Children on Medi-Cal, California’s insurance program for its poorest residents, might wait months for urgent psychiatric care, according to an audit released last week.
The California State Auditor’s office performed a survey of providers who accept Medi-Cal in the state and found hundreds couldn’t meet the established standard wait times for an appointment. The audit also found that the Department of Health Care Services and the Department of Managed Health Care are not keeping comprehensive data on wait times in the state, or doing enough to force counties and health plans to see patients in a timely manner.
The audit found 43% of providers surveyed couldn’t provide an appointment for a child needing urgent psychiatric care within the state-standard of four days. For those providers, the average wait time was 13 days, with some only having appointments more than three months out.
For children urgently seeking therapy, 58% of appointments exceeded the standard wait time of 48 hours, with some verging into a 100-day wait.
Some children can’t wait that long, according to Lishaun Francis, senior director of behavioral health with Children Now, a nonprofit that advocates for children’s rights.
“I think this is why you see an uptick in emergency room visits due to mental health concerns, due to self harm,” she said.
The audit identified at least one case where a child’s care was delayed and their condition deteriorated.
According to medical records, after an initial visit, the child was scheduled for a follow-up appointment two months later. Their parent requested an earlier appointment, but wasn’t accommodated. A week later, the parent called with concerns about the child’s symptoms, but the record doesn’t show a sooner appointment was scheduled.
“Later the same day, the child was admitted to a hospital with suicidal and homicidal ideation,” the audit states.
The authors add that the case “demonstrate[s] the potentially harmful effects of delays in receiving behavioral health care.”
In fact, the audit determined that families are consistently relying on emergency departments to meet the behavioral health needs of their children. Children came to emergency departments across the state with behavioral health issues an average of 83,000 times per year between 2017 and 2021.
According to the Centers for Disease Control and Prevention, more than one in five teenagers have or have had a seriously debilitating mental illness.
Long wait times an ‘ongoing issue’
To Francis with Children Now, the results of the audit are nothing new.
“I read the audit and thought ‘yes, and water is wet,’” she said. “[It’s] not really big news here from my perspective. This has been an ongoing issue.”
Francis said the real takeaway of the audit is that DHCS continues to be unable to hold health plans and counties accountable to lowering their wait times.
In their report, the auditors said DHCS and Managed Health Care should be doing more to alleviate difficulties children are facing in accessing mental health care.
In its recommendations to DHCS, the auditors propose that within the next year, the agency should get better at monitoring compliance with standard wait times and develop a policy by which it can impose financial penalties to health plans and counties that don’t follow timely access.
They also suggest that the department do a reassessment of how many providers are needed and how long is reasonable for people to have to travel to access behavioral health care.
In their response to the auditors, DHCS said it is already conducting its own assessments of Medi-Cal access and is working to improve monitoring. It added it has a number of programs underway that are attempting to better meet the needs of children with behavioral health needs.
In their response, the Department of Managed Health Care acknowledged the recommendations and stated it’s interested in ways to improve its monitoring of health plan wait times.
In the meantime, California is facing a health care worker shortage that includes providers of mental health care.
Francis says that shortage likely won’t be fixed for a while. In the meantime, there are some promising developments for children’s mental health, including a new program to credential “wellness coaches” for youth in California.
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