MENTAL HEALTH SCREENING FOR NEW JERSEY’S CHILDREN ON MEDICAID

"States are failing to adopt the most effective policies under their Medicaid programs to identify mental health or substance abuse problems in children", according to the new national study published in the May 2003 issue of Psychiatric Services journal. Almost 21 percent of children and adolescents have a diagnosable behavioral disorder. Under Medicaid’s EPSDT mandate, states are required to screen all children on Medicaid for physical and behavioral health disorders - an estimated 20 million children each year. A 1999 Surgeon General’s report recognized that identifying disorders is the critical first step in providing mental heath treatment.

States can’t provide treatment of children’s mental disorders and substance abuse if they don’t know the problem exists.

• Under the Early and Periodic, Screening, Diagnosis and Treatment (EPSDT) mandate in section 1905 (r) of the federal Social Security Act, all Medicaid-eligible children under the age of 21 are entitled to receive regular screening for both physical and mental conditions. All Medicaid-eligible children are "EPSDT children."
• Until 1989, states were permitted to limit the services furnished to only those listed in the Medicaid plan. Since federal law made most community-based services optional, and few states covered them, many children who were screened were still not eligible for effective community mental health treatments.
• The EPSDT mandate was greatly strengthened in 1989. The Omnibus Budget Reconciliation Act of 1989 significantly improved their situation. It strengthened EPSDT by requiring states to make available to children who had been screened, any medically necessary Medicaid service authorized in federal law, whether or not the service was listed on the state plan.
• For children who need mental health care, this was a tremendously important change. Federal Medicaid covers not only all traditional medical and clinical treatment, but also case management and various rehabilitative community-based services many of which can be attained through waivers. As a result, Medicaid-eligible children are now entitled to a wide array of highly effective services. This makes the identification of their mental disorders through EPSDT screening all the more important.
• For families who are enrolled in Medicaid FFS the state remains entirely responsible for implementing EPSDT screens and providing the necessary follow-up services. For families enrolled in Medicaid HMOs, even in this situation where the responsibility has been contracted out, the state remains legally responsible for ensuring that the screens are conducted.

Which Children are Eligible for Medicaid?

Federal law requires that Medicaid coverage be provided for certain "categorically needy" groups of children.

• Children whose families receive welfare benefits (TANF children).
• Children in families whose economic circumstances are similar to welfare families’ are eligible, including children who meet the welfare law standards (AFDC).
• Families, and children in foster care/adoption in the child welfare system.
• In most states (including NJ) children who receive Supplemental Security Income (SSI) disability benefits.
• Children under age 6 in families with incomes at or below 133% of poverty.
• Children under age 16 in families with incomes at or below 100% of poverty.
• Low income children not previously eligible for Medicaid, can now be covered through the State Children’s Health Insurance Program (CHIP) authorized in 1997 as Title XXI of the Social Security Act. The state of NJ chose to expand Medicaid for children beyond the federal minimum requirements. NJ set the family income limit to 350% of poverty.

The most frequently cited problems with EPSDT:

• How to get more information and how to file a grievance or an appeal.
• Children and families are uninformed of their rights - they do not know they are entitled to regular screening, follow-up services, special checkups (inter-periodic screening) if they are concerned their child has mental illness, or what they can do if the initial screen indicates no problem even though they still believe their child needs mental health services.
• States have not conducted outreach to identify children who are eligible but not enrolled in Medicaid.
• States have not conducted outreach to encourage families whose children are on Medicaid to bring the children in for regular screenings.
• When screens are conducted, many states use screening tools that do not adequately address mental health issues (only 14 states have specific tools for mental health screening).
• Some states have reported that the reason they haven’t pushed to create specific screening tools for children’s mental health, is because if it is determined that the child needs mental health care services they would have no available mental health services to provide them.
• States have been slow to explain the EPSDT rules for mental health, and generally do not encourage them to conduct inter-periodic screening and to then refer Medicaid-eligible children for treatment.
• Primary care providers, who are generally responsible for such screenings, frequently fail to identify mental health problems. They generally have little training in mental health and substance abuse, and typically receive no guidance from Medicaid agencies on screening tools that would help them accurately identify behavioral health problems. Previous studies have found that pediatricians who rely only on professional judgment, miss more than 40 percent of children with a diagnosable disorder, and the use of standardized, specialized tools considerably increases identification rates.

At this moment the Partnership for Children, along with the State Medicaid office, is working on addressing the need for mental health screening in New Jersey. Their goal to create a friendly, extensive and action oriented screening assessment. The other concern that must be addressed in NJ is the fact that many pediatricians do not take Medicaid. They are also working hard to make sure that EPSTD is placed in all Medicaid HMOs. And of course, expanding the Partnership, so that kids who are screened and determined to be in need will receive the services.

Write your legislator and tell him/her the importance of funding services for children’s mental health.

FEDERAL HOUSING: URGE NJ SENATORS & CONGRESSIONAL REPRESENTATIVES TO FULLY FUND THE SECTION 8 VOUCHER PROGRAM

In July, the U.S. House of Representatives passed the VA-HUD appropriations legislation, which included a narrowly-approved amendment moving $150 million from HUD’s Working Capital Fund to Section 8 Voucher Renewals. Our thanks to the New Jersey Congressional Representatives who supported this amendment: Congressmen Robert E. Andrews (D1), Christopher Smith (R4), Frank Pallone (D6), William Pascrell, Jr. (D8), Steven R. Rothman (D9), Donald M. Payne (D10), Rush Holt (D12) and Robert Menendez (D13).

Even with the additional $150 million, funding for Section 8 Voucher Renewals remains approximately $433 million short. This means that an estimated 63,000 vouchers will be lost nationwide, including nearly 2,000 vouchers in New Jersey. These cuts will fall primarily on low-income working families, the elderly, and people with disabilities. This change constitutes an unprecedented reduction in assistance under the voucher program.

Please urge New Jersey Senators Jon Corzine and Frank Lautenberg and your Congressional Representative to fully fund the Section 8 Voucher Program. Log onto MHANJ website at www.mhanj.org for contact information.

CONSUMER ADVOCATE OF THE MONTH

Kudos to Joseph Gutstein. We met Joe in DC this past June where he had won a scholarship to the NMHA conference. Joe immediately started talking about children with mental illness, "I am hoping that the Childrens’ Initiative will work. This is our last great chance. Kids have a chance." Joe is well-versed and indefatigable as a member of the Bergen County Mental Health Board. He’s been through it, so he knows. He is not afraid to speak out or disagree. He is not afraid to admit that the lack of services for adults with mental illness is serious and for children, it is dire. And he is not afraid to make sure that we know it. "When someone needs help, they must get what they need when they need it, otherwise it’s like quicksand. And sometimes the rope is not good enough or long enough and then we are told that we didn’t try hard enough." But above all, Joe is not afraid to show his heartfelt concern for the most vulnerable among us, "I am really concerned about the kids. They must be helped before it is too late. Before they become ‘too old and too sick!" By his very nature, Joe reminds us that there is no room for complacency. Thanks Joe.

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C. Chin at 973.571.4100 Ex. 37