Up to 85 percent of youth in foster care have some condition or disorder that requires mental health treatment. Given the trauma they have experienced in their young lives, they are three to six times more likely to experience emotional, behavioral and developmental problems than youth who are not in foster care. Left untreated, those problems often result in placement instability, school failure, psychiatric hospitalization, delinquency, homelessness and even death.
Especially at risk are some 13,000 foster youth who were residents of one county when they entered foster care, but later were placed in care in a different county. In 2011, researchers found foster youth placed out-of-county were more likely to have been diagnosed with a serious mental health disorder than those placed in-county, but were 10-15 percent less likely than their in-county peers to receive any mental health service at all.
The problem stems from California’s county-based system of mental health care delivery for Medi-Cal beneficiaries, including foster youth. The system’s specialty mental health services are provided using a system of county-operated Mental Health Plans (MHPs) under contract with the state’s Department of Health Care Services. Each MHP, in turn, contracts with a network of local private mental health care providers or uses county mental health staff to deliver services.
The legal responsibility of arranging for or providing mental health care for a county’s foster youth rests with its MHP, regardless of where the foster youth live. When foster youth are placed out-of-county, the county-operated MHPs face substantial administrative obstacles to providing services in the youth’s county of residence, including difficulty finding providers and services, contracting for care, getting treatment authorizations, coordinating and monitoring care, and securing adequate reimbursements from responsible federal, state, and local agencies.
Tragically, this problem has festered for over 20 years. But today we have a long-awaited opportunity to solve the problem and ensure that young people in foster care have access to the mental health services they need. Authored by Assembly Member Sebastian Ridley Thomas, Assembly Bill (AB) 1299 would have the Department of Health Care Services establish the presumptive transfer of responsibility for providing or arranging for mental health services from the MHP of a foster youth’s county of jurisdiction to the MHP of the county where the youth is living.
Here is a solution that is elegant, effective, and efficient: the county where a foster youth lives is responsible for his or her mental health care. AB 1299 would ensure that funding for mental health services follows any foster youth placed out-of-county utilizing the state’s existing mechanism for allocating 2011 realignment funding.
And should it be in the youth’s best interests that responsibility for mental health care remain with the MHP of the county of jurisdiction – for continuity of care, for example – the bill also provides a method by which the child welfare caseworker, in consultation with the youth’s child and family team, may waive the presumptive transfer.
AB 1299 passed out of all Assembly and Senate policy committees and off the floor of the Assembly with unanimous votes, no opposition and with robust support from child advocates, youth, family members, and providers across the state. An extended stakeholder process with state departments and representatives of county government made it possible to address all state and local concerns.
Now, in this 11th hour, the Senate Appropriations Committee must release AB 1299 from the suspense file so that it can pass out of the committee and on to the Senate floor. Young people should not have to wait any longer to receive the mental health services they desperately need.
Carroll Schroeder is Executive Director of the California Alliance of Child and Family Services; Anna Hasselblad is Policy Director of the Steinberg Institute and Surina Khan is CEO of the Women’s Foundation of California (the Women’s Policy Institute). The organizations are co-sponsors of AB 1299.