BILL ANALYSIS �
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 :
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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
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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
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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.
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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.
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Analysis Prepared by : Cassie Royce / HEALTH / (916) 319-2097