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LA, Riverside And Orange Counties Will Be Among The First In California To Implement Judge-Ordered Mental Health Care

, By Eric Westervelt, NPR, 

On a recent afternoon Diana and Lorrin Burdick share pictures and swap stories with three other parents over a lunch of chicken curry sandwiches and fruit salad. They’re hosting an informal but semi-regular support group at their home in suburban Rancho Cordova east of Sacramento.

“Yeah, she loves having family dinners. Sunday is family dinner day now,” says Elizabeth Kaino Hopper as she and husband, Marvin, show a recent picture of their 37-year-old daughter, Christine.

This ordinary lunch with friends is also a vital one: Every parent here has an adult child with a severe mental illness; a son or daughter who’s also struggled with homelessness, substance abuse and arrests. The gatherings give them the chance to share stories, strategies and challenges of having a child with a serious and untreated mental disorder.

“That’s pretty much what he looks like now,” says Diana Burdick as she shows the others a phone shot of her son, Michael, 49, who has lived on the streets for a nearly a decade.

“Aww, see, anybody looking at him would say, he’s not right, he doesn’t feel good,” Elizabeth Hopper says, shaking her head in between lunch bites.

Eight California counties are going first in a planned statewide, controversial experiment to try to fix a seemingly intractable problem every parent around the table is grappling with: How to get treatment and support for loved ones with serious mental health challenges, mostly schizophrenia and other psychotic disorders.

Some of these people end up cycling in and out of police holds, jails, emergency rooms and homeless shelters and encampments. The nationwide problem is particularly acute in California, which accounts for nearly one third of all people in the United States experiencing homelessness.

Some cities including Los Angeles estimate that 10% to 17% of individuals who are unsheltered have been diagnosed with a serious mental illness. But the fact that so many go without a formal diagnosis, experts say the true percentage is likely far higher.

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Groups sue to block Newsom’s CARE Courts program for severe mental illness

, By Lara Korte, Politico, 

SACRAMENTO, Calif. — Civil rights groups are challenging Gov. Gavin Newsom’s new court program for people with severe mental illness.

Three groups — Disability Rights California, Western Center on Law & Poverty, and The Public Interest Law Project — filed a petition to the California Supreme Court on Thursday challenging the constitutionality of the CARE Courts program, which Newsom designed, championed, and signed into law last year.

Civil rights groups file lawsuit to block Newsom’s plan for treating people with mental illness

, By Hannah Wiley, Los Angeles Times, 

SACRAMENTO — 

A coalition of disability and civil rights advocates filed a lawsuit Thursday asking the California Supreme Court to block the rollout of Gov. Gavin Newsom’s far-reaching new plan to address severe mental illness by compelling treatment for thousands of people.

In their filing, representatives from three organizations — Disability Rights California, Western Center on Law and Poverty and the Public Interest Law Project — asked the state’s high court to strike down as unconstitutional the program known as CARE Court (for Community Assistance, Recovery and Empowerment). The groups argue that the sweeping new court system will violate due process and equal protection rights under the state constitution, while “needlessly burdening fundamental rights to privacy, autonomy and liberty.”

Newsom announced CARE Court in March as a new strategy to help an estimated 7,000 to 12,000 Californians struggling with severe mental health disorders like schizophrenia access housing, treatment and mental health services. It was signed into law in September as Senate Bill 1338.

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Western Center’s Analysis of Governor Newsom’s 2022-23 May Budget Revision

The Newsom Administration released its 2022-23 May Revise budget, which includes a massive three year budget surplus of over $90 billion. While the budget includes many noteworthy proposals, overall it fails to provide robust help to those who need it most. Rather than target the surplus on increased tax credits and emergency relief for people with low incomes, the budget proposal provides more than $11 billion in tax credits to car owners, including households with incomes up to $250,000.

Paradoxically, the state has so much extra revenue that General Fund spending is limited since the increased revenue exceeds the State Appropriations Limit (aka the Gann limit). As such, the May Revise proposes large infrastructure spending that is not counted towards the Gann limit. While those proposals are not without merit, the Revise fails on fundamental anti-poverty measures, like backfilling the lost federal child tax credits proven to reduce child poverty, leaving hundreds of thousands of children at risk of unnecessarily falling back into poverty. The Revise also fails to fully eliminate civil assessment fees that disproportionately punish people experiencing poverty who cannot afford to pay a traffic ticket or take time to appear in court.

Care Court

The governor proposes $65 million to fund a new court process called Care Court, which would force unhoused individuals with schizophrenia and other psychotic disorders into a court ordered treatment plan. Western Center has been tracking the proposal and vocal about our opposition since the governor revealed it in March, as it touches on each of our issue areas.

The Revise provides $39 million to the Judicial Council to run the court process, $10 million to finance a supporter program within the state Department of Aging, and $15 million to counties for training and technical assistance.

With its lack of necessary interventions, like a clear budget strategy and mechanisms for creating housing, we believe the framework of the proposal is fundamentally flawed. If implemented, it is likely CARE Court will lead to unnecessary institutionalization of people with disabilities and unhoused people and likely create a chilling effect that will prevent people from seeking services for fear of being institutionalized. Additionally, by involving the court system the proposal will perpetuate institutionalized racism and exacerbate existing disparities in health care delivery since Black, Indigenous and other people of color are significantly more likely to be diagnosed with psychotic disorders than white people. All evidence shows that adequately-resourced, intensive, voluntary outpatient treatment – not court-ordered treatment – is most effective for treating the population CARE Court seeks to serve.

HOUSING & HOMELESSNESS

The governor’s May Revise proposes a $2.5 billion dollar increase for housing and homelessness programs from last year for multi-year investments to build housing and behavioral health housing. The Revise includes an additional $150 million to fund Homekey projects, $50 million to build interim housing and $500 million to accelerate affordable housing production and conversions of retail space in downtown corridors.

Even with the economic fallout of the pandemic raging on, the proposal does not include additional funding for tenants at the brink of eviction for their inability to pay rent. To confuse matters, the governor announced a $2.7 billion budget allocation for rental assistance, but it is not a new commitment. Rather, it’s part of the commitment the legislature made in February via Senate Bill 115, designed to ensure full coverage for rental assistance applications submitted before March 31. However, because of the burdensome application process, tenants accrue debt while they wait for approval and still face the threat of eviction for the months their application was being processed.

The governor’s proposal fails to comply with the legal requirement for the state to fully fund rental assistance applications submitted before March 31 by paying those tenants 100% of their accrued debt at the time they are approved. To keep tenants housed and fulfill the promise of the rental assistance program, the massive budget surplus must be used to fully fund tenants’ rental debt and ensure that vulnerable Californians remain housed.

Western Center will continue to advocate for other sponsored proposals missing in the May Revise, including $500 million in the Community Anti-Displacement and Preservation Program (CAPP) to acquire unsubsidized affordable housing and make them permanently affordable, $200 million in the Reentry Housing and Workforce Development Program to provide stable housing and supportive services to formerly incarcerated people as outlined in AB 1816 (Bryan), and $150 million for eviction defense funding and community education and outreach.

PUBLIC BENEFITS & ACCESS TO JUSTICE

CalWORKs

The May Revise proposes an 11.1 percent increase in CalWORKs, the largest one-year increase in the grant levels in recent memory. The funding for this comes from the Child Poverty subaccount which has seen a significant increase along with the overall budget. Even with this increase, CalWORKs grants for most families are still not out above deep poverty (50 percent of the federal poverty level). That is because most families have an excluded adult. We are calling on the legislature to fulfill the commitment made four years ago to fund CalWORKs grants at the assistance unit plus one level. See the chart below for what the gap will remain at:

Child Support Pass Through

The May Revise makes no change in the administration’s proposal to pass through all child support to former CalWORKs families. While advocates support the proposal, we seek to have it extended to current CalWORKs cases where families have lower incomes and could use the child support assistance immediately.

Food Assistance

The May Revise makes no change to the governor’s January proposal seeking to expand the California Food Assistance Program to Californians regardless of immigration status for those 55 years of age and older. Western Center stands with our partners advocating for the expansion of the program to include Californians of all ages. Many immigrant families were excluded from pandemic relief and continue to be left behind as we rebuild the state’s safety nets.

SSI/SSP

The governor’s May Revise budget makes no proposal to increase grants for blind, aged and disabled Californians. There is a provisional agreement to restore the remainder of the 2009 SSP grant cuts beginning in January 2024 but the governor did not include CA4SSI’s request to accelerate the grant increase to January 2023. By delaying the second restoration, the value of the grant will decline when compared to the federal poverty level.

HEALTH CARE

The governor’s May Revision maintains the expansions proposed in the January proposal, including expanding Medi-Cal to all adults regardless of immigration status (Health4All), zeroing out premiums and copayments for Medi-Cal, and expanding Medi-Cal coverage of custom crowns for back teeth. In addition, the May Revision makes new investments to increase the Medi-Cal doula reimbursement rate, provides navigator funding, and permanently extends presumptive eligibility for older adults and individuals with disabilities. Unfortunately, the May Revision does not update the Medi-Cal share of cost, fully fund SB 65, or implement Health4All sooner than January 2024.

Below is summary of health proposals in the May Revision, which still needs to be negotiated with the legislature by the budget deadline of June 15th.

Medi-Cal

  • Increased Doula Reimbursement Rate: The May Revision proposes to increase the average doula service reimbursement rate from $450 to $1,094, which includes antepartum visits, delivery, and postpartum visits. The implementation date for the doula benefit will be shifted from July 2022 to January 2023 resulting in $974,000 total funds ($377,000 General Fund) in 2022-23 for this benefit.
  • $60M One-time Navigator Funding: The May Revision proposes to add $60 million total funds ($30 million General Fund) to the Health Enrollment Navigators available over four years through fiscal year 2025-26 to assist in outreach, application assistance, enrollment, and retention for difficult-to-reach populations, including the implementation of Health4All.
  • Presumptive Eligibility for Individuals 65 +, Blind, or Disabled: The May Revision includes $73 million total funds ($37 million General Fund) to continue Medi-Cal presumptive eligibility for older adults and individuals who are blind or disabled. Already permanent for other populations, this gives eligible older adults and individuals who are blind or disabled instant Medi-Cal eligibility for a limited time. Advocates are working to ensure this means two Presumptive Eligibility periods per year, as is currently available during COVID.
  • Equity and Practice Transformation Payments: To close health equity gaps in preventative, maternity, and behavioral health care measures, and to address gaps in care, the May Revision proposes an additional $300 million ($150 million General Fund) to the $400 million proposed in January for a combined $700 million in total funds.
  • Transitions to Managed Care: Under CalAIM, various populations are shifting to mandatory managed care effective January 2022 and January 2023. The May Revision proposes to delay the transition of ICF/DDs and Subacute Care Facilities into managed care from January 1, 2023 to July 1, 2023 to prepare for the transition. The administration also identified additional individuals subject to mandatory managed care that were assumed to already be included and will provide details on specific populations once determined.
  • LA Care Sanctions: The May Revision proposes budget bill language to use monetary sanctions collected from LA Care in the budget year to award grants to qualifying non-profit legal aid programs and organizations that serve Medi-Cal managed care enrollees in Los Angeles County or other impacted counties, for purposes of improving access to care in the Medi-Cal program.
  • Medi-Cal Media and Outreach Campaign: In an April budget change proposal prior to the May Revision, the Department of Health Care Services (DHCS) requested $25 million ($12.5 million General Fund) for a media and outreach campaign to encourage members to update their contact information with their counties, and to educate members of potential Medi-Cal termination if requested information is not submitted.
  • Additional AB 97 Provider Payment Reductions Elimination: In addition to elimination of AB 97 payment reductions in the January proposal, the May Revision proposes to include doula services, community health worker services, asthma prevention services, health care services delivered via remote patient monitoring, dyadic services, Medication Therapy Management, and continuous glucose monitoring system, supplies and accessories.

Other Health Proposals

  • Covered California: The May Revision proposes $304 million to extend California’s premium subsidy program for middle income Californians with incomes between 400 and 600% FPL. This represents a fraction of potential loss if federal relief is not extended.
  • Children and Youth Behavioral Health Initiative Grants: The May Revision includes $85 million General Fund for Children and Youth Behavioral Health Initiative (CYBHI) grants to schools, cities, counties, tribes, and/or community-based organizations. This includes grants to wellness and mindfulness programs as well as parent support and training programs.
  • Reproductive Health: The May Revision includes $57 million one-time General Fund to support safe and accessible reproductive health care, for a total of $125 million including investments in the January budget. Specifically, $40 million to DHCS for uncompensated reproductive health care, $15 million for the California Reproductive Justice and Freedom Fund at the Department of Public Health (DPH); $1 million to DPH for the Comprehensive Reproductive Rights Website, and $1 million to DPH for research on unmet needs for reproductive health care.

____________________________________________________________

PDF of this document available here.

For questions contact:

 

Western Center Roundup – April 2022

Our opposition to CARE Court, an opportunity to meet our advocates, and Black maternal health resources

Why Western Center Opposes “CARE Court” 

You may have heard about Governor Newsom’s “CARE Court” proposal, billed as a way for the State of California to help people with severe mental health challenges get off the street. Western Center, alongside 40+ organizations, submitted an official opposition letter to the legislative version of the proposal and we are vocal about our many concerns, which are mentioned in The Los Angeles Times (twice), The Sacramento Bee, and this blog post by our Director of Policy Advocacy, Mike Herald. The bill, SB 1338, passed out of its first hearing this week, which means much more debate to come.

With its lack of necessary interventions like guaranteed housing, we believe the framework of the proposal is fundamentally flawed and will lead to the unnecessary institutionalization of people with disabilities and unhoused people, and likely create a chilling effect that will prevent people from seeking services for fear of being institutionalized. Additionally, by involving the court system the proposal will perpetuate institutionalized racism and exacerbate existing disparities in health care delivery since Black, Indigenous and other people of color are significantly more likely to be diagnosed with psychotic disorders than white people. All evidence shows that adequately-resourced, intensive, voluntary outpatient treatment — not court-ordered treatment — is most effective for treating the population CARE Court seeks to serve.

For more information about the CARE Court proposal and others meant to address California’s homelessness crisis, we invite you to join Western Center policy advocate Cynthia Castillo and senior attorney Helen Tran at 12:30 pm PT on Monday, May 16th for our virtual Meet the Advocate event.

Uplifting Black Maternal Health

Black Maternal Health Week (BMHW) was April 11 –17th, but one week is not nearly enough to cover such an important issue. As you may recall, last year Western Center co-sponsored California’s Momnibus bill package to reduce birth disparities that too often prove deadly for Black people in our state. This year marked the 5th anniversary of Black Maternal Health Week, which was founded by the Black Mamas Matter Alliance (BMMA) to increase awareness, activism, and community building around the issue. You can watch the Black Mamas Matter Alliance’s 2022 Black Maternal Health Week national call here.

Kudos to our partners at the National Birth Equity Collaborative (a BMMA founding member) for their rich 2022 BMHW programming!

PRESS RELEASE: Disability, Civil Rights Groups Say Fundamental Questions Must Be Answered Regarding ‘CARE Court’ Proposal

FOR IMMEDIATE RELEASE 

After issuing a letter in strong opposition, groups request specific answers for core components of proposal

Sacramento, CA – With Governor Gavin Newsom’s proposal for a so-called “CARE Court” set to be heard by the legislature this week, and after more than 40 advocacy groups including ACLU California Action, Disability Rights California, and Western Center on Law & Poverty submitted resounding opposition to its related bill, SB 1338 (Umberg & Eggman), advocates say fundamental questions remain unaddressed by the administration and bill authors.

The specific questions advocates have about the proposal include:

  1. How would the CARE Court respond to the crisis of insufficient housing and treatment availability for people who need either or both?
  2. How would the CARE Court avoid reinforcing systemic racial biases which result in disproportionate numbers of Black and brown people unhoused and under court supervision?
  3. How would the CARE Court achieve effective outcomes with coerced treatment where evidence has consistently supported adequately resourced voluntary treatment instead?
  4. How would the CARE Court avoid fast-tracking vulnerable people with disabilities to conservatorship and the diminution of their autonomy and legal rights?

The joint opposition letter sent to legislators this month unequivocally states that the framework of the proposal is entirely and irreparably flawed. Specifically, if these fundamental questions go unaddressed, the proposal is simply bill language without substance.

“Instead of creating a new court system to delegate medical care, California should guarantee housing for people who are unhoused and for those with severe mental health disabilities,” says Helen Tran, health attorney for Western Center on Law & Poverty. “Forcing people into court-ordered treatment without guarantee of permanent housing will create a continuous cycle of court intervention when people find themselves back on the street due to California’s severe lack of affordable, permanent supportive housing. State funds should be directed toward the creation of housing and supportive services to help people maintain their housing and health care needs.”

The groups say the proposed CARE Court model will lead to unnecessary institutionalization of people with disabilities and unhoused people and will likely create a chilling effect that prevents people from seeking supportive services for fear of being institutionalized or otherwise having their rights stripped. The proposal also feeds into the false narrative that most unhoused people have a psychiatric disorder.

“CARE Court is a fast track to re-institutionalize Californians living with mental health disabilities,” says Kim Pederson, senior attorney at Disability Rights California. “The state should invest in evidence-based practices for voluntary engagement in community-based, trauma-informed, culturally-responsive mental health services. Instead, CARE Court creates a punitive system under which a person must comply with court orders or risk being conserved and institutionalized. True recovery and empowerment can only come from providing people with meaningful opportunities to make their own choices about the services that will work best for them.”

Additionally, by involving the legal system the proposal will perpetuate institutional racism and exacerbate existing disparities in health care delivery since Black, Indigenous and other people of color are significantly more likely to be diagnosed with psychotic disorders than white people, and because there is clear evidence that adequately resourced, intensive, voluntary outpatient treatment is more effective than court-ordered treatment.

“At a time when there is an unprecedented housing crisis that disproportionately impacts Black people and other people of color, many of whom have already been entangled in failed legal and other systems, this proposal if enacted would have disastrous consequences,” says Brandon Greene, director of the Racial and Economic Justice Program at the ACLU of Northern California. “What we need is investment in holistic community driven systems not punitive ones that further alienate and ostracize.”

Read the full letter of opposition.

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ACLU California Action is the statewide legislative policy arm of the ACLU affiliates in California. The ACLU works to protect civil liberties and civil rights and advance equity, justice, and freedom for all.

Disability Rights California (DRC) is the agency designated under federal law to protect and advocate for the rights of Californians with disabilities. The mission of DRC is to advance the rights, dignity, equal opportunities, and choices for all people with disabilities.Western Center on Law & Poverty fights in courts, cities, counties, and in the Capitol to secure housing, health care, and a strong safety net for Californians with low incomes, through the lens of economic and racial justice.

 

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