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