Allocating Equality: EPSDT, Realignment, California and Foster Care

The California Senate Budget Subcommittee on Health and Human Services heard testimony Monday, May 18th, on proposed changes to the methodology used to allocate 2011 Realignment Behavioral Health Growth funding to county mental health programs.

The Department of Health Care Services (DHCS) is considering submitting a recommendation to the Department of Finance (DOF), the agency ultimately responsible for setting the methodology, to distribute growth funding based almost entirely on historical spending patterns. The Medi-Cal Early and Periodic, Screening, Diagnosis and Treatment (EPSDT) specialty mental health program, a core component of California’s public mental health system for children, took central focus at yesterday’s hearing.

2011 Realignment’s impact on EPSDT services is a critical issue for California’s young people with unmet mental health needs. According to law, the distribution of realignment funds is at the discretion of DOF in consultation with key stakeholders.

We believe that in exercising that discretion, DOF must ensure California complies with Medicaid law and regulations, including the requirement that access to EPSDT services must be provided statewide to all Medi-Cal eligible children and youth.

Accordingly, the allocation of funding to counties must ensure that children and youth are afforded equal access to medically necessary services without regard to where they live within the state.

Under the existing EPSDT funding allocation, we believe the state is falling far short on this legal obligation. The 2011 Behavioral Health Growth funding formula provides a critical opportunity for California to overcome healthcare access inequities for young people and bring the state into full compliance with Medicaid law.

During the hearing on May 18, Senate Budget Subcommittee members raised several concerns about California’s EPSDT children’s specialty mental health program. Senators noted problems of decreasing access, disparities in services among counties, and reports of county spending caps.

Children’s mental health stakeholders echoed these concerns. Young Minds President Patrick Gardner testified about significant access to care problems based solely on where children live. For instance, according to state data, children in Fresno County are one-third as likely to get any care as compared with children in Butte County.

Gardner noted that allocating funding based on past spending increases unequal access to services in many counties. During 2013, Fresno County’s penetration rate was 4.3 percent while Alameda County’s was 10.6 percent. Nevertheless, Alameda County’s share of total funding has increased since 2011 Realignment, whereas Fresno County’s has declined–because funding allocations are tied to past spending.

As a result, Fresno County’s ability to close the gap on equal access to care has been made more difficult. Patrick Gardner’s written testimony provided to the subcommittee’s members is available here.

Other stakeholders raised policy objectives that could be advanced through a more goals-based allocation formula. Eva Terrazus from EMQ Families First testified that, as an agency serving children in 32 counties statewide, they continue to be told by county mental health plans that EPSDT specialty mental health allocations are capped due to Realignment, and, as a result, have witnessed growing waitlists of children in need of services.

She urged the state to live up to the EPSDT entitlement by fully and timely reimbursing counties for all EPSDT expenditures. Dr. Lynn Thull, representing the California Alliance of Child and Family Services, noted that utilization of Katie A. intensive community mental health services has plateaued despite low penetration rates among eligible subclass members. Dr. Thull advocated using growth funding to help incentivize counties to fully implement these services.

The Senate Budget Subcommittee held the Behavioral Health Growth Allocation agenda item open to allow DOF and DHCS time to complete an updated proposed funding formula. The Subcommittee’s agenda materials are available here. DHCS told committee members it plans to continue to work with stakeholders to develop an allocation formula. DOF and the Legislative Analysis Office provided no comments to the subcommittee.

The May 18 hearing was recorded. The archived video is available here and, alternatively, an audio recording is available here.

Young Minds Advocacy Project engages in legal advocacy and community education to assist low-income youths and their families and communities in accessing appropriate mental health services and supports

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About Young Minds Advocacy 20 Articles
Young Minds Advocacy is a nonprofit organization based in San Francisco, California that uses strategic advocacy and communications to help youths and their families to access mental health services and supports, and improve mental health system performance and accountability.