Budget Hearings Continue On EPSDT Entitlement Under Realignment

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Budget Hearings Continue On EPSDT Entitlement Under Realignment

Stakeholders share concerns over county contract caps limiting services 

This post is the second installment of our coverage on the effects of the 2011 Realignment on EPSDT services for young people with mental illness in California. Access to EPSDT services is a critical issue for California’s young people with unmet mental health needs, and a key focus of Young Minds’ advocacy. If you haven’t already, please read the first installment by visiting here.

Last week, on Hear Me Out, we covered the California Senate Budget Subcommittee on Health and Human Services’ hearing about the funding allocation formula for the 2011 Realignment Behavioral Health Subaccount. On Monday, the Assembly held its own hearing on this complex issue. Young Minds’ advocates and other mental health stakeholders attended the hearing and provided testimony about their concerns that EPSDT funding under realignment is restricting access to mental health treatment.

The Assembly Subcommittee focused on issues reflecting stakeholder concerns about funding levels and service accessibility, and highlighted allegations that caps on funding for mental health services are causing limitations on services. This may signal progress toward a legislative commitment to address these problems.

Stakeholders continued to call for clarification of the EPSDT growth allocation formula, as they did in the Senate hearing, and a clear commitment to reimbursing counties for money spent on EPSDT services.

[See prior post for quotes from stakeholders.]

A Clear Entitlement, Limited In Practice

A cornerstone issue during the hearing was the worry/perception that counties continue to limit EPSDT services despite their entitlement status. While county representatives continued to insist programs are not capped, reports from stakeholders suggest otherwise.

Assembly Member Roger Dickinson, District 7, supported further clarification from the Administration to the counties that EPSDT is indeed an entitlement. Agency staff observed that they have repeatedly affirmed that all medically necessary specialty mental health services under Medi-Cal, which includes EPSDT, are an entitlement, and that they would continue to work with counties to ensure compliance.

In her testimony, Kirsten Barlow, Associate Director of the California Mental Health Directors Association (CMHDA), confirmed that EPSDT is an entitlement program that cannot be capped. However, she conceded that counties may be limiting or capping local service providers’ contracts. She insisted that this does not mean that EPSDT services themselves are capped.

The Administration clarified that capping a contract with a specific provider is allowable, as long as beneficiaries are able to receive services within the county network.  However, counties cannot cap services as a whole.

Rusty Selix, Executive Director of the California Council on Community Mental Health Agency and Mental Health America of California, testified that the last three months of the fiscal year is when these providers begin to reach their contract caps.  “In order to go beyond those caps,” he said, “the counties have to identify that they will have additional money.”  With the lack of clarity on whether additional expenses will be reimbursed by the state, counties are hesitant to authorize EPSDT services above the contract caps.  Many providers are reporting that the counties believe that there will be no additional state funding if spending outpaces current allocations.  As a result, providers are being told that they cannot provide additional services to eligible children.

Assembly Member Dickinson expressed concern on continuity of care for beneficiaries, if contract caps limit treatment from their existing providers.

After the hearing, Patrick Gardner, President of Young Minds Advocacy Project, observed, “it makes no difference whether a cap is imposed through state funding allocations or county-controlled provider contracts, the result is that children and families are being denied services they need and are entitled to under state and federal law.  Our obligation as advocates and stakeholders is to deliver the message to legislators that children should not be denied required services while state and county administrators haggle over who must pay the bill.”

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Realignment’s effect on EPSDT services is a critical issue for California’s young people with unmet mental health needs, and a key focus of Young Minds’ advocacy. What do you think about this important issue? Send us your thoughts at info@youngmindsadvocacy.org or Tweet us @YoungMindsAdvoc #EPSDT.

By |2016-11-17T17:26:21-08:00April 10th, 2014|EPSDT, Featured Posts, Policy Action|0 Comments

About the Author:

Wesley Sheffield
Wesley Sheffield is an Associate Attorney at Young Minds.