The state is failing to support the mental health of more than 5 million of the state’s most vulnerable children, according to a new report released by the California Children’s Trust (CCT), the National Center for Youth Law (NCYL) and the National Health Law Program (NHeLP).

“Meeting the Moment” provides background on the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) mandate, whereby Medi-Cal beneficiaries under age 21 are entitled to comprehensive mental health screening and diagnostic services, as well as receiving the support necessary to address identified issues.

“EPSDT is a broad legal entitlement that reflects the importance of promoting children’s healthy development through proactive identification and treatment of needs,” said Rachel Velcoff Hults, NCYL senior equity and access attorney. “At a time when California’s families are facing heightened challenges, it is especially crucial that the state meet its obligation to fully implement the EPSDT entitlement and ensure equitable access to mental health care.”

The report argues that California needs a new, pragmatic approach to fulfill its obligations to children and youth enrolled in Medi-Cal, and also offers specific recommendations to generate new federal revenue to expand access to services and supports that do not require a diagnosis. It calls for a rethinking on service delivery and for beneficiaries’ agency and inclusion in improving access and delivery of services. The report also urges for more accountability and transparency among and between systems and levels of government.

“California must ensure that all of its Medi-Cal-managed care plans are accountable for providing children and youth with mental health needs prevention, early intervention and treatment services through specific obligations under its contracts,” said Kim Lewis, NHeLP managing attorney.

This report is particularly timely, given that the events of 2020 added new and complex stressors, which exacerbated California’s existing mental health challenges while also creating new barriers to care.

The California Medical Association (CMA) believes the state must have a robust and well-functioning system in place to identify children’s mental health needs early, effectively and equitably.

To that end, CMA is a proud grantee of the first-in-the-nation ACEs Aware initiative, which aims to establish routine adverse childhood experiences (ACEs) screening in primary care and develop a network of care, including cross-sector coordination supports aligned with primary care.

By screening for ACEs, providers can better determine the likelihood a patient is at increased health risk due to a toxic stress response, a critical step in responding with trauma-informed care that connects patients with a supportive network of care to mitigate the impact of ACEs.

CMA encourages all physicians, particularly Medi-Cal providers, to receive the free, two-hour training to learn how screening, risk assessment and evidence-based care can effectively intervene on toxic stress. 

Physicians may receive 2.0 continuing medical education (CME) and 2.0 maintenance of certification (MOC) credits upon completion – as well as receiving reimbursement for providing ACEs screening to Medi-Cal beneficiaries.

See also: CMA’s Top Issues: Adverse Childhood Experiences (ACEs)