VFA Response to Senate Finance Committee Regarding Mental Health Issues & Access
On September 21, 2021, the United States Senate Committee on Finance put out a call to American people and organizations to send in information pertaining to the mental health and wellbeing of our the Nation, and requested evidence-based program and policy recommendations. Our nation faces a mental health and substance use crisis, which has only worsened with the pandemic. Anxiety, psychological distress, overdose deaths, and mental health emergencies have all increased over the past year and a half. Chairman Wyden and Ranking Member Crapo are looking to address barriers to mental health care by improving policy relating to behavioral health for Medicare, Medicaid, CHIP, and ACA marketplace beneficiaries. See full letter from the Senate Finance Committee here.
Four main areas for improvement are
1) Workforce - explore options to address the behavioral health workforce shortage, increase health professional diversity, and more
2) Integration, Coordination, and Access - support care integration and coordination efforts and ensure that historically underserved communities have equitable access to culturally and linguistically appropriate care
3) Parity - improve oversight, data reporting, and enforcement of mental health parity laws and access potential shortcomings in Medicare, Medicaid, and CHIP programs
4) Telehealth - expand access to telehealth services while maintaining safeguards for beneficiaries and taxpayer dollars
After several meetings with advocacy groups, coalitions, VFA’s membership, and VFA’s board of directors we submitted a letter to the Senate Finance Committee with your recommendations here is a summary of what the letter contains. For the full letter with rationale click here.
VFA recommends that Congress do the following:
Fund Post-Permanency Support Services
Congress should require and fund a core set of support services for children and families exiting foster care to a permanent family, with such services to include trauma-informed and permanency-competent mental and behavioral health services.
Improving Access for Children and Young People
Congress must maintain access to Medicaid for youth who age out of foster care up until age 26 and assure this coverage extends across state lines when a young person moves to a new state. This requirement should take effect immediately rather than in 2023 as currently written.
Congress must protect this Medicaid benefit in every state by precluding work requirements for youth who have experienced foster care.
Congress must extend access to Medicaid to children who leave foster care to adoption and guardianship, just as it extends the benefit to those who emancipate from care.
Strengthening Workforce
Congress should:
Support the expansion of adoption-competency training for mental health providers and caseworkers and encourage their participation by providing ongoing funding to the National Adoption Competency Mental Health Training Initiative and other similar adoption-competency programs.
Provide federal incentives to recruit and train more master-level clinicians. There is a shortage of well-trained mental health specialists who can meet the complex and unique needs of the child welfare and adoption community.
Provide funding for targeted recruitment and retention initiatives to recruit, train, and support BIPOC and LGBTQ+ clinicians to address the unique needs of BIPOC and LGBTQ+ children and families in foster care and adoption.
Increasing Access to Care
Congress should increase Medicaid rates to align with private insurance.
Congress should ensure that Medicaid includes coverage for family therapy, not just services to individuals, as well as nontraditional treatments that effectively help those affected by trauma.
Congress must support the development and advancement of services sensitive to racial, cultural, LGBTQ+, BIPOC needs, including ensuring that Medicaid and other insurers cover them.
Congress should require Medicaid and other insurers to cover the subspecialty of therapists to include competence in child welfare and adoption.
Congress should amend the Dosha Joi Immediate Coverage for Former Foster Youth Act (S. 712) and the Expanded Coverage for Former Foster Youth Act (S. 709) to include explicit language stating that Medicaid covers individual therapy and telehealth therapy services for young people who are or were in foster care.
Congress should also support expanded telehealth options, including allowing reimbursement to providers in other states, maintaining equal reimbursement rates for telehealth and in-person visits, and setting national standards for telehealth services.
Increase the Federal Match Assistance Percentage (FMAP) rate for all children’s mental health and supportive services provided under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) entitlement, covering all children under the age of 21 in all states and territories. In addition, Congress should expand access to these services for children and youth in foster care and who have exited care to adoption and guardianship while ensuring that such services are adoption/permanency-competent for this population.
Refine language in the Timely Mental Health for Foster Youth Act (S. 3625) to mandate all jurisdictions to participate and require an additional mental health screening by trauma-informed professionals conducted 60 days before youth exit care to permanency or due to emancipation. Ensure that professionals work with families or young people to arrange for services to address any needs identified.
Mandate that the National Youth in Transition Database (NYTD) measure outcomes for healing and trauma through a qualitative question that addresses how to best support youth with their mental health and healing needs.
Ensuring Parity
Congress should ensure that all health insurance provides true parity for mental and behavioral health services in all health insurance plans. Congress should hold more hearings, issue state report cards, and direct HHS to craft model state laws to reach parity.
