BILL ANALYSIS Ó ------------------------------------------------------------ |SENATE RULES COMMITTEE | AB 989| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ------------------------------------------------------------ THIRD READING Bill No: AB 989 Author: Mitchell (D), et al. Amended: 5/27/11 in Assembly Vote: 21 SENATE HEALTH COMMITTEE : 9-0, 6/22/11 AYES: Hernandez, Strickland, Alquist, Anderson, Blakeslee, De León, DeSaulnier, Rubio, Wolk SENATE APPROPRIATIONS COMMITTEE : 8-1, 8/25/11 AYES: Kehoe, Alquist, Emmerson, Lieu, Pavley, Price, Runner, Steinberg NOES: Walters ASSEMBLY FLOOR : 63-13, 6/1/11 - See last page for vote SUBJECT : Mental health: childrens services SOURCE : Childrens Advocacy Institute of the University of San Diego School of Law DIGEST : This bill requires programs contained in county Mental Health Services Act plans, which are required to include services to address the needs of transition-age youth, to also consider the needs of transition-age foster youth. ANALYSIS : CONTINUED AB 989 Page 2 Existing law: 1. Establishes 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. 2. Establishes the Mental Health Services Act (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 one percent income tax on personal income above $1 million. 3. Requires each county mental health department, until March 2011, to prepare and submit a three-year plan to the Department of Mental Health (DMH) for approval for MHSA funding which 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. 4. Requires DMH to establish guidelines for the content of each component. 5. Beginning March 2011, removes the state approval of county mental health programs, and declares the intent of the Legislature to ensure continued state oversight and accountability of MHSA. In eliminating state approval, the Legislature expects the state, in consultation with the Mental Health Services Oversight and Accountability Commission (MHSOAC), to establish a more effective means of ensuring that county performance complies with MHSA. 6. Specifies that 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 MHSA. 7. Permits provisions clarifying the procedures and terms of MHSA to be added by majority vote. AB 989 Page 3 This bill requires programs contained in county MHSA plans, which are required to include services to address the needs of transition-age youth, to also consider the needs of transition age foster youth. Background Mental Health Services Act . In November 2004, voters passed MHSA, also known as 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 MHSOAC. DMH is required to provide guidelines to counties related to each component of 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. Transition-age foster youth . There are approximately 26,000 foster children ages 16 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 of their peers in the general population who can often rely on assistance from their parents and families for financial and emotional support. 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 bill's sponsor, the Children's Advocacy Institute (CAI) at the University of San Diego AB 989 Page 4 School of Law, 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 a 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 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, 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. 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 transition-age youth populations being served by their programs. Other transition age youth populations include prisoners returning to society or transition-age youth 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 fifteen percent of these youth, received a D grade, meaning that these youth live in counties with MHSA programs that lack adequate capacity to meet their 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 AB 989 Page 5 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 a public mental health program. 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 states 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 transition-age youth MHSA funds to this particular population by providing supportive housing services, transportation assistance, employment services, educational support, linkages to community resources, and peer mentoring, in addition to mental health treatment. FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes Local: Yes According to the Senate Appropriations Committee: Fiscal Impact (in thousands) Major Provisions 2011-12 2012-13 2013-14 Fund Potential cost shifts Unknown, potentially significant Special* for foster youth services * Mental Health Services Fund AB 989 Page 6 SUPPORT : (Verified 8/25/11) Children's Advocacy Institute of the University of San Diego School of Law (source) California Alliance of Child and Family Services California Mental Health Director's Association California State Parent Teacher Association California Youth Connection National Alliance on Mental Illness California ARGUMENTS IN SUPPORT : CAI, the bill's sponsor, points out that this bill does not require, set aside, or prioritize MSHA funding or seeks to alter, direct, or control how these funds are spent, but rather clarifies that there is a smaller category of transition age foster youth that should be taken into account when making decisions to fund transition-age youth services. CAI further states that transition age foster youth experience panic disorder at three times the rate of the general population, drug and alcohol dependence at seven times the rate of the general population, and bulimia at seven times the rate of the general population. The California State Parent Teacher Association points to the CAI report which finds that transition-age foster youth experience post-traumatic stress disorder at higher rates than war veterans, and supports the consideration and establishment of services for youth as they age out of the foster care system and into independent living situations and adulthood. ASSEMBLY FLOOR : 63-13, 6/1/11 AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Beall, Bill Berryhill, Block, Blumenfield, Bonilla, Bradford, Brownley, Buchanan, Butler, Charles Calderon, Campos, Carter, Cedillo, Chesbro, Conway, Cook, Davis, Dickinson, Eng, Feuer, Fletcher, Fong, Fuentes, Furutani, Galgiani, Gatto, Gordon, Grove, Halderman, Hall, Hayashi, Roger Hernández, Hill, Huber, Hueso, Huffman, Lara, Bonnie Lowenthal, Ma, Mendoza, Mitchell, Monning, Nestande, Olsen, Pan, Perea, Portantino, Silva, Skinner, Smyth, Solorio, Swanson, Torres, Valadao, Wieckowski, Williams, Yamada, John A. Pérez AB 989 Page 7 NOES: Donnelly, Beth Gaines, Hagman, Harkey, Jones, Knight, Logue, Mansoor, Miller, Morrell, Nielsen, Norby, Wagner NO VOTE RECORDED: Garrick, Gorell, Jeffries, V. Manuel Pérez CTW:mw 8/26/11 Senate Floor Analyses SUPPORT/OPPOSITION: SEE ABOVE **** END ****