Medicaid has been a hot-button political issue since it was enacted 50 years ago this month. Although public debate these days often focuses on the Affordable Care Act, the conversation must also discuss a cost-neutral Medicaid waiver called the 1915c Youth Empowerment Services (YES) Waiver.
The Texas Department of State Health Services is currently implementing statewide rollout of the YES Waiver, with all counties in Texas expected to provide YES Waiver services by September, but it’s facing challenges in some counties. We must address these barriers and support must increase.
Imagine being the parent of a 12-year-old experiencing serious mental health needs but being unable to afford the services and treatment your child needs. This is a real situation that has left parents with the heartbreaking decision to call the police or relinquish their child to the foster care system in order to access care. I should know. My organization, the Texas Institute for Excellence in Mental Health, works with local mental health organizations across the state.
In 2004, the U.S. House of Representatives found two-thirds of juvenile detention facilities across the country reported holding youths in detention because they were awaiting mental health care, not because of the seriousness of their offenses. Relinquishing a child should not be the only way a parent can adequately provide care.
It’s a troubling scenario that too many Texas families experience. It is also an expensive one. Texas spends nearly $17 million every month on youths in secure state correctional facilities and another $97 million on residential treatment for foster youths. And guess what? Youths who are served in these settings are disproportionately more likely to return for additional placements, incurring even more costs to the system.
We all know that long-term outcomes for young people in foster care and state correctional facilities are often poor. Foster youths are more than twice as likely as their peers to be disconnected from work and education, and more than one-third lack a high school diploma or GED. Why would we allow youths with caring families to go down a path that sets them up for failure when there’s a cost-effective alternative?
The YES Waiver provides an alternative to foster care and juvenile justice, allowing parents to keep their kids at home and, most importantly, allowing children to grow up in their homes and communities surrounded by their teachers, coaches, parents and friends.
YES Waiver covers services not typically covered by Medicaid at no extra cost such as nonmedical transportation and music or arts therapy, and is based on the child’s income rather than that of the adults in the family, making every child in Texas eligible.
We must support communities as they adopt YES Waiver. It’s a daunting challenge for mental health organizations because communities across Texas will have to rethink the way they currently coordinate services for young people with mental health needs.
It’s not business as usual, and we will face challenges. We’re working to decrease high caseloads, fight turnover in a high-stress field and garner buy-in from upper management at local mental health organizations where time and money will ultimately be invested before we see the return. We also must provide adequate training time for communities to understand and successfully implement the YES program. In turn, communities must support the YES Waiver.
Oftentimes we struggle with limited resources for young people with serious emotional disturbances. Through the YES Waiver, mental health organizations across Texas can build partnerships, giving them the opportunity to find creative ways to use resources locally. Our kids and families are depending on it.
Erin Espinosa is a research associate at the Texas Institute for Excellence in Mental Health in the School of Social Work at The University of Texas at Austin.
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