Clarifying a landmark court decision, the California Department of Health Care Services has announced (PDF) that all Medi-Cal recipients under age 21 who meet "medical necessity" criteria are eligible for home-based mental health services that were previously limited to youth in the foster care system.
The 2002 class-action lawsuit, Katie A. v Bonta, involved a 14-year-old girl who had been in foster care for most of her life. The decision secured the right to care coordination and other intensive mental health services—provided in the child's home rather than an institution—for up to 28,000 California foster youth and children at risk of entering the foster system.
Several studies of children entering foster care have found that almost 90 percent of these children had physical, developmental, or mental health needs, with more than half displaying two or more problems; almost a quarter demonstrated concerns on developmental screening.
Five years after the Katie A. suit was settled, we sat down with Patrick Gardner, who served as one of her attorneys, to discuss the meaning and implementation of the law. Gardner is the executive director of Young Minds Advocacy, an organization that helps young people access quality mental health care.
Why is the Katie A. law important?
It's about fairness. Children with mental health needs are society's most vulnerable kids and they are mostly ignored. Up until about 10 years ago, the US spent 75 percent of its mental health budget on congregate care, or group homes. But, segregation and isolation make people less than human. If we can coordinate care in the home, families don't break up, kids can function in society, and we save money, because institutions are expensive. For me, fairness and equity demands that, rather than warehousing these extremely vulnerable children and families, we provide appropriate, quality care.
What's one of the biggest misconceptions about the law?
That Katie A. services are only for foster kids. Initially that was true—children in foster care were eligible, and so were youth who were at risk of foster placement. However, eligibility for Katie A. services is based on medical necessity, so now that the case has ended, all full-scope Medi-Cal youth are potentially eligible. Katie A. was the nose under the tent, and now whoever meets medical necessity is eligible. That was the whole idea all along.
How many kids are entitled to Katie A. benefits?
There are about 53,000 kids in the foster care in California. If we add children who are at risk of entering foster care or those in the child welfare system, we're looking at 60,000 to 80,000 kids. Counties have estimated that roughly 28,000 of these youth are presently eligible for Katie A. services. In addition, tens of thousands more children who are not child welfare-involved are also now eligible for care.
Does Katie A. put California ahead of the curve in terms of caring for these kids?
If Katie A. is well implemented, I would say definitely in California. Plus, if Katie A. services are covered by law in California, and the federal government is cost-sharing these services under Medicaid, then Katie A. services are mandatory in other states, too. Under Medicaid, every medically necessary service now that includes Katie A. services—must be provided to eligible youth. So, not surprisingly, there are now similar settlement agreements in Washington, Arizona, Idaho and Massachusetts, and more.
By Ling Woo Liu