Last week, at the beginning of what has traditionally been called “Children’s Mental Health Awareness Week,” we shared our support for the National Federation of Families’ declaration: “It’s time to move beyond the term awareness. This significant shift to acceptance speaks more directly to our goal for the campaign – to eliminate prejudice and discrimination that individuals with a mental illness diagnosis or symptoms experience.”
Acceptance campaigns focus on systemic issues without sacrificing the positive aspects of raising awareness. The primary focus of acceptance campaigns is the right of people with mental illness to do the same things that other people do, such as live, work and go to school in the community.
This week, we commend the National Health Law Program for its recently shared mental health goals. The italicized information is quoted directly from the law program. We encourage you to consider both the information and the links within it thoughtfully. They contain a lot of information to help our children thrive in their homes and communities.
The National Health Law Program believes that children with significant mental health needs can and should receive the support they need to thrive in the communities where they live. We litigate and advocate to protect the rights of children and adolescents to receive the quality services and support they need, including mental and behavioral health care and services.
- Fact Sheet: Children’s Behavioral Health Mobile Response and Stabilization Services (February 2022): Mobile Response and Stabilization Services (MRSS) is a specific kind of mobile crisis and stabilization service for children and youth with behavioral health conditions. It is an upstream intervention for children and youth that are beginning to experience an acute behavioral health issue and are in crisis. This evidence-based service can help prevent unnecessary emergency department utilization and hospitalization. This fact sheet discusses the evidence-base for MRSS as well as children’s right to access MRSS via Medicaid. It concludes with recommendations for concrete steps advocates can take to ensure that children can access MRSS when and where they need it.
- Flip Chart: Addressing Barriers to Behavioral Health Coverage for Low-Income Youth (September 2021): This flip chart contains various scenarios and barriers that low-income youth with behavioral health conditions might face when trying to access services, and includes suggested steps an advocate could take to work through those barriers.*
- Medicaid is the country’s most inclusive health care program, providing high quality, affordable coverage to more than 75 million low-income individuals. Approximately 38% of all children are covered by Medicaid. Medicaid plays an outsized role in funding behavioral health services – it is the single largest payer for mental health and substance use disorder services. In exchange for federal funding, states must meet a number of requirements governing who is eligible, what health care must be provided, and protections for enrollees.
- One of these Medicaid requirements is Early and Periodic Screening, Diagnostic and Treatment (EPSDT) – a benefit that entitles low-income children under age twenty-one to a myriad of medically necessary behavioral health services. Because of the EPSDT benefit, children in Medicaid are often entitled to an array of community-based behavioral health interventions that children enrolled in private insurance are not.
- Fact Sheet: Children’s Mental Health Services: The Right to Community Based Care (August 2018): About 3.8 to 4.6 million children between the ages of nine and 17 have mental health needs. Evidence and experiences demonstrates that, with the right approaches and health services, youth with significant mental health concerns can and do thrive in family settings. This issue brief provides health advocates with the information and guidance to ensure state health officials understand their legal obligations and experiences in implementing home-based services, and with this information advocates will have a greater ability to judge the adequacy of current services, and tools to imagine a better functioning system.
- Statement for the Record to the United States Senate Committee on Finance on Youth Mental Health (February 2022): NHeLP submitted a statement for the record to the Senate Finance Committee on approaches to improve coverage and services for youth with mental health conditions. The statement offers policy options in three areas where additional legislation, oversight, or guidance would further the Senate Finance Committee’s priority of improving behavioral health care for young people and children: 1) improving access to intensive community-based services for children and youth enrolled in Medicaid; 2) enhancing oversight and enforcement of parity for mental health and substance use disorder services, and 3) improving Medicaid coverage for youth involved in the juvenile justice and foster care systems.
A Selection of Our Children’s Behavioral Health Cases
- K.B. v. Michigan D.H.H.S., Eastern District of Michigan: A class of Medicaid-eligible children with intensive mental health care needs who are at risk of avoidable psychiatric hospitalizations or commitment to the juvenile delinquency system sued the Michigan Department of Health and Human Services for failing to provide needed mental health services in the community as required by the Early and Periodic Screening, Diagnostic and Treatment and the Americans with Disabilities Act.
- A.A. v. Gee, Middle District of Louisiana; Medicaid eligible children who require intensive home and community-based mental health services challenged Louisiana’s failure to arrange for or provide those medically necessary services. The failure to provide these services has forced thousands of Louisiana children to unnecessarily cycle in and out of hospitals and psychiatric facilities far away from their homes for extended periods of time and has resulted in some children becoming inappropriately involved in the juvenile justice system.
- T.R. v. Dreyfus, U.S. District Court, Western District of Washington: This class action lawsuit against the Washington State Department of Social and Health Services (DSHS) was brought on behalf of Medicaid-eligible children under age 21 in Washington State who were denied necessary intensive home and community-based mental health services. The lawsuit also claimed that the state has failed to comply with the American with Disabilities Act (ADA), which requires that public entities such as DSHS provide services to children with psychiatric disabilities in the most appropriate integrated setting. In March 2012, the parties reached an Interim Agreement. The agreement suspended litigation while the State worked to build a framework for reform of the mental health system for children on Medicaid. Before the Interim Agreement expired, the parties negotiating a full settlement agreement. On September 27, 2013, the court granted preliminary approval of the proposed settlement, and on December 19, 2013, after a fairness hearing, granted final approval of the settlement.
- Katie A. v. Los Angeles County, Central District of California/Western Division: Katie A. v. Bonta is a class action lawsuit that was filed in July 2002 against California’s State Departments of Health Care Services and Social Services (the state case), as well as Los Angeles County and its child welfare agency (the county case). It challenges the State and County’s failure to provide necessary home-based and community-based mental health services to children who are in or at risk of foster care. A settlement agreement with Los Angeles County was reached in 2003 wherein the County agreed to close its large shelter facility for foster youth – MacLaren Children’s Center – and to develop appropriate child welfare and mental health services in the community. An expert Advisory Panel was established as part of the settlement agreement to monitor implementation and assist the County. While one lawsuit was filed against both the State and LA County, this part of the case is known as Katie A. v. Los Angeles County. In 2019 the County moved to end the agreement and dismiss the litigation. In September 2020, a new settlement agreement was reached between the parties. The new agreement requires the County to take specific steps over a period of approximately 9 months to ensure children in or at risk of foster care in the county receive necessary intensive home based mental health services. The agreement must still be approved by the federal district court.