BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  AB 989
                                                                  Page  1

          Date of Hearing:   March 29, 2011

                            ASSEMBLY COMMITTEE ON HEALTH
                              William W. Monning, Chair
                   AB 989 (Mitchell) - As Amended:  March 21, 2011
           
          SUBJECT  :  Mental health: children's services.

           SUMMARY  :  Requires counties to include programs addressing the 
          needs of transition age foster youth in their three-year plans 
          for funding from the Mental Health Services Act (MHSA).

           EXISTING LAW  :

          1)Establishes the MHSA, enacted by voters in 2004 as Proposition 
            63, to provide funds to counties to expand services and 
            develop innovative programs and integrated service plans for 
            mentally ill children, adults, and seniors through a 1% income 
            tax on personal income above $1 million.

          2)Requires each county mental health department to prepare, and 
            submit to the Department of Mental Health (DMH) for approval, 
            a three-year plan for MHSA funding that must include several 
            components, including: programs for prevention and early 
            intervention; services to children, adults, seniors, and 
            transition age youth ages 16 to 25; innovations; and, 
            technological needs and capital facilities.  Requires DMH to 
            establish guidelines for the content of each component.  

          3)Specifies that the MHSA may only be amended by a two-thirds 
            vote of both houses of the Legislature and only as long as the 
            amendment is consistent with and furthers the intent of the 
            MHSA.  Permits provisions clarifying the procedures and terms 
            of the MHSA to be added by majority vote.

          4)Establishes, under federal law, the Early and Periodic 
            Screening, Diagnosis, and Treatment (EPSDT) Program to provide 
            physical and mental health services to Medicaid (Medi-Cal in 
            California) beneficiaries under the age of 21, including 
            current and former foster youth. 

           FISCAL EFFECT  :  This bill has not yet been analyzed by a fiscal 
          committee.

           COMMENTS  :   








                                                                  AB 989
                                                                  Page  2


           1)PURPOSE OF THIS BILL  .  According to the author, transition age 
            foster youth between the ages of 16 and 25 suffer among the 
            worst rates of mental illness of any population as a result of 
            being uniformly abused and neglected by their parents, 
            separated from their siblings and grandparents, shuffled from 
            placement to placement, and kicked to the streets to fend for 
            themselves when they turn 18 and age out of the system.  The 
            author notes that while the MHSA directly references the need 
            to fund programs that ensure that transition age youth (TAY) 
            ages 16-25 achieve self-sufficiency successfully, transition 
            age foster youth are a subgroup of this population that 
            warrants special treatment and elevated priority because they 
            have uniquely acute mental health needs that separate them 
            from their TAY peers.

           2)TRANSITION AGE FOSTER YOUTH  .  There are approximately 26,000 
            foster children 16 years and older in California, 4,000 of 
            whom age out of the system every year.  Research shows that 
            outcomes for these youth are far worse than those for their 
            peers in the general population, who can often rely on 
            assistance from their parents and families for financial and 
            emotional support.  Transition age foster youth face daunting 
            odds once they are emancipated and many ultimately return to 
            the care of the state as adults, either through the public 
            welfare, mental health, or criminal justice systems.  It is 
            well-documented that, when compared to youth in the general 
            population, transition age foster youth face higher rates of 
            incarceration, struggle to achieve financial independence and 
            often end up homeless, are less likely to earn a high school 
            diploma and attend college, are more likely to experience 
            mental illness and untreated medical issues due to lack of 
            access to health care, and are more likely to be single 
            parents. 

          In January 2010, the Children's Advocacy Institute (CAI), the 
            sponsor of this bill, released a report that reviewed whether 
            or not MHSA-funded programs are reaching the state's 
            transition age foster youth.  The report notes that foster 
            youth transitioning out of care have unique standing among 
            priority populations for programs funded by MHSA for numerous 
            reasons.  Specifically, the report finds that transition age 
            foster youth lack parental support to help them cope with 
            their mental health challenges and, as children of the State, 
            they are owed a special moral as well as legal obligation to 








                                                                  AB 989
                                                                  Page  3

            ensure their emotional and mental wellness; they are cloaked 
            by a confidential child welfare system that makes it difficult 
            for them to provide input to county officials when making 
            local planning decisions; they experience mental illnesses, 
            including suicidal behavior, major depressive disorder, and 
            post-traumatic stress disorder, at significantly higher rates 
            than the general population, and, lastly, they lack the 
            traditional roots provided by a family structure so they tend 
            to move between counties as they exit the foster care system 
            and are unable to take advantage of county programs that do 
            not accept out-of-county youth.  

           3)MHSA  .  In November 2004, voters passed MHSA or Proposition 63. 
             MHSA requires each county mental health department to prepare 
            and submit a three-year plan to DMH that must be updated each 
            year and approved by DMH after review and comment by the 
            Mental Health Services Oversight and Accountability Commission 
            (MHSOAC).  DMH is required to provide guidelines to counties 
            related to each component of the MHSA, including, among other 
            things, community services and support content to provide 
            integrated mental health and other support services to those 
            whose needs are not currently met through other funding 
            sources; prevention and early intervention content to provide 
            services to avert mental health crises; and, innovative 
            program content to improve access to mental health care.  In 
            their three-year plans, counties are required to include a 
            list of all programs for which MHSA funding is being requested 
            that identifies how the funds will be spent and which 
            populations will be served.

          The CAI report graded California counties on the extent to which 
            they are using MHSA funds to benefit transition age foster 
            youth.  The report found that most counties acknowledge these 
            youth as highly at risk of developing mental illnesses and 
            appropriately identify them as a priority population for 
            MHSA-funded services but only as one of several other at-risk 
            TAY populations being served by their programs.  Other TAY 
            populations include prisoners returning to society or TAY 
            exiting the juvenile justice system.  According to the report, 
            26 counties received a failing grade for having MHSA programs 
            that are not effectively reaching roughly four out of every 
            five of the state's transition age foster youth.  Another 
            seven counties, home to approximately 15% of these youth, 
            received a D grade, meaning that these youth live in counties 
            with MHSA programs that lack adequate capacity to meet their 








                                                                  AB 989
                                                                  Page  4

            needs and must compete with priority populations for these 
            limited services.      

          In February 2010, the California Mental Health Directors 
            Association (CMHDA), which represents county mental health 
            departments, issued a statement in response to the report, 
            contending that while the report provides well-founded reasons 
            why mental health services are needed for transition age 
            foster youth, it ignores the important progress California 
            counties have made in serving the needs of local communities, 
            including transition age foster youth, through MHSA and other 
            funding sources.  CMHDA notes that MHSA requires counties to 
            exhaust other resources before expending MHSA funds, and 
            specifically requires that funds be used to serve individuals 
            not covered (or not fully covered) by private insurance or 
            public mental health.  CMHDA points out that many transition 
            age foster youth are served by Medi-Cal and EPSDT services 
            until age 21 and, once these entitlement services are 
            exhausted, counties can use MHSA funds to fill in the gaps.  
            CMHDA also argues that many counties have put in place 
            "graduated foster youth" programs to help these youth 
            transition to MHSA-funded full service partnership programs 
            that provide "whatever it takes" services to keep individuals 
            from homelessness, hospitalization, and institutionalization.  
            CMHDA maintains that county MHSA plans do not ignore the needs 
            of youth transitioning out of the foster care system and many 
            dedicate their TAY MHSA funds to this particular population by 
            providing, in addition to mental health treatment, supportive 
            housing services, transportation assistance, employment 
            services, educational support, linkages to community 
            resources, and peer mentoring.

           4)SUPPORT  .  CAI writes in support that, because transition age 
            foster youth have unique experiences and unique 
            characteristics as a group, any program attempting to address 
            their mental health and well-being must be equally unique, and 
            specifically tailored to meet these specific issues.  CAI 
            states that this bill simply clarifies for local MHSA 
            authorities that funding for programs for transition age youth 
            includes programs that address the more acute and desperate 
            needs of the smaller subcategory of transition age foster 
            youth.  The California Alliance of Child and Family Services 
            adds that the inclusion of transitional foster youth in county 
            MHSA plans will ensure that this fragile population is better 
            able to access mental health services to address their needs. 








                                                                  AB 989
                                                                  Page  5


           5)SUPPORT IF AMENDED  .  CMHDA supports this bill if it is amended 
            to make it permissive, rather than mandatory, for each 
            county's MHSA plan to include transition age foster youth in 
            their required programs for services for TAY.  CMHDA is 
            concerned that specifically requiring the inclusion of 
            transition age foster youth in county MHSA plans will create a 
            preference for this population over other TAY populations and 
            flout the local community-driven process of identifying and 
            prioritizing local needs and populations.  

           6)RELATED LEGISLATION  .

             a)   AB 181 (Portantino) sets forth rights for foster youth 
               relating to mental health services and directs the Office 
               of the State Foster Care Ombudsperson to consult with 
               specified entities to develop standardized materials 
               explaining these rights and to distribute the information 
               to foster youth by July 1, 2012.  AB 181 is scheduled for a 
               hearing in the Assembly Human Services Committee on April 
               26, 2011.

             b)   AB 100 (Committee on Budget) makes necessary changes to 
               enact the Budget Bill for fiscal year 2011-12 related to 
               MHSA and, among other things, eliminates the existing 
               requirement for DMH and MHSOAC to review and approve county 
               plans.  AB 100 is pending enrollment to the Governor's 
               desk.

           7)DOUBLE-REFERRAL  .  This bill has been double-referred.  Should 
            this bill pass out of this committee, it will be referred to 
            the Assembly Human Services Committee.

           REGISTERED SUPPORT / OPPOSITION  :   

           Support 
           
          Children's Advocacy Institute (sponsor)
          California Alliance of Child and Family Services

           Opposition 
           
          None on file.

           








                                                                 AB 989
                                                                  Page  6

          Analysis Prepared by  :    Cassie Royce / HEALTH / (916) 319-2097