resides in a
residential group home.

                                FACTUAL FINDINGS

       1.     Claimant is a 17-year-old client of the service agency. She was adopted
at 18 months from Amador County. Claimant’s adoptive mother is related to her birth

mother. Claimant was going to be placed into foster care because of parental neglect
when her adoptive parents agreed to adopt her. They did not know at the time that she
was a special needs child.

         2.    Claimant resided at home with her parents until November 2001, when
she was placed at Devereux Santa Barbara because of unsafe behaviors. It was at or
about this time that claimant became a client of the service agency. Throughout her
life, claimant’s parents received direct payments from the Amador County Adoption
Assistance program. When claimant was placed at Devereux, those payments stopped
and the Adoption Assistance program instead provided full funding for her residential
placement at Devereux.1

        3.      Claimant completed her program at Devereux in June 2004. In
accordance with her Individual Program Plan (IPP), claimant transitioned to a less
restrictive residential setting. On June 13, 2004, she moved to a group home in Union
City. This placement allowed her to be closer to home so that she could spend more
time with her parents. One of the goals reflected in the Individual Service Plan (ISP)
prepared for claimant’s stay at the group home is that she can visit with her parents any
time she wants. Claimant currently spends one evening a week (from after school until
bedtime, when she returns to the group home) and weekends (from Friday evening until
Sunday evening) at her parents’ home.

        4.     When claimant moved into the group home, the service agency, Regional
Center of the East Bay, agreed to fund the placement until the Amador County Adoption
Assistance program picked up that funding. On August 26, 2004, the service agency
notified claimant’s parents that it was denying funding for the out-of-home placement
because a generic resource (Amador County Adoption Assistance) was available to fund
the placement. But the service agency advised the parents that its funding would remain
in place until Amador County took over payment. On August 30, 2004, claimant’s
parents requested a hearing. The issue they raised, and which the parties agree is the
actual issue in this proceeding, is not funding for claimant’s placement (which Amador
County has picked up) but a request for reimbursement for various personal expenses
they have incurred for their daughter.

       5.      Among the expenses claimant’s parents are now absorbing, and for
which they request reimbursement, are claimant’s Kaiser health care premiums and
co-payments, medications not covered by Kaiser or Medi-Cal, clothing, the cost of
claimant’s cell phone, and entertainment, food and miscellaneous expenses incurred
because claimant is in the family home about half the week. Because they no longer
receive direct payment from the Adoption Assistance program as they did before
            In this complex case, other funding was also provided. It appears that Amador County
Mental Health funded mental health services for claimant and that the Fremont Unified School
District provided educational funding.

claimant was placed at Devereux, these expenses have negatively impacted claimant’s
parents’ budget.

        6.     The Adoption Assistance program currently pays claimant’s group home
$5,120 per month. Of this, $111 is designated for claimant’s “personal and incidental”
(P&I) expenses. Claimant’s IPP provides that the group home will work with her to
devise a budget and to plan expenditures of her P&I money, establishing such categories
as clothing, entertainment, personal care and savings. The $111 monthly P&I money is
maintained by the group home in a “bank” for respondent to use throughout the month in
accordance with her budget.

        7.     One of claimant’s “target behaviors” as identified in her ISP is
“inappropriate phone usage.” Claimant talks on the house phone for extended periods,
and may act inappropriately if she cannot access the phone immediately or if she is
asked to hang up so others can use it. In addition, she has made long distance phone
calls she cannot pay for. To address claimant’s excess use of the house phone, the ISP
suggested two possible alternatives. The first was to establish a written phone schedule
for claimant, permitting her to use the phone at certain times of the day and for certain
lengths of time. The second was to provide claimant with her own phone line: “If [she]
agrees to pay for her own phone line with unlimited long distance, conflicts regarding
use of the house phone might be eliminated.”

               Claimant’s parents elected to get claimant a cell phone for two reasons:
when claimant ran up a large phone bill, the group home took it out of her P&I money,
decreasing the amount she had to spend for personal expenses; and, they say, a service
agency behavioralist recommended this. (While the option of getting claimant her own
phone line is mentioned in the ISP, it was not clear it was a service agency behavioralist
who made the recommendation. Claimant’s out-of-home placement includes a behavior
component that is not funded by the service agency and there was no indication the
service agency was involved in creating the ISP.)

       8.       The service agency takes the position that it is not obligated to reimburse
claimant’s parents for any of the personal expenses they have incurred. First, food and
clothing expenses are included in claimant’s out-of-home placement. Any additional
food or clothing her parents choose to provide are the sort of expenses parents typically
incur for their children. Second, claimant receives Medi-Cal through Amador County,
thus there is no need for the parents to maintain private health insurance.2 Third, a cell

           Claimant’s parents testified that when they adopted claimant they were told they needed
to maintain such insurance, that Medi-Cal would serve as secondary coverage. They have
maintained this private insurance since they adopted her. A February 2004 addendum to claimant’s
IPP seems to support that position, stating that “Amador County will provide Medi-Cal funding as
secondary coverage.” Whether claimant’s parents must maintain private health insurance is unclear.
It is something that should be discussed with Amador County.

phone for claimant is not something that is required by her IPP. Providing her such a
phone was a choice her parents made. It is the sort of expense parents typically incur for
their children.

                                   LEGAL CONCLUSIONS

        1.      Under the Lanterman Act,3 the State of California accepts responsibility
for persons with developmental disabilities and pays for the majority of their “treatment
and habilitation services and supports” in order to enable such persons to live in the
least restrictive environment possible.4 The State agency charged with implementing
the Lanterman Act is the Department of Developmental Services. The Lanterman Act
authorizes the department to contract with regional centers to provide developmentally
disabled individuals with access to the services and supports best suited to them
throughout their lives.5

        2.     The “services and supports” regional centers are obligated to provide
are those specialized services and supports that are directed toward the alleviation of a
developmental disability, or toward the individual’s habilitation or rehabilitation, or
toward the achievement and maintenance of an independent, productive, normal life.
The determination of which services and supports are necessary to meet these ends is
made through the IPP process.6 Because regional centers are subject to budgetary and
fiscal constraints, the Lanterman Act requires that the provision of services reflect the
cost-effective use of public resources.7

       3.      With the possible exception of the cell phone, the expenses for which
claimant’s parents seek reimbursement are not fundable “treatment and habilitation
services and supports” as contemplated by the Lanterman Act. Parents are typically
responsible for providing the necessities of life for their children.8 Thus, claimant’s
parents’ provision of health insurance, food, clothing, entertainment expenses, and
other miscellaneous items for their daughter when she is in the family home are not
reimbursable by the service agency. These are essentially expenses of daily living
that could be incurred by any child, developmentally disabled or not, and for which
           Welfare and Institutions Code section 4500 et seq.
           Welfare and Institutions Code sections 4501 and 4502, subdivision (a).
           Welfare and Institutions Code section 4620, subdivision (a).
           Welfare and Institutions Code section 4512, subdivision (a).
           Welfare and Institutions Code section 4646, subdivision (a).
          See, generally, Penal Code section 270 and Family Code section 4053. See also, Family
Code section 9305, which provides the same responsibility applies to adoptive parents.

parents usually responsible. None of these expenses were identified through the IPP as
services to be provided, and none go toward the alleviation of claimant’s developmental
disability, toward her habilitation or rehabilitation, or toward the achievement or
maintenance of an independent, productive, normal life.

                The cell phone potentially could be a reimbursable expense if it were
identified in claimant’s IPP as a service or support specifically needed to achieve the
goals of that plan. But the cell phone was simply identified in the ISP (not the IPP) as
one possible option for addressing claimant’s inappropriate phone usage. It was not the
only option, and it certainly was not the most cost-effective option. Considering all the
circumstances, claimant’s cell phone is not an expense the service agency is required to

        4.     Many issues concerning claimant’s financial status need to be clarified
by her parents, with the assistance of the service agency. These issues include whether
claimant is required to have private health insurance or whether she is fully covered
by Medi-Cal, what effect her recent approval for SSI has upon her placement funding,
whether all her clothing needs are being appropriately met by the group home, and the
status of claimant’s P&I funds at the group home. Resolution of some or all of those
issues might ease the burden on their budget that claimant’s parents have experienced
since their daughter was placed in the group home. Their commitment to their daughter
has been impressive and they are to be highly commended. Unfortunately, their request
for reimbursement of expenses they have incurred cannot be granted.


       The appeal is denied. The service agency is not required to reimburse claimant’s
parents for the requested expenses.


       This is the final administrative decision; both parties are bound by this decision.
Either party may appeal this decision to a court of competent jurisdiction within 90 days.

DATED: _________________________

                                           MICHAEL C. COHN
                                           Administrative Law Judge
                                           Office of Administrative Hearings


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