Positively Impacting Not Just One, But Thousands

Revealing Inequities in SMHS Funding for Medi-Cal Eligible Youth

Young Minds Advocacy complied all the publicly available data on California's EPSDT Specialty Mental Health Services program from Realignment 2011 to FY2021 in order to better understand how California’s Children’s Mental Health system operates across counties. By comparing a decade of funding, spending, and performance, YMA was able to determine the driving forces behind who gets (and doesn’t get) mental health care, and what sort of care do they get.

Our research has revealed many things, but most importantly, we learned that California’s discretionary allocation of 2011 Realignment mental health funding has resulted in enormous inequities in access to care. Sixteen medium and large counties, serving more than a third of California’s youth, missed out on $3 billion in mental health funds and failed to serve about ½ million youths since 2011 Realignment. In FY 2019-20 alone, we estimate that at least 46,000 youths failed to receive any SMHS due to disproportionate 2011 Realignment funding.

That hundreds of thousands of young people have been denied needed mental health care due to choices made by the State for allocating mental health funding is a call for action. Our goal in researching and writing about this problem is to push California’s leaders to properly fund mental health services to low-income youth at a time when the need is enormous. While the Newsom Administration proceeds with allocation of $4.7 billion in new, one-time funds under California’s Master Plan for Kids’ Mental Health it must first address inequities in the existing system that deny care to tens of thousands of eligible children.

Read the 2022 report here.

Policy Agenda for Improving the Lives of Young People with Mental Health Needs in California

In recognition of Children’s Mental Health Awareness Day 2017, Young Minds Advocacy released a comprehensive report California’s Children and Youths’ System of Care: An Agenda to Transform Promises into Practice, authored by YMA’s president, Patrick Gardner. Made possible by the generous support of the Zellerbach Family Foundation, the report underscores California’s need for a coordinated, youth-focused mental health policy that is distinct and separate from the state’s adult system of care. The report reviews California’s existing publicly funded mental health system for young people, and examines challenges related to access, coordination of services, quality of treatment, leadership, and accountability. The report offers a framework for identifying specific activities that can be combined into a proactive stakeholder agenda for achieving better outcomes for thousands of California’s children and youth with unmet mental health needs.

Equal Access to Care for Foster Youth

All young people deserve equal access to mental healthcare, no matter where they live. YMA is working to end delays and/or denials of services and supports for foster youth moved across county lines. A major milestone was achieved in September 2016, when Governor Jerry Brown signed AB 1299 (Ridley-Thomas), “Medi-Cal Specialty Mental Health Services for Foster Youth,” into law. This represented a significant turning point in the delivery of mental health services to foster youth in California where out-of-county will no longer mean out-of-luck. The passage of AB 1299 represents years of advocacy by Young Minds and a host of dedicated allies.

In order for AB 1299 to work, however, it has to be successfully turned into practice. This requires continued collaboration and commitment by stakeholders to develop regulations and monitor implementation. YMA is working to ensure equal access to mental health services among California’s counties, so that services in the Central Valley are every bit as accessible and appropriate as services on the Coast.

Preserving Youth Entitlement to Care

The federal entitlement known as the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) provides comprehensive, preventive health care services for children under age 21 who are enrolled in Medi-Cal. Counties deliver EPSDT services to beneficiaries and are reimbursed for the costs, in part, with federal Medicaid funding, and until California’s funding Realignment of 2011, matched with State general funds. After Realignment 2011, counties were delegated the responsibility to fund the state share of costs using a fixed percentage of state sales tax receipts and vehicle licensing fees. As a result, many counties began treating EPSDT as a capped entitlement program—making access to care contingent on state funding allocations.

In 2014, YMA and our allies prevailed upon the California Department of Health Care Services (DHCS) to issue an All County Information Notice (ACIN) reaffirming the EPSDT entitlement for youth living with mental illness. In particular, ACIN No. 14-017 confirmed that Realignment legislation did not limit or cap the EPSDT entitlement, reminding counties and providers that all Medi-Cal eligible young people must be provided full access to necessary mental health care. This Realignment funding decision signals an important policy victory for young people and families in California with mental health needs.

Measuring Quality of Care

A variety of assessment tools exist to help decision-makers measure the effectiveness and quality of mental health care for young people. YMA has long argued that a common assessment methodology, one used by all 58 counties, is the only way to achieve a systematic evaluation of State’s mental health program performance. After years of advocacy, a major milestone was passed, when, in 2017, California’s Department of Social Services and Department of Health Care Services adopted a multi-purpose assessment tool known as CANS (Child and Adolescent Needs and Strengths) to support level of care and service planning, facilitate quality improvement initiatives, and allow for the monitoring of outcomes of services. This remarkable and far-reaching result is the cornerstone of real system reform.

Reducing Youth Institutionalization and Expansion of Services

Attorneys at YMA were co-counsel in Katie A. v. Bonta, a federal class action lawsuit filed in Los Angeles in 2002. Advocates filed the case seeking better coordination of child welfare and mental health programs and to provide Medi-Cal-funded intensive home and community-based mental health services to child welfare-involved youth. After litigating for almost a decade, California agreed to add three new intensive mental health services to the Medi-Cal menu—Intensive Care Coordination (ICC), Intensive Home and Community-Based Services (IHBS), and Therapeutic Foster Care (TFC) at YMA’s prompting. The judgment was expanded in 2016 to include all Medi-Cal youth with serious mental health needs, not just child welfare-involved youth. In order to meet this commitment, the state promised to coordinate information, management, and clinical practice among CDSS, DHCS, county child welfare programs, and MHPs. When the Katie A. agreement is fully implemented, 40,000 or more children annually should receive Medi-Cal funded home and community-based services using a wraparound model.