Equal Access to Care for Foster Youth (“Out-of-County”)
Foster youth are 3 to 6 times more likely to experience mental health challenges than children in the general population. Foster youth who are bounced from home to home (a foster home, group home, etc.) are even more vulnerable. They often experience greater mental health challenges as a result of their placement instability. They also encounter greater barriers to receiving mental health services, especially when they are moved to a home or other placement outside of the county in which they entered care. Youths who are placed across county lines, or “out-of-county,” often experience lengthy delays or denials in accessing treatment. This situation is similar to when a person seeks healthcare treatment “out-of-network” – insurance coverage could be delayed or denied. For foster youth especially, the delay or denial of mental healthcare can have disastrous consequences. All foster youth deserve and are entitled to equal access to mental health treatment, whether or not they are moved across county lines. The out-of-county problem denies thousands of youth in California of that right.
Young Minds’ Impact
Young Minds has been working to solve the “out-of-county” problem and ensure all foster youth have equal access to mental health treatment. Before founding Young Minds, Patrick Gardner and other advocates worked to bring the issue to the attention of the California Child Welfare Council, an advisory body responsible for working to improve the child welfare system. This led in 2010 to the Council’s unanimous support of an action plan aimed to fix the problem. Since then, however, negotiations between the counties and the state stalled, and, once again, we see that foster children were promised results that were not delivered.
In 2014, Young Minds again pushed this issue to the fore and the State recommitted to taking action at the Child Welfare Council’s meeting in December 2014. Shortly thereafter, legislation was introduced in the form of AB 1299 (Ridley-Thomas) that would transfer responsibility for providing mental health treatment to the county of residence for most foster youth. AB 1299 is now a two-year bill awaiting Legislative action early in 2016.
How’d we get here? Issue Background
The “out-of-county” problem stems from California’s county-based system of mental health service delivery. Medi-Cal Specialty Mental Health Services are provided using a system of county-based managed care agencies, known as Mental Health Plans (MHPs), under contract with the Department of Health Care Services. Each MHP, in turn, contracts with local private mental health service providers (or uses county mental health staff) to deliver services. This system works well for many children and youth. However, the county-based MHPs face substantial administrative barriers when services must be provided to young people placed out-of-county, outside the service area for its network of providers–think “out-of-network.” These problems include difficulty: 1) finding providers and services in the child’s county of residence (“host” county); 2) contracting for care; 3) getting treatment authorizations; 4) coordinating and monitoring care; and 5) securing adequate reimbursements from responsible parties including federal, state, and local agencies.
Solving the out-of-county problem and providing equal access to mental healthcare for out-of-county foster youth will require.
- A shift in the focus of responsibility to provide or arrange for mental health services from the home to the host county. This will stop counties from declining to provide mental health services to foster youth simply because they entered foster care in another county.
- An assurance that the providing host county is reimbursed the full cost of serving out-of-county foster children—including the federal, state, and home county cost-shares of all treatment.
As advocates for youth with mental health needs, we all have a stake in ensuring this issue is addressed, and soon.