California Is Unlawfully Denying Mental Health Services to Medicaid Youth

Some of the most important rights to mental health care for children and youth come from Medicaid, a federal entitlement and state partnership that guarantees help for low-income families and individuals. Generally, an entitlement is a legally enforceable guarantee of access to a public benefit or service. In other words, the prescribed service must be provided to anyone who meets the eligibility criteria.

All Medicaid-eligible children in California are entitled to mental health care under the Early Periodic Screening, Diagnosis and Treatment (EPSDT) provisions. EPSDT requires states to screen eligible youth for health needs, including mental health disorders, and also provide necessary diagnosis and treatment services to help improve identified conditions.

But the state is not living up to that assurance for many of its low-income children, reserving key mental health services for kids covered by the settlement of a state lawsuit.

Included among the services covered by Medicaid are two types of community-­based mental health services known as Intensive Care Coordination (ICC) and Intensive Home Based Services (IHBS). These intensive services improve outcomes for children and youth with mental health needs and allow them to live and thrive in their own homes and communities.

As a result of the class-­action lawsuit Katie A. v. Bonta, California has received federal Medicaid reimbursement since 2013 for ICC and IHBS delivered to a limited population of Medi­-Cal (California’s Medicaid program) beneficiaries. This population is known as the ‘Katie A. Subclass.’  Its members include foster youth or youth at­ risk of out-of-home placement with open child welfare cases for whom ICC and IHBS have been deemed “medically necessary.”

California is denying Medi­Cal-eligible children access to ICC and IHBS solely because these children are not members of the Katie A. Subclass, regardless of whether they otherwise meet medical necessity criteria.

County mental health plans should make ICC and IHBS available to all eligible youths. But counties are refusing to provide these Medicaid-­covered services based on state policy guidance and information that restricts services to Katie A. subclass members.

As a result, Medi­-Cal children for whom these services are medically necessary are being unlawfully denied access to these intensive home and community-­based services. On May 20, Young Minds Advocacy Project sent a letter to the California Department of Health Care Services (DHCS) requesting action within 60 days to end the prohibition on providing ICC and IHBS to all eligible Medi­-Cal beneficiaries under age 21.

Young Minds further requested that DHCS expeditiously issue a policy statement or similarly enforceable guidance that is consistent with the federal mandate requiring these services to be provided as part of California’s EPSDT program.

As of July 10, Young Minds has not received a substantive response from DHCS regarding our letter. The 60-day deadline for the department to take action is July 20.

We sent this letter, and will follow up to ensure compliance, because we believe access to these community-­based services is an essential part of an effective System of Care for California’s youth with mental health needs. We urge the department to take action to come into compliance with federal law and to meet its obligations to youth and families in need.

Young Minds Advocacy Project engages in legal advocacy and community education to assist low-income youths and their families and communities in accessing appropriate mental health services and supports

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