{"edition":"california","organization":"Disability Rights California","organizationId":"org:disability-rights-california","boundaryVersion":"US-CA-state-v1","updated":"2026-09-14","model":{"version":"ca-drc-conditional-individual-health-access-v2","costScope":"Full ordinary-recipient donation, all functions. The historical annual-report expense denominator is $46,894,183; $100,000 is an analytical normalization, not a suggested gift. Only the individual access-to-care health pathway is quantified. Systemic litigation, policy, income, autonomy and other benefits are omitted, not assumed zero. Public care and other actors' incremental resources are excluded from the donor price but required for a social-cost estimate.","geographicAttribution":"Count California residents' modeled two-year benefit time only, g=1 after this filter. National precedent spillovers excluded.","formula":"N_CA = (C/E) × R × d × h × m × a; Q_CA = N_CA × du × sum(t=1..T, s^(t−1)/(1+r)^t) − H. Central E=46894183, R=22297, d=0.6, h=0.15, m=0.5, a=0.25, du=0.02, s=0.5, T=2, r=0.03, H=0. N means unique additional implemented care-access trajectories, not requests or legal wins. Price = 10 × C / Q_CA for positive Q_CA. All recipient costs are retained while counting only the individual health-access channel.","counterfactual":"Existing publicly contracted rights work, county plans and treatment, fee-funded enforcement, other advocates and alternative care continue. Count acceleration only for the time genuinely gained. A legal settlement or award does not imply all associated services disappear without a new gift. A case must change actual usable care or personal support, not merely legal eligibility; self-advocacy, existing staff/contracts and alternative provider/family support remain. Unfunded need does not prove an ordinary donation changes it.","attribution":"d deduplicates requests; h isolates potentially health-relevant care/support requests; m discounts marginal spending productivity for public contracts, reserves, alternative finance and differing marginal allocation; a is the joint chance that added advocacy changes actual care beyond existing family/agency/other-advocate action. No historical settlement percentage or equal coalition share assigned. du and persistence are within-person health differences, not disability weights or valuations of persons. Overlapping nursing/IHSS/insurance gains count one trajectory.","uncertainty":"Very-low-confidence conditional central for a partial health pathway, not comprehensive portfolio return. Organization counts and costs observed; all key marginal conversions and health effects are explicitly subjective priors. External trials establish possible and null incremental care effects but do not estimate DRC casework QALYs. Scenario endpoints are not empirical confidence bounds; zero, harms and omitted positive systemic benefits remain possible.","nativeOutcomes":"Unique additional California residents receiving usable appropriate health care, nursing or personal assistance; duration gained relative to services that would otherwise occur; finite within-person health-utility improvement. Requests, training, dollars awarded, hours authorized and placements are intermediate and cannot be treated as QALYs.","inputs":[{"name":"E","value":46894183,"unit":"USD per fiscal year","basis":"observed","rationale":"FY 2025 primary annual table, all functions. Original Form 990 expenses of $46,787,232 plus $110,521 direct event costs give $46,897,753, still $3,570 higher. The accounting presentations are not fully reconciled.","sourceIds":["finance25","irs25-original"]},{"name":"R","value":22297,"unit":"requests for assistance per FY2025","basis":"observed","rationale":"FY 2025 reported requests for assistance across DRC; these are not unique people or completed cases.","sourceIds":["impact"]},{"name":"d","value":0.6,"unit":"unique effective-client fraction of requests","basis":"judgment","rationale":"Judgment loosely anchored to OCRA's 6,406 clients and 10,475 issues (0.612 clients per issue). Different periods, units and program mix prevent treating this as an observed DRC-wide conversion.","sourceIds":["ocra25"]},{"name":"h","value":0.15,"unit":"fraction of unique effective requests with care-access pathway","basis":"judgment","rationale":"Judgment for the share concerning health care, nursing or personal assistance. Case examples establish a pathway, not its frequency across DRC.","sourceIds":["ocra25","ocra-stories25"]},{"name":"m","value":0.5,"unit":"marginal-to-historical productivity multiplier","basis":"judgment","rationale":"Judgment after public contracts, reserves, replacement financing and different marginal allocation. Roughly 91% public/State Bar revenue does not imply either zero or full ordinary-gift additionality. No unfunded caseload is costed.","sourceIds":["finance25","irs25-original","dhcs"]},{"name":"a","value":0.25,"unit":"additional implemented care trajectories per eligible client","basis":"judgment","rationale":"Judgment of joint additional advocacy success and actual service uptake beyond family, agency and existing advocates. Selected success stories are not representative success rates.","sourceIds":["ocra-stories25"]},{"name":"du","value":0.02,"unit":"first-year average health-utility increment per implemented trajectory","basis":"judgment","rationale":"Subjective within-person health change, equivalent to a 0.1 utility gain for 2.4 months. Oregon's insurance experiment supports possible benefit but does not validate this value for DRC clients. Other community-care trials include null results.","sourceIds":["oregon","react","housing"]},{"name":"s","value":0.5,"unit":"fraction of first-year incremental benefit retained next year","basis":"judgment","rationale":"Joint judgment for counterfactual catch-up, attrition, survival and continued California residence. No benefit is carried past year two in the central case.","sourceIds":[]},{"name":"T","value":2,"unit":"years","basis":"judgment","rationale":"Finite central effect window; no carry-forward beyond the second year.","sourceIds":[]},{"name":"r","value":0.03,"unit":"annual discount fraction","basis":"judgment","rationale":"Year-end discount convention.","sourceIds":[]},{"name":"H","value":0,"unit":"net harm QALYs per normalization","basis":"judgment","rationale":"Central convention, not proof of no harm. A separate signed-harm stress test is retained.","sourceIds":[]}],"scenarios":[{"id":"central","label":"Conditional individual care-access health channel, not portfolio return","costUSD":100000,"allPopulationQalys":0.015428615622571185,"editionQalys":0.015428615622571185,"assumptions":"E=46894183, R=22297, d=0.6, h=0.15, m=0.5, a=0.25, du=0.02, s=0.5, T=2, r=0.03, H=0. All recipient costs retained; unmodeled pathways are excluded, not assumed valueless."},{"id":"favorable","label":"Favorable partial-channel stress test","costUSD":100000,"allPopulationQalys":1.977572769106161,"editionQalys":1.977572769106161,"assumptions":"E=46894183, R=22297, d=0.8, h=0.3, m=1, a=0.75, du=0.1, s=0.8, T=3, r=0.03, H=0. All recipient costs retained; unmodeled pathways are excluded, not assumed valueless."},{"id":"pessimistic","label":"Low additionality and small health change","costUSD":100000,"allPopulationQalys":0.000002769755832897311,"editionQalys":0.000002769755832897311,"assumptions":"E=46894183, R=22297, d=0.3, h=0.02, m=0.1, a=0.05, du=0.002, s=0, T=1, r=0.03, H=0. All recipient costs retained; unmodeled pathways are excluded, not assumed valueless."},{"id":"zero","label":"No incremental health benefit","costUSD":100000,"allPopulationQalys":0,"editionQalys":0,"assumptions":"E=46894183, R=22297, d=0.6, h=0.15, m=0, a=0.25, du=0.02, s=0.5, T=2, r=0.03, H=0. All recipient costs retained; unmodeled pathways are excluded, not assumed valueless."},{"id":"harm","label":"Possible net harm","costUSD":100000,"allPopulationQalys":-0.004571384377428815,"editionQalys":-0.004571384377428815,"assumptions":"E=46894183, R=22297, d=0.6, h=0.15, m=0.5, a=0.25, du=0.02, s=0.5, T=2, r=0.03, H=0.02. All recipient costs retained; unmodeled pathways are excluded, not assumed valueless."}],"sensitivity":["Price varies inversely with d, h, m, a and du; the data do not identify their joint product. Changing du from 0.02 to 0.002 alone raises the price tenfold.","At central q=0.0288434 QALYs per trajectory, $1 million per 10 QALYs requires 34.66998 additional trajectories per $100,000, versus the central 0.53491. The $100,000 target requires 346.6998. These benchmarks do not bound systemic policy effects.","OCRA's unique-client fraction is only a deduplication proxy, not a clinical success rate. All DRC requests may have a different mix.","Replacing annual expenses of $46,894,183 with the gross Form 990 figure of $46,897,753 changes the price by only 0.0076%, negligible beside model uncertainty.","At zero additional care or zero health improvement, there is no finite favorable price. Improved autonomy, housing or income may remain valuable outside the QALY measure.","A future case-level cohort should jointly track baseline alternative care, actual funded service hours, uptake, unique people, health utility and counterfactual catch-up time. Do not add this model to Tulare housing or ACT benefits without deduplication."],"missingInputs":["Costed unfunded marginal recipient portfolio and restrictions on public-contract funds","Gift-induced legal capacity and substitution by other donors or fee recoveries","Case-level change in implementation probability/timing versus existing county plans","Actual additional uptake, attrition, survival and overlap across services","Comparable person-level health utility and duration, with non-health rights benefits reported separately","FY2025 original-account reconciliation and entity/presentation comparability"]},"sources":[{"id":"annual25","title":"2025 Annual Report","url":"https://www.disabilityrightsca.org/2025-annual-report","published":"2026-05-04","publisher":"Disability Rights California","retrieved":"2026-09-13"},{"id":"finance25","title":"2025 annual financials and employment","url":"https://www.disabilityrightsca.org/2025-annual-report/financials-and-employment","published":"2026-01-22","publisher":"Disability Rights California","retrieved":"2026-09-13"},{"id":"finance24","title":"2024 annual financials and employment","url":"https://www.disabilityrightsca.org/2024-annual-report/financials-and-employment","published":"2025-04-01","publisher":"Disability Rights California","retrieved":"2026-09-13"},{"id":"audit24","title":"FY2024 consolidated financial statements and single audit, with FY2023 comparative accounts","url":"https://projects.propublica.org/nonprofits/download-audit?download=true&filename=2024-09-GSAFAC-0000360163","published":null,"publisher":"Disability Rights California and independent auditors; Federal Audit Clearinghouse copy","retrieved":"2026-09-13"},{"id":"tax-index","title":"IRS filing index and extracted totals, EIN 94-2505916","url":"https://projects.propublica.org/nonprofits/organizations/942505916","published":null,"publisher":"ProPublica / IRS","retrieved":"2026-09-13"},{"id":"impact","title":"2025 reported impact","url":"https://www.disabilityrightsca.org/2025-annual-report/impact","published":"2026-02-25","publisher":"Disability Rights California","retrieved":"2026-09-13"},{"id":"settlement","title":"Tulare County settlement agreement, original instrument","url":"https://www.disabilityrightsca.org/system/files/file-attachments/Tulare_Settlement_0.pdf","published":null,"publisher":"Disability Rights California","retrieved":"2026-09-13"},{"id":"tulare-current","title":"Tulare County mental health settlement implementation account","url":"https://www.disabilityrightsca.org/2025-annual-report/tulare-county-mental-health-settlement-agreement","published":"2026-01-22","publisher":"Disability Rights California","retrieved":"2026-09-13"},{"id":"county","title":"County describes community behavioral health expansion","url":"https://tularecounty.ca.gov/tulare-county-behavioral-health-expands-services-with-commitment-to-community-salud-conductual-del-condado-de-tulare-amplia-sus-servicios-con-un-compromiso-a-la-comunidad","published":null,"publisher":"Tulare County","retrieved":"2026-09-13"},{"id":"dhcs","title":"Patients' rights: state contract and responsibilities","url":"https://www.dhcs.ca.gov/services/patients-rights/","published":null,"publisher":"California Department of Health Care Services","retrieved":"2026-09-13"},{"id":"act-positive","title":"Randomized trial of ACT for homeless persons with severe mental illness, 1997","url":"https://pubmed.ncbi.nlm.nih.gov/9366661/","published":null,"publisher":"Lehman and colleagues, Archives of General Psychiatry","retrieved":"2026-09-13"},{"id":"react","title":"REACT randomized trial of ACT versus community mental health teams","url":"https://discovery.ucl.ac.uk/166247/1/Bebbington_REACT.pdf","published":"2006-03-16","publisher":"Killaspy and colleagues, BMJ","retrieved":"2026-09-13"},{"id":"housing","title":"Cost-effectiveness of Housing First with intensive case management","url":"https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2748596","published":"2019-08-21","publisher":"Latimer and colleagues, JAMA Network Open","retrieved":"2026-09-13"},{"id":"donate","title":"DRC donation page","url":"https://www.disabilityrightsca.org/drc-donation","published":"2024-11-15","publisher":"Disability Rights California","retrieved":"2026-09-13"},{"id":"irs25-original","title":"Original Form 990, fiscal year ended September 30, 2025","publisher":"Disability Rights California / IRS, ProPublica original filing copy","url":"https://projects.propublica.org/nonprofits/full_text/202641769349300314/IRS990","published":null,"retrieved":"2026-09-13"},{"id":"ocra25","title":"OCRA annual director report, July 2024–June 2025","publisher":"Disability Rights California","url":"https://www.disabilityrightsca.org/system/files/file-attachments/Directors%20Report.FINAL__0.pdf","published":"2025-08-13","retrieved":"2026-09-13"},{"id":"ocra-stories25","title":"OCRA advocacy report, January–June 2025","publisher":"Disability Rights California","url":"https://www.disabilityrightsca.org/system/files/file-attachments/Exhibit%20C%20-%20Advocacy%20Report.FINAL__0.pdf","published":"2025-08-13","retrieved":"2026-09-13"},{"id":"ocra-index25","title":"OCRA Annual Report 07/2024–06/2025 publication page","publisher":"Disability Rights California","url":"https://www.disabilityrightsca.org/latest-news/ocra-annual-report-07-2024-06-2025","published":"2025-08-13","retrieved":"2026-09-13"},{"id":"oregon","title":"The Oregon Experiment—Effects of Medicaid on Clinical Outcomes","publisher":"Baicker and colleagues / New England Journal of Medicine","url":"https://www.nejm.org/doi/full/10.1056/NEJMsa1212321","published":"2013-05-02","retrieved":"2026-09-13"}]}