Child Welfare Council Urged to Take Action Before November Election
By Kate Walker
Isaiah was 6 when he was removed from his mother’s home and placed in foster care. After one failed placement, he was moved from his home county, the county where he entered foster care, and placed with his aunt and uncle in another county, his placement county. Isaiah was traumatized by the abuse and neglect he had suffered early in life and was assessed as needing intensive mental health services. Despite his aunt and uncle’s best efforts, Isaiah was unable to access these services in his placement county because his Medi-Cal benefits were through his home county. The home county provided sporadic treatment, but it was insufficient. Isaiah’s condition deteriorated to a level where his aunt and uncle could no longer care for him, and he had to be moved yet again. The failure of both his home county and his placement county to provide him with necessary mental health services resulted in Isaiah losing a safe, loving and potentially permanent home.
Every year, California places an average of 18,000 foster children – more than 20 percent of the state’s foster population – outside the county in which they first entered foster care. These “out-of-county” children are often unable to access the mental health services they desperately need. Between 50 and 70 percent of all foster children have mental health needs. Research by the National Center for Youth Law [NCYL] shows that out-of-county foster children across California have significantly lower access to mental health services than children who remain in their home counties, despite both having the same legal entitlement to services under Medi-Cal. This is because California’s county-based system of mental health care creates unique structural and administrative barriers to mental health care for out-of-county foster children.
Barriers to Accessing Mental Health Care: Access, Authorization, and Payment
The first barrier relates to access to mental health services: children placed across county lines are ineligible for mental health services in their placement county, which often refuses to treat them because they are from another county. The second barrier relates to authorization of mental health services: the home county and the placement county often disagree on appropriate treatment, resulting in the home county’s unwillingness to authorize the placement county’s proposed treatment. The third barrier relates to payment: because the placement county is not fully reimbursed for serving out-of-county foster children, it is hesitant to serve them at all. All these barriers arise as a result of placement across county lines, a decision over which foster children have no control.
The Child Welfare Council’s September meeting is the last opportunity before the election to bring these efforts to fruition
The out-of-county problem has existed for almost two decades. Of the many attempts to solve it, Senate Bill 785 is the most recent. However, the bill’s most important benefit, shifting responsibility for providing services to the placement county, only applies to former foster children, those in the Adoptions Assistance Program [AAP] or the Kinship Guardianship Assistance Program [Kin-Gap]. The provisions of SB 785 that apply to all foster children relate only to the standardization of contracts and forms. These standardization provisions help streamline the process, but do not deal with the more fundamental issues of access, authorization, and payment described above.
NCYL will soon release a report explaining the out-of-county problem and proposing a comprehensive solution. The details of this solution have already been presented to the California Child Welfare Council, a statewide body of more than 50 state and local agencies working to improve outcomes for foster children by coordinating the provision of services. To be comprehensive, any solution to the out-of-county problem must have the following three elements:
- It must ensure that out-of-county foster children have access to mental health services regardless of where they are living. This can be achieved by shifting the responsibility to provide or arrange for services to the placement county if the home county is unable to adequately serve these children. This guards against outright denial of services by the placement county, while also preserving existing arrangements between counties that have proven effective.
- Both the home and the placement county should have the power to authorize services and must authorize services if the child is eligible and the services are medically necessary.
- The county that provides the services should be fully reimbursed for the cost of care in a timely manner.
Over the next month, NCYL plans to circulate a proposal based on the above principles to the California Mental Health Directors Association, California Welfare Directors Association, and the California Child Welfare Council. Kim Belshé, Secretary of Health and Human Services and co-chair of the Child Welfare Council, has shown leadership in prioritizing the out-of-county problem for the Council and bringing together multiple state and county agencies to solve it. The Council’s September meeting is the last opportunity before the election to bring these efforts to fruition, and ensure that California’s out-of-county foster children, deprived of adequate mental health care for almost 20 years, are given a fair chance at a healthy, stable future.
