Recent articles by The Imprint have described a long-standing problem wherein many children who are removed from their homes due to abuse and neglect are provided inadequate access to mental health care. That’s because California’s county-run mental health system will not effectively deliver mental health care to children who are placed out of county.
Virtually everyone who confronts this problem agrees that it is unfair, harmful to foster youth and needs to be fixed. And yet nothing has been done, year after year.
This year is shaping up to be no different. After months of haggling over a legislative fix, Assembly Bill 1299, the California Senate Appropriations Committee held the bill over until next year.
AB 1299, introduced by Assembly member Sebastian Ridley-Thomas (D), seeks to do a very simple thing: transfer the Medi-Cal obligation to provide and pay for mental health services from the county in which a foster child enters care to the county in which the child resides. That way, foster youth would live in the mental health network that serves them, rather than having to contract for care that is available ten, fifty or sometimes a hundred miles away. The bill also includes exceptions to the transfer when doing so would limit, delay or disrupt treatment.
Who is to blame for stalling the bill and causing this latest failure? That is not entirely clear. Arguments were raised about the cost of the change. Fears of unfunded mandates were stoked. In truth, these concerns are unfounded because providing mental health care to foster youth is a longstanding federal and state duty, and no new services are required by the bill. All that is required is for the counties is to meet existing obligations to the state’s most vulnerable youth in a timely fashion.
What is clear is that lobbyists for three county-centered entities — the California State Association of Counties, the California Behavioral Health Directors Association and the California Welfare Directors Association — opposed two critical parts of the solution. They opposed having funding follow the child to the child’s county of residence. Instead, the counties proposed giving half of the cost of services (the federal reimbursement half) to the county that provides treatment.
They also opposed having the foster parent, or the person who is responsible for making mental health decisions for the child, decide whether to transfer mental health care responsibility. Instead, the counties wanted social workers and probation officers to be gatekeepers.
It’s absurd to think that a system fix that covers only half the cost of care would work. It is also unreasonable to put responsibility for making system-wide mental health policy on individual social workers or probation officers, something that is clearly outside of their wheelhouse.
In short, it appears that the county lobbyists opposed the bill because it would have changed business as usual to ensure that foster youth who are sent to live in another county are no longer discriminated against when seeking mental health care. It’s a classic case of taking care of the system instead of taking care of the kids.
When one talks to individual social workers and probation officers, or even directors of children’s services or mental health care programs, they universally favor shifting responsibility for care to the county that can best deliver treatment and making sure full funding is there to pay for the services provided.
They also favor having exceptions when transferring responsibility would make treatment more challenging. Unfortunately, the hard-working and dedicated people on the front lines have been undercut by their representatives in Sacramento in the name of preserving the status quo. As a result, thousands of foster youth will continue to wait for services they desperately need.
Patrick Gardner is the director of the Young Minds Advocacy Project.