Breaking news! Young Minds Advocacy has released an exclusive table on access to Early, Periodic, Screening, Diagnosis and Treatment (EPSDT) mental health services. The table, available for download here, provides data on California’s provision of Medi-Cal specialty mental health services to children and youth—and, more specifically, a county-by-county comparison of EPSDT penetration rates from FY 2011/12 through FY 2014/15.
Young Minds compiled the table using Department of Health Care Services’ Performance Outcomes System (POS) data collected through August 3, 2016. (DHCS has yet to release EPSDT penetration data on FYs 15/16 and 16/17.) YMA’s table features: (a) individual county EPSDT penetration rates; (b) average cost per beneficiary; (c) total expenditures; and (d) the statewide totals and cumulative change over time for (a) through (c), from FY 11/12 through FY 14/15. No other single source presents data in this manner.
Digging Into the Data
What Is a “Penetration Rate,” and Why Is It Important?
Shown by percentage, penetration rates are service access rates – calculated using the number of Medi-Cal clients who received at least one EPSDT service in a fiscal year divided by the total number of children and youth on Medi-Cal. Penetration rates are important data points for assessing gaps that exist between how many youth may need services versus how many are actually receiving mental health treatment.
Tracking penetration rates and their cumulative change over time, can also reveal gaps in access. For instance, analysis shows that many youth do receive care, but many more do not: We know that about 8 to 10 percent of low-income children in California meet criteria for Serious Emotional Disturbance (SED). Using this rate, an expected 440,000 to 550,000 (out of approximately 5.5 million) youth enrolled in Medi-Cal in 2014/15 would likely have needed EPSDT mental health services. Comparing this estimate with the statewide average penetration rate and total youth served reveals that in 2014/15 alone, more than one-quarter of a million eligible California children with serious mental health needs received no Medi-Cal specialty mental health services at all.
Worsening Penetration Rates Statewide – Even As Spending Increased
YMA’s table reflects a concerning trend: On the whole, penetration rates have worsened. The statewide penetration rate declined from to 4.8 percent in FY 11/12 to 4.2 percent in FY 14/15 – a downward pattern repeated in the vast majority of counties across California. The statewide decline in access impacts far more than statistics: The more than one-half percentage point decline over the course of a year means that more than 25,000 fewer youth received meaningful access to care.
What does this all mean? A growing proportion of young people – estimated in the tens of thousands – are not able to access crucial mental health services they are entitled to under the law.
Using Data to Evoke Action
Timely, accurate, and consistent penetration rate data can be used to measure outcomes and promote accountability for programs serving youth. Knowing who does and does not receive EPSDT services can help unlock barriers to care for thousands of eligible young people awaiting treatment. Young Minds will continue to work with our partners toward improving reporting measures – and ultimately, service access – across the youth and children’s mental health system.
YMA’s report, “California’s Children and Youths’ System of Care: An Agenda to Transform Promises into Practice,” emphasizes the importance of high quality, accessible data in helping to ensure that all young people receive the mental health care they need and deserve to live happy, successful lives.
To learn more about our recommendations on improving the mental health system for young people, read our full report here. And, in the coming weeks, look out for more YMA analysis and recommendations regarding the State’s EPSDT penetration data.
 In California, Serious Emotional Disturbance (SED) refers to youth under age 18 who have a qualifying mental disorder that results in “behavior inappropriate to the child’s age according to expected developmental norms.” W&I Code § 5600.3.