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Historic State Budget—Will It Transform Children’s Behavioral Health?

Dear Friends and Allies

If you’re feeling both optimistic and overwhelmed by the funding and reforms focused on children’s mental and behavioral health, you’re not alone. The scope and scale of the current reform agenda, and the dozens of relevant investments included in the budget just signed by Governor Newsom, are unprecedented.  

Children and families, advocates, and systems leaders have achieved consensus that we must reimagine how we support the social and emotional health of children in California. Thank you to the many aligned voices and leaders for their dedication and commitment to bringing us to this moment.

“We’ve never seen an investment like this anywhere in the nation aimed at addressing children’s behavioral health issues”  
~ Dr. Mark Ghaly, California Secretary of Health and Human Services, EdSource

As the state advances the many commitments enabled by the 2021-22 budget, CalAIM, and the Managed Care Plan re-procurement process, CCT reiterates the fundamental values and primary goals articulated in our Framework for Solutions and Belief Statement.

This framework is built on the belief that children are not broken or pathological, and system challenges are not only for technocrats to fix. The building blocks of healing are in the wisdom and intelligence of marginalized communities, and they can help repair and rebuild the human capital and connectivity essential to social and emotional well-being. We need to create roles for people with lived experience, social models that rely on mutual aid, peer programs, and a racially aligned workforce. And, we must move these strategies from the margins to the center—this will be hard.

"Behavioral health work with children and youth must center people, relationships, and seasoned servants who work to heal, protect, empower, and love those in desperate and debilitating need.”  
~ Jevon Wilkes, Executive Director, CCY & Director of Youth Engagement, CCT

The following is a rundown of recent CCT priorities and advancements, and how the budget and current administration’s commitments to change can take progress to scale while holding a focus on health equity and healing. We welcome your feedback, input, and recommendations as we seek to make the most of this historic moment.

Equity and Justice

Possibility continues to outweigh progress, as 400 years of structural racism cannot be easily resolved with even the most bold vision and ambitious state budget. CCT does not claim to have essential expertise in this area, however we do bring a thorough understanding of how Medicaid can be a tool for justice and equity, and every aspect of the extensive writing, thinking and action we have advanced during our short history has attempted to center race, class, equity, and justice. We have not always succeeded, and are grateful for friends and allies who redirect and educate us.

We continue to provide significant investments in youth-led organizations to build capacity and structures that lift up the voices of youth leaders and help the Administration engage their wisdom and intelligence to set us on a course of radical healing. Young people must lead us in acknowledging the impact of racism and poverty and shifting agency and power to support and enhance the social and emotional health of children and youth. In implementing this unprecedented investment in schools, children, and youth, we all need to be brave enough to not only listen to youth but to create permanent paths for them to lead and guide change.

Expand Access and Participation

  • Removing diagnosis as a prerequisite for treatment: Advocacy efforts by CCT and partners contributed to a change in the state’s definition of medical necessity, allowing children to receive a specified amount of therapy without a diagnosis, as outlined in the “game-changing” Family Therapy Benefit Guide and essential (if incremental) changes to the 1915(b) waiver submission.
  • Centering pediatric primary care to support caregivers and young children: A “pilot to practice” success story, Dyadic Benefit started as a collaboration between CCT and the UCSF/Zuckerberg San Francisco General Hospital and Trauma Center/Children’s Health Center and has now received $800 million in the 2021-22 budget for statewide implementation.

Call to Action

  • Advocating for full removal of diagnosis to resist pathologizing adversity: CalAIM has the opportunity to remove the requirement of adversity screening “scores” and a yet-to-be-determined level of care screening mechanism between delivery systems in order to increase the agency and power of beneficiaries. CCT has provided input for this change and DHCS leadership has affirmed their commitment to these principles

Maximize Funding

  • $4.4 billion Youth Behavioral Health Initiative (YBHI): CCT is honored to have had the opportunity to offer expert guidance in the development of this transformational investment in children’s mental health reform. We have also attempted to distill the complex funding streams to facilitate discussion and action.
  • Centering schools as places to heal and thrive: Nearly 25% ($1 billion) of the YBHI investment is focused on schools as the most effective way to scale a child and youth wellbeing initiative. CCT helped ignite this conversation with the August 2020 release of the Practical Guide for Financing Social, Emotional, and Mental Health in Schools.
  • Engaging local school districts to secure Medicaid matching funds: CCT is helping school district leadership operationalize the Practical Guide models to establish or expand mental health programs that pull down a Medicaid match for sustainable impact. CCT was also part of a coalition that advocated for AB 586 which was funded in the 2021-22 state budget. The legislation establishes a pilot project in up to 25 public school districts to expand comprehensive health and mental health services to students while developing a system that will leverage ongoing Medi-Cal funding.

Reinvent Systems

  • Holding Managed Care Organizations (MCO) accountable to low-income children and youth: 96% of children insured by Medi-Cal—the majority of whom are Black or brown—get their care delivered through an MCO. In September 2020, the state launched a re-procurement process to change the way MCOs serve the needs of California’s low-income children and youth. In partnership with multiple child-serving organizations and youth leaders, CCT has submitted extensive input throughout the process.

Call to Action

  • Continue to monitor and advocate for MCO accountability to low-income children: Specifically, CCT will focus on ensuring that MCOs: 1) reach children where they are by delivering on the requirements of the $400 Million grants program, 2) improve access to services by partnering with schools and child-serving organizations on care coordination, 3) stop pathologizing adversity by expanding the Mild to Moderate benefit, and 4) innovate to increase services for children by expanding value add and grant investments programs.
  • Shift agency and power by building a mental health delivery system by the people, for the people: The 2021-22 state budget takes a significant step in this direction by building provider capacity with investments in Peer-to-Peer Certification (SB 803) in higher education, as well as apprenticeship, mentorship and academic, career, and psycho-social support to prepare students with lived experience and/or from underrepresented and low-income backgrounds for behavioral health careers. BH Coaches, Community Health Outreach Workers and Doulas will all be formally added to an expanded provider class. Our call to action is to ensure these new provider classes are not tokenized or marginalized, and that rates and reimbursement practice makes them scalable and sustainable at a living wage. CCT will continue to monitor the implementation and oversight of this work and lift up specific actions for public advocacy.
The billions that have been pledged are gratefully acknowledged, but systems change in the context of 400 years of racial inequality will inevitably be messy. 

We appreciate the partnership of our allies and coalition members, and acknowledge the work you are doing to ensure this moment gives birth to a transformed and socially, racially and economically just system for children’s mental health delivery.

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