“Finally a guardian is no longer responsible for their basic needs so homelessness becomes more likely and the criminal justice system holds them more accountable for any criminal behavior.”

The Advisory Workgroup came up with several different priorities including:

  • Eligibility (including issues of insurance coverage for YIT). — This seemed to be the one most discussed in the Population workgroup
  • Diverse Population – SED, Juvenile Justice, Foster Care, OMRDD
  • College Students Gaining Access to Outpatient Services
  • Cross-Systems Approach for Young Adults not eligible for OMH or OMRDD services.

Eligibility
In the literature search, it was very evident that the best-practice in the field was to insure age of eligibility be the same across all sectors. It was also clear that eligibility is a huge determinant of the delivery of services. If an individual in foster care qualified for youth services until the age of 21 while an individual with psychiatric disabilities in the mental health system, ages out at 18, it becomes very difficult to get the various systems of care to work together. Several states have confronted this problem and have put together some progressive ways to respond to the inconsistent eligibility criteria.

According to the GAO Report, adult and children mental health policies were different in 34 states and in 31 of those states, it was more limited for adults than children. This translates into an adult service system that is not as responsive to the needs of youth in the children’s mental health system as they transition to adult services.

The disparity becomes evident as one of the author’s of the Massachusetts YIT program said, “Finally a guardian is no longer responsible for their basic needs so homelessness becomes more likely and the criminal justice system holds them more accountable for any criminal behavior.”

An additional problem with eligibility is health insurance coverage for YIT.  In the 2007, YIT Report it was noted that young adults are the largest population in the United States without health insurance. Upon turning 19, they lose coverage under parents’ policies, Medicaid or SCHIP.

State Programs:
Massachusetts
Massachusetts can provide ‘presumptive eligibility’ to adolescents as they age out which enables young adults to access mental health services without having to reapply for benefits. (National Council on State Legislatures)

The reason that there is an interest in providing presumptive eligibility is because it allows ‘interim Medicaid eligibility’ for youth when they turn eighteen providing them with a seamless process for Medicaid approval. Under presumptive eligibility, they are presumed eligible for Medicaid services and do not have a disruption in their services during the application process. Without presumptive eligibility, youth in transition who turn 18 and apply for Medicaid as an adult may have to wait months before they are approved for adult Medicaid benefits. As a result, many of these youth are unable to pay expenses while they are awaiting Medicaid approval and they could end up in emergency rooms, homeless shelters or in the criminal justice system.

Maryland
Maryland broadened eligibility criteria for mental health services for young adults beyond the medical necessity criteria that had been developed. State officials approved eligibility for young adults who had not in the past met all criteria of serious mental illness. (GAO)

Oklahoma
Oklahoma has broadened the eligibility standards so that youth served in the child mental health system are automatically eligible for adult services if they qualify by income. (Ohio YIT Report)

Montana
17 year-olds can qualify for adult mental health services until they reach age 21. (NCSL Data)

Vermont
Transition Coordinators are responsible for identifying young people who do not meet eligibility criteria in order for them to receive special services funded by the adult system. (The Coalition of Behavioral Health Agencies, Inc. Report)

New Jersey
Reworded the definition of SMI and program eligibility criteria to help youngsters transition more smoothly. (NCSL)

California
Legislature passed a bill that would allow county child welfare agencies to screen for kids at 16 or 17 for mental or physical disability and assist them in applying for SSI. Goal is to have SSI in place once they age out of foster care. (Partnership for Youth in Transition Initiative)

Expert Recommendations:
The Coalition of Behavioral Health Agencies, Inc.’s Report
Create a work group to study eligibility requests for child and adult mental health services system and modify diagnostic and discrepancies. Grandfather adolescent clients into the adult system and extend Medicaid for YIT until 21.

New Hampshire White Paper Report
Conduct a study to establish an interim eligibility classification for adolescents transitioning into the adult mental health system.

Recommendation from American Psychological Association
Guarantee medical eligibility through age 24 for treatment of YIT with serious mental illness.

National Experts Counsel/Mental Health Services Youth Transition Policy Meeting
Services and supports need to be developmentally appropriate and appealing to this population and available regardless of the system with which they are involved. Provision of continuity of care should be for ages 14 – 16 to ages 25 – 30.

New York State Children’s Plan
Develop a standard age at which school services end and adult services begin (18 or 21). Create more flexibility with program eligibility so that admission/continuation decisions can be made based on maturity and skill level.