California Foster Care, Mental Health Reforms

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Under a new agreement, California will begin providing intensive mental health services, both home- and community-based, for children in foster care or at risk of entering the foster care system as part of the early periodic screening, diagnosis and treatment (EPSDT) requirements mandated by federal law.

The new services will be available to a class of children covered under Medicaid, a requirement virtually all foster kids and those at risk of entering foster care meet, according to advocates.

The agreement is the result of a settlement reached after nearly two years of negotiations in a class action suite, Katie A. v. Bonta, aimed at statewide child welfare and health reform. The case, first filed more than nine years ago, charges county and state agencies with neglecting to provide federally-mandated mental health services to children in the state’s foster care system.

The California suit is just one of many that is in the process of or has already been filed across the country seeking to force states to comply with federal Medicaid requirements concerning the well-being of children.

“These services will ensure that thousands of Medicaid-eligible children obtain access to the mental health services they need to live in a family and succeed in school and later life,” Robert Newman, attorney for the plaintiffs, of the Western Center for Law and Poverty said in a press release.

Los Angeles County, where the original case was filed, began providing mandated mental health services in 2003 after settling with the plaintiffs in the case, but state-wide compliance has largely varied by county -– a trend the suite filed against the state hopes to eliminate. Previous rulings from the case established the state's obligation to ensure such services are made available.

“It’s a very good thing for the children,” said Kimberly Lewis, Managing Attorney of the California Office at the National Health Law Program. “Families sometimes think they have to enter the system to get help, whether it be the foster care system of juvenile justice system, but that’s not the case.

In addition to providing home- and community- based services, California officials will be required to take a number of steps to ensure the state’s children in need received the appropriate services:

  • Determine what “Therapeutic Foster Care” services are covered under Medicaid;
  • Instruct providers on delivering therapeutic foster care as a Medicaid service;
  • Convene an interagency taskforce to advance keeping children with mental health issues with their families; and
  • Create a system to identify children in need of the covered mental health services, and link them to those services.

Federal EPSDT requirements, first mandated in 1967, were expanded in 1989 to cover any necessary medical treatment for children covered under Medicaid even if state programs weren't in place to provide those services. Since then, states around the nation have had varying degrees of success in meeting the requirements. Suites have been filed in more than a dozen other states around the nation, including Maine, Massachusetts, West Virginia, Pennsylvania Illinois, and Tennessee.

"The larger implications of this issue is that some people come from the perspective that these kids are going to end up in jail at some point," said Aaron Rapier, attorney with The Collins Law Firm in Illinois and plaintiff attorney for a recent EPSDT law suite in that state. "So they're almost indifferent to their medical needs [before they reach incarceration]."

In California, an estimated 70,000 to 80,000 children would receive needed mental health services within the next three years if the settlement is finalized. California state Judge A. Howard Matz issued preliminary approval Sept. 27, with a final settlement approval expected in early December.

The children in the plaintiff class, Katie A. v. Bonta, are represented by a coalition of a half-dozen advocacy and legal groups.

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