BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                      



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          |SENATE RULES COMMITTEE            |                   AB 989|
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                                 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





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          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.







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          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 







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          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 







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          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








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           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







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          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

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