The Chronicle of Social Change is highlighting each of the policy recommendations made this summer by the participants of the Foster Youth Internship Program (FYI), a group of 12 former foster youths who have completed congressional internships. The program is overseen each summer by the Congressional Coalition on Adoption Institute. Each of the FYI participants crafted a policy recommendation during their time in Washington, D.C.
Today we highlight the recommendation of Justin Abbasi, a student at Yale University.
Abbasi would update the Chafee Foster Care Independence Program to include two new grants:
Support for “trauma-informed, evidence-based psychosocial services” for transition-age youth.
Support for services that help these youth access behavioral health services, including “transportation costs” and “reimbursement for lost wages.”
Abbasi would also amend the case-planning requirements for aging out youth to mandate that they’re informed about their health coverage and local providers that they can see.
Abbasi makes a three-pronged argument for the need of the services he proposes that Congress fund. It begins with the citation of a long list of research to support his notion that “youth in care face a higher risk for experiencing behavioral health disorders than the general population of youth.”
Second, he argues, the mental health services delivered to youth in care “are often insufficient and can, at times, be inappropriate.” Of particular concern here, he points out, is the alarmingly disproportionate rate at which foster youth are prescribed psychotropic medication.
Finally, Abbasi argues, while youth in care might get bad service, aging-out youth are at risk of getting none at all, especially if they are not made aware of their options.
In his own words
“Transitioning from care can present challenges both small and large to the 20,000 adolescents who age out each year, often without the social supports that they had in care. These challenges range from moving their belongings to a new location to building a new support network.
The federal and state governments have an ethical obligation, by assuming responsibility for youth in care, to ensure that transition-age adolescents who need behavioral health services receive them.”
The Chronicle‘s take
There are two relevant pieces of the Affordable Care Act that apply to the situation Abbasi proposes to address.
First, the ACA ensured that youth who exit foster care are Medicaid-eligible until the age of 26, at least in the state from which they aged out of care. This locks in health coverage for between three and six years after aging out, depending on whether a state has extended foster care to age 21.
Second, the Essential Health Benefits laid out by the ACA generally apply to Medicaid. And those essential benefits include mental health services.
The sum of those two should be that youth aging out of care have access to mental health services. But it does not guarantee the type of quality, trauma-informed help Abbasi envisions, which is not always present and available to Medicaid recipients.
Perhaps the best use of a Chafee behavioral health program would be to help states support the development of psychosocial services exclusively for this group. This would leave it to states to determine the right places to invest in such services to reach the greatest number of youth heading into adulthood from foster care. There should absolutely be a requirement that any services assisted through this program be open to Medicaid, and only available to former foster youth.
The idea of a complementary grant program to promote accessibility is the exact sort of thing you need former foster youth to point out. Improved mental health services are fantastic, but only if you can afford to get to them and can afford to miss work.
How that is distributed, we aren’t sure. Perhaps some smaller version of the Chafee Educational Training Voucher program, which flows to states that break it into aid that current and former foster youth can use for college expenses.
Another point to make on all this: if replacement of the ACA results in changes or removal of essential health benefits, you can expect to see a very wide range from state to state in the quality and availability of mental health services under Medicaid. Abbasi’s proposal is sound in enhancing an existing guarantee, but aging out youth will need more help than that if mental health is cut out of Medicaid.
By John Kelly
3 August 2017