BILL ANALYSIS �
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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 Le�n, 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
Hern�ndez, 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. P�rez
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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
P�rez
CTW:mw 8/26/11 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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