Can California make the most of a rare health care win?

By George B. Sanchez-Tello, Capital & Main

This story is produced by the award-winning journalism nonprofit Capital & Main and co-published here with permission.

One month after 19 children and two adults were killed in the Uvalde County, Texas, school shooting, Congress offered something more than thoughts and prayers, passing the Bipartisan Safer Communities Act in June 2022. The BSCA provides more than $13 billion for public safety by strengthening existing gun laws.

The act also confronted the decades-old scapegoat of mass shootings — that they are caused by mental illness — by actually investing in health care through schools and public clinics.

It was great news for Californians. It would be even better news if the state could improve its health care system for low-income people. A 2019 state auditor’s report found that while more than 5.5 million youth 20 and under were enrolled with Medi-Cal in 2017, fewer than 50% received well-child screenings, including physical exams, immunizations, mental health screening and dental assistance.

Of the $13 billion in the BSCA, $50 million is meant to support services nationally for students enrolled in Medicaid. Here in California, that means Medi-Cal, California’s free or low-cost health care for those who qualify. Medi-Cal is funded by federal Medicaid as well as by state taxes and local funds.

At the BSCA signing ceremony on June 25, 2022, President Joe Biden said the new law “provides historic funding to address the youth mental health crisis in this country, especially the trauma experienced by the survivors of this gun violence.”

The National Education Association, the nation’s largest teachers union, called the BSCA a “game changer,” by expanding school-based mental health services, making funds more accessible and recognizing schools as sites for “observation and intervention.”

While the provisions for mental health care for young people didn’t grab headlines, school administrators and education officials are beginning to envision how this funding will move student well-being forward.

“There are huge advantages to funding mental health. Hiring more social workers, psychiatrists, counselors versus hiring SROs [school resource officers],” said Ron Avi Astor, a professor of social welfare at the UCLA Luskin School of Public Affairs.

“Removing barriers to accessing behavioral health services is key to getting kids the support they need to thrive academically and beyond,” said California state Sen. Anthony J. Portantino (D-Burbank) in an email. Portantino was invited to Washington, D.C., for the bill signing. “California is addressing these challenges through legislation and federal efforts outlined in the Bipartisan Safer Communities Act for school-based programs [that] will go a long way in expanding mental health care,” said Portantino.

Nationally, the BSCA provides $500 million in grants for mental health services at schools; $500 million for mental health practitioners working in schools; $240 million in mental health training for school staff; and $28 million for school-based trauma support.

Soon after Biden signed the law, criticism came from all sides. Mental health advocates were quick to note how elected officials’ continual and inaccurate connection of mass shootings to mental illness further stigmatized the latter. Community advocates raised concerns that funding for additional school police would harm students, particularly Black youth. (And, of course, Second Amendment enthusiasts opposed the bill as the National Rifle Association came down on the side of profits over children’s lives long ago. I am loath to give them any space for the usual claims of abuse, infringing on their rights and overreach.) But there has also been recognition of an opportunity to better support community mental health and improve student health.

For sure, California will access some of the billions in funding provided by the BSCA once application guidelines have been established. State innovations in relaxing previous barriers to treatment were highlighted in the National Education Association report on the BSCA. Still, delivery of services to those Californians who need it the most — the impoverished – must be ensured.

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Everyone under age 21 in California is eligible for Medi-Cal. With the health and well-being of young people on the line, access should remain simple. But closer inspection of a federal audit of Medicaid funding shows otherwise. Federal records for the Early & Periodic Screening, Diagnostic and Treatment data, which includes childhood wellness checks, lead testing, hearing tests as well as screening for depression, asthma, ADHD and dental services, revealed that the number of Medi-Cal beneficiaries aged 20 and under who received these services declined by more than half between 2010 and 2017: from 91% to 49%. By age group, Medi-Cal youth testing dipped below 50% starting at age 6 and dropped ultimately to 14% among 19- to 20-year-olds. The percentage of young beneficiaries receiving preventive dental services is dismally low as well. In 2017 it peaked at 45%, but for every other year since 2011 the percentage has hovered in the thirties.

Nobody seems able to explain the gap between youth eligible for aid and those actually receiving health care. That was not the GAO’s mandate in its report to Congress. But hints can be found by closely reading some of the proposed changes, like easier billing for schools, removing referrals for certain tests and reimbursing schools for identifying and enrolling eligible youth.

Health care providers have long known that a patchwork of service — including multiple referrals to different providers, which causes patients to have to repeat their medical information to various doctors and nurses, and long waits — creates barriers in California. One report found this created “lack of trust in the system that is responsible for supporting their well-being.” The BSCA pledges to make billing and invoicing easier. Medicaid enrollment requires parental consent. Consent requires awareness. And in many rural and small districts, distance is an issue. The BSCA will reimburse school and district staff who identify and ensure children are enrolled in Medi-Cal.

More Californians need to know about the health funding available for students. Most reporting on the BSCA has focused on the gun control aspects. Not even the rare event of major bipartisan legislation generated much attention. A report from the National Education Association on how to access federal funds for student health needs, including Medicaid, seemingly didn’t draw attention — or at least not press.

For years, the narrative around massacres and mass shootings has focused on “sick individuals” and mental illness, rather than addressing the tools of violence — guns, particularly automatic weapons. Elected officials have offered little more than the usual talking points. While the Bipartisan Safer Communities Act is far from the complete solution — even Biden acknowledged this — at least it is proposing to address, with resources, the perceived culprit. It offers an important recognition that mental health — that of the harmed and the survivors — indeed needs to be addressed. It offers a chance to address mental health needs; a chance to improve states’ support of the health of young people; and a chance to reduce the harm we are doing ourselves. I’ll take a real commitment of funding, people and support over thoughts and prayers any day.

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