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Katie A. Ruling Moves CA Closer to Providing Foster Children the Mental Health Services They Need

Sept. 28, 2008 – Federal Judge A. Howard Matz ordered the parties in Katie A. v. Bonta to meet promptly and report back to the Court by October 29 on how “wraparound” services can be covered by Medi-Cal and properly billed—thereby ensuring that mental health care providers will be reimbursed for delivering these critical services to children in foster care. Wraparound refers to community based services and supports tailored to an individual child that build on that child’s and family’s strengths. These services are provided through teams that link children and families with providers in child welfare, health, mental health, education and juvenile justice.

The US District Court’s Sept. 28 order came in response to Plaintiffs’ renewed motion for preliminary injunction. The motion for the injunction was filed in January to compel the state to expand mental health treatment to include intensive home-based wraparound services and therapeutic foster care for foster children and children at imminent risk of foster care placement.

Katie A. v. Bonta is a class action lawsuit filed in 2003 challenging the long-standing practice of confining abused and neglected children with mental health problems in costly hospitals and large group homes instead of providing services that would enable them to stay in their homes and communities. (See related Youth Law News article, April-June 2006, “Landmark Decision for California’s Most Vulnerable Children.”) NCYL is co-counsel in the case with the Western Center on Law & Poverty, Bazelon Center for Mental Health Law, Protection & Advocacy Inc., ACLU of Southern California, and the law firm Heller Ehrman.

More than 80,000 children are in foster care in California. Studies have found that 70 to 84 percent of them experience a mental health problem. The state’s current approach to addressing their needs through institutional care is costly and often ineffective.  For example, California is spending $540 million each year to keep 4,500 children in high-level group homes—placements that experts say could be avoided by offering appropriate services in the home and community that has proven more successful with the majority of children.

The Court ruled that all of the mental health services identified by Plaintiffs as components of wraparound are Medi-Cal eligible. The Court ordered the parties to provide guidance to county mental health agencies and eligible recipients on how wraparound services should be designated and billed. Judge Matz noted that these negotiations will “assist the parties in reducing or eliminating the confusion about wraparound’s Medicaid/ Medi-Cal status” and will “reduce or eliminate the concern of MHPs (County Mental Health Plans), providers, and recipients as to whether such services will be reimbursed.”

At the outset of his decision, Judge Matz described what he called the ‘big picture’ challenge:

This case involves complex statutes and regulations; innovative strategies for dealing with mental illness and behavioral problems afflicting children and adolescents; the challenge of coordinating the efforts of such disparate Medicaid providers as physicians, social workers, lawyers, teachers, family members and foster parents, all of whom serve or treat those children; foster care systems throughout the state that are beleaguered on many fronts, and the ever present (and growing) gap between the legal responsibilities of governments and their capacity to discharge those costly responsibilities.

More concretely, Judge Matz observed that there is “genuine… confusion as to whether certain components of wraparound and TFC (Therapeutic Foster Care) qualify as required [mental health] services.”   “[T]he main practical barrier,” he concluded, “is determining how providers may and should bill for those services.”

In response to these challenges, Judge Matz determined that:

  • Changes during and after the hearing in the State Defendants’ position on what components are covered by Medi-Cal “went a considerable distance toward accepting Plaintiffs’ contentions.”
  • Wraparound services consisting of nine specific components, including family and child engagement and ongoing crisis and safety planning, are Medi-Cal eligible.
  • “[T]here is clear support for the conclusion that wraparound services must be coordinated to be effective. In addition, “wraparound is considered an ‘evidence-based practice’ and the ‘gold-standard’ in the mental health field…”

In the next few weeks, the parties will be working together to accomplish the tasks set forth in Judge Matz’s Order. In addition, key issues regarding timing, service expansion, funding, the roles and responsibilities of health care providers and administrative agencies, and oversight and quality assurance remain to be ironed out. But by working together, the parties have an opportunity to ensure that all of California’s at-risk youth are provided the intensive mental health services they need to remain safely at home.

For further information please contact:

Patrick Gardner, National Center for Youth Law
(510) 835-8098, pgardner(at)youthlaw.org
Kim Lewis, Western Center on Law and Poverty
(213) 235-2628, klewis(at)wclp.org