BILL ANALYSIS �
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 989
A
AUTHOR: Mitchell
B
AMENDED: May 27, 2011
HEARING DATE: June 15, 2011
9
CONSULTANT:
8
Tadeo
9
SUBJECT
Mental health: children's services
SUMMARY
Requires programs contained in county Mental Health
Services Act (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.
CHANGES TO EXISTING LAW
Existing federal law:
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.
Existing state law:
Establishes 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
percent income tax on personal income above $1 million.
Continued---
STAFF ANALYSIS OF ASSEMBLY BILL 989 (Mitchell) Page
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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. Requires DMH to establish guidelines for the
content of each component.
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.
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.
Permits provisions clarifying the procedures and terms of
MHSA to be added by majority vote.
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.
FISCAL IMPACT
The Assembly Appropriations Committee analysis of AB 989
was conducted on the March 21, 2011 version of this bill
which required county mental health plans to include
programs addressing the needs of transition age foster
youth in their three-year plans for funding under MHSA.
The bill has since been amended removing this requirement
and instead requires county mental health programs to
consider the needs of transition age foster youth.
STAFF ANALYSIS OF ASSEMBLY BILL 989 (Mitchell) Page
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The analysis states that this bill has negligible net state
fiscal impact. The analysis also states that, to the
extent that counties must divert MHSA funding from existing
local priorities to new services for transition-age foster
youth, it has the potential to reduce MHSA spending on
services for other target populations.
The analysis further states that, depending on how counties
interpret and apply these provisions and the extent to
which counties are currently providing services for
transition-age foster youth, AB 989 could result in unknown
cost shifts. Potential cost shifts would likely not exceed
the low millions of dollars.
BACKGROUND AND DISCUSSION
According to the author, transition-age foster youth are
particularly vulnerable as they age out of the foster care
system. They have higher rates of suicide, incarcerations,
school failure or dropout, unemployment, prolonged
suffering due to serious mental health issues and
homelessness than that of transition-age youth with no
history of foster care. They are removed from their
families, often due to physical or sexual abuse or neglect
and then face an uncertain future in the foster system.
The author adds that the state pays the price when
transition-age foster youth end up incarcerated, unemployed
or homeless. The author contends that AB 989 takes
advantage of existing funds to make sure that the needs of
this vulnerable group is considered.
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
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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 sponsor of this bill, the Children's
Advocacy Institute (CAI) at the University of San Diego Law
School, 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.
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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
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
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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.
Related bills
AB 100 (Committee on Budget), Chapter 5, Statutes of 2011,
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 MHSA plans.
AB 181 (Portantino) establishes the Foster Youth Mental
Health Bill of Rights 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. This bill was held under submission by the
Assembly Appropriations Committee.
Prior legislation
AB 1571 (Committee on Veterans Affairs), Chapter 546,
Statutes of 2009, includes veterans and representatives
from a veterans organization in the list of local
stakeholders required to be consulted in the development
and update of each county's MHSA plan and requires DMH to
inform the California Department of Veterans Affairs of
county plans that have outreach programs or that provide
services specifically for veterans.
SB 785 (Steinberg), Chapter 469, Statutes of 2007,
facilitates the access to mental health services for foster
children who are placed outside of the original county of
jurisdiction, including those being adopted or entering
into a guardianship with a relative.
Arguments in support
CAI, sponsor of AB 989, 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
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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 Parent Teachers 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.
PRIOR ACTIONS
Assembly Health: 15- 1
Assembly Human Services:6- 0
Assembly Appropriations:12- 5
Assembly Floor: 63- 13
POSITIONS
Support: Children's Advocacy Institute of the University
of San Diego School of
Law (sponsor)
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
Oppose: None received
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