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California Is Expanding Insurance Access for Teenagers Seeking Therapy on Their
Own
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CALIFORNIA IS EXPANDING INSURANCE ACCESS FOR TEENAGERS SEEKING THERAPY ON THEIR
OWN

By April Dembosky, KQED March 28, 2024

Republish This Story

Disponible en Español

During their last year of high school, Esther Lau (left) and Fiona Lu advocated
for a bill to expand access to mental health care for children 12 and older in
low-income households in California. Democratic Gov. Gavin Newsom signed it into
law in October. (Esther Lau)

When she was in ninth grade, Fiona Lu fell into a depression. She had trouble
adjusting to her new high school in Orange County, California, and felt so
isolated and exhausted that she cried every morning.

This article is from a partnership that includes KQED, NPR, and KFF Health News.
It can be republished for free.

Lu wanted to get help, but her Medi-Cal plan wouldn’t cover therapy unless she
had permission from a parent or guardian.

Her mother — a single parent and an immigrant from China — worked long hours to
provide for Fiona, her brother, and her grandmother. Finding time to explain to
her mom what therapy was, and why she needed it, felt like too much of an
obstacle.

“I wouldn’t want her to have to sign all these forms and go to therapy with me,”
said Lu, now 18 and a freshman at UCLA. “There’s a lot of rhetoric in immigrant
cultures that having mental health concerns and getting treatment for that is a
Western phenomenon.”

By her senior year of high school, Lu turned that experience into activism. She
campaigned to change state policy to allow children 12 and older living in
low-income households to get mental health counseling without their parents’
consent.

In October of last year, Gov. Gavin Newsom signed a new law expanding access to
young patients covered by Medicaid, which is called Medi-Cal in California.

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Teenagers with commercial insurance have had this privilege in the state for
more than a decade. Yet parents of children who already had the ability to
access care on their own were among the most vocal in opposing the expansion of
that coverage by Medi-Cal.

Many parents seized on the bill to air grievances about how much control they
believe the state has over their children, especially around gender identity and
care.

One mother appeared on Fox News last spring calling school therapists
“indoctrinators” and saying the bill allowed them to fill children’s heads with
ideas about “transgenderism” without their parents knowing.

Those arguments were then repeated on social media and at protests held across
California and in other parts of the country in late October.

At the California Capitol, several Republican lawmakers voted against the bill,
AB 665. One of them was Assembly member James Gallagher of Sutter County.

“If my child is dealing with a mental health crisis, I want to know about it,”
Gallagher said while discussing the bill on the Assembly floor last spring.
“This misguided, and I think wrongful, trend in our policy now that is
continuing to exclude parents from that equation and say they don’t need to be
informed is wrong.”

State lawmaker salaries are too high for them or their families to qualify for
Medi-Cal. Instead, they are offered a choice of 15 commercial health insurance
plans, meaning children like Gallagher’s already have the privileges that he
objected to in his speech.

To Lu, this was frustrating and hypocritical. She said she felt that the
opponents lining up against AB 665 at legislative hearings were mostly
middle-class parents trying to hijack the narrative.

“It’s inauthentic that they were advocating against a policy that won’t directly
affect them,” Lu said. “They don’t realize that this is a policy that will
affect hundreds of thousands of other families.”

Sponsors of AB 665 presented the bill as a commonsense update to an existing
law. In 2010, California lawmakers had made it easier for young people to access
outpatient mental health treatment and emergency shelters without their parents’
consent by removing a requirement that they be in immediate crisis.

But at the last minute, lawmakers in 2010 removed the expansion of coverage for
teenagers by Medi-Cal for cost reasons. More than a decade later, AB 665 is
meant to close the disparity between public and private insurance and level the
playing field.

“This is about equity,” said Assembly member Wendy Carrillo, a Los Angeles
Democrat and the bill’s author.

The original law, which regulated private insurance plans, passed with
bipartisan support and had little meaningful opposition in the legislature, she
said. The law was signed by a Republican governor, Arnold Schwarzenegger.

“Since then, the extremes on both sides have gotten so extreme that we have a
hard time actually talking about the need for mental health,” she said.

After Carrillo introduced the bill last year, her office faced death threats.
She said the goal of the law is not to divide families but to encourage
communication between parents and children through counseling.

More than 20 other states allow young people to consent to outpatient mental
health treatment without their parents’ permission, including Colorado, Ohio,
Tennessee, and Alabama, according to a 2015 paper by researchers at Rowan
University.

To opponents of the new law, like Erin Friday, a San Francisco Bay Area
attorney, AB 665 is part of a broader campaign to take parents’ rights away in
California, something she opposes regardless of what kind of health insurance
children have.

Friday is a self-described lifelong Democrat. But then she discovered her
teenager had come out as transgender at school and for months had been referred
to by a different name and different pronouns by teachers, without Friday’s
knowledge. She devoted herself to fighting bills that she saw as promoting
“transgender ideology.” She said she plans to sue to try to overturn the new
California law before it takes effect this summer.

“We’re giving children autonomy they should never have,” Friday said.

Under the new law, young people will be able to talk to a therapist about gender
identity without their parents’ consent. But they cannot get residential
treatment, medication, or gender-affirming surgery without their parents’ OK, as
some opponents have suggested.

Nor can minors run away from home or emancipate themselves under the law, as
opponents have also suggested.

“This law is not about inpatient psychiatric facilities. This law is not about
changing child custody laws,” said Rachel Velcoff Hults, an attorney and the
director of health of the National Center for Youth Law, which supported AB 665.

“This law is about ensuring when a young person needs counseling or needs a
temporary roof over their head to ensure their own safety and well-being, that
we want to make sure they have a way to access it,” she said.

Removing the parental consent requirement could also expand the number of mental
health clinicians in California willing to treat young people on Medi-Cal.
Without parental consent, under the old rules, clinicians could not be paid by
Medi-Cal for the counseling they provided, either in a private practice or a
school counselor’s office.

Esther Lau struggled with mental health as a high school student in Fremont.
Unlike Lu, she had her parents’ support, but she couldn’t find a therapist who
accepted Medi-Cal. As the only native English speaker in her family, she had to
navigate the health care bureaucracy on her own.

For her, AB 665 will give clinicians incentive to accept more young people from
low-income households into their practices.

“For the opposition, it’s just about political tactics and furthering their
agenda,” Lau said. “The bill was designed to expand access to Medi-Cal youth,
period.”

This article is from a partnership that includes KQED, NPR, and KFF Health News.

April Dembosky, KQED: @adembosky

RELATED TOPICS

* California
* Insurance
* Medi-Cal
* Medicaid
* Mental Health
* Multimedia
* States
* Alabama
* Audio
* Children's Health
* Colorado
* Legislation
* Ohio
* Tennessee

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COPY AND PASTE TO REPUBLISH THIS STORY

CALIFORNIA IS EXPANDING INSURANCE ACCESS FOR TEENAGERS SEEKING THERAPY ON THEIR
OWN

By April Dembosky, KQED March 28, 2024

Article HTML <h1>California Is Expanding Insurance Access for Teenagers Seeking
Therapy on Their Own</h1> April Dembosky, KQED
When she was in ninth grade, Fiona Lu fell into a depression. She had trouble
adjusting to her new high school in Orange County, California, and felt so
isolated and exhausted that she cried every morning. Lu wanted to get
help, but her Medi-Cal plan wouldn’t cover therapy unless she had permission
from a parent or guardian. Her mother — a single parent and an immigrant
from China — worked long hours to provide for Fiona, her brother, and her
grandmother. Finding time to explain to her mom what therapy was, and why she
needed it, felt like too much of an obstacle. “I wouldn’t want her to
have to sign all these forms and go to therapy with me,” said Lu, now 18 and a
freshman at UCLA. “There’s a lot of rhetoric in immigrant cultures that having
mental health concerns and getting treatment for that is a Western
phenomenon.” By her senior year of high school, Lu turned that experience
into activism. She campaigned to change state policy to allow children 12 and
older living in low-income households to get mental health counseling without
their parents’ consent. In October of last year, Gov. Gavin Newsom signed
a <a
href="https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB665">new
law</a> expanding access to young patients covered by Medicaid, which is called
Medi-Cal in California. Teenagers with commercial insurance have had this
privilege in the state for more than a decade. Yet parents of children who
already had the ability to access care on their own were among the most vocal in
opposing the expansion of that coverage by Medi-Cal. Many parents seized
on the bill to air grievances about how much control they believe the state has
over their children, especially around gender identity and care. One
mother <a href="https://www.foxnews.com/video/6323586560112">appeared on Fox
News</a> last spring calling school therapists “indoctrinators” and saying the
bill allowed them to fill children’s heads with ideas about “transgenderism”
without their parents knowing. Those arguments were then repeated on
social media and at protests held across California and in other parts of the
country in late October. At the California Capitol, several Republican
lawmakers voted against the bill, AB 665. One of them was Assembly member James
Gallagher of Sutter County. “If my child is dealing with a mental health
crisis, I want to know about it,” Gallagher said while discussing the bill on
the Assembly floor last spring. “This misguided, and I think wrongful, trend in
our policy now that is continuing to exclude parents from that equation and say
they don’t need to be informed is wrong.” State lawmaker <a
href="https://www.dhcs.ca.gov/services/medi-cal/Pages/DoYouQualifyForMedi-Cal.aspx">salaries
are too high</a> for them or their families to qualify for Medi-Cal. Instead,
they are offered a choice of <a
href="https://www.calhr.ca.gov/cccc/Pages/cccc-2023-summary-of-constitutional-and-legislative-officer-benefits.aspx">15
commercial health insurance plans</a>, meaning children like Gallagher’s already
have the privileges that he objected to in his speech. To Lu, this was
frustrating and hypocritical. She said she felt that the opponents lining up
against AB 665 at legislative hearings were mostly middle-class parents trying
to hijack the narrative. “It’s inauthentic that they were advocating
against a policy that won’t directly affect them,” Lu said. “They don’t realize
that this is a policy that will affect hundreds of thousands of other
families.” Sponsors of AB 665 presented the bill as a commonsense update
to an existing law. In 2010, California lawmakers had made it easier for young
people to access outpatient mental health treatment and emergency shelters
without their parents’ consent by <a
href="https://www.lacpa.org/2016MinorConsentUpd">removing a requirement</a> that
they be in immediate crisis. But at the last minute, lawmakers in 2010
removed the expansion of coverage for teenagers by Medi-Cal for cost reasons.
More than a decade later, AB 665 is meant to close the disparity between public
and private insurance and level the playing field. “This is about
equity,” said Assembly member <a href="https://a52.asmdc.org/">Wendy
Carrillo</a>, a Los Angeles Democrat and the bill’s author. The original
law, which regulated private insurance plans, passed with bipartisan support and
had <a href="https://legiscan.com/CA/votes/SB543/2009">little meaningful
opposition</a> in the legislature, she said. The law was signed by a Republican
governor, Arnold Schwarzenegger. “Since then, the extremes on both sides
have gotten so extreme that we have a hard time actually talking about the need
for mental health,” she said. After Carrillo introduced the bill last
year, her office faced death threats. She said the goal of the law is not to
divide families but to encourage communication between parents and children
through counseling. More than 20 other states allow young people to
consent to outpatient mental health treatment without their parents’ permission,
including Colorado, Ohio, Tennessee, and Alabama, according to <a
href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393016/">a 2015 paper</a> by
researchers at Rowan University. To opponents of the new law, like Erin
Friday, a San Francisco Bay Area attorney, AB 665 is part of a broader campaign
to take parents’ rights away in California, something she opposes regardless of
what kind of health insurance children have. Friday is a self-described
lifelong Democrat. But then she discovered her teenager had come out as
transgender at school and for months had been referred to by a different name
and different pronouns by teachers, without Friday’s knowledge. She devoted
herself to fighting bills that she saw as promoting “transgender ideology.” She
said she plans to sue to try to overturn the new California law before it takes
effect this summer. “We’re giving children autonomy they should never
have,” Friday said. Under the new law, young people will be able to talk
to a therapist about gender identity without their parents’ consent. But they
cannot get residential treatment, medication, or gender-affirming surgery
without their parents’ OK, as some opponents have suggested. Nor can
minors run away from home or emancipate themselves under the law, as opponents
have also suggested. “This law is not about inpatient psychiatric
facilities. This law is not about changing child custody laws,” said <a
href="https://youthlaw.org/profile/rachel-velcoff-hults">Rachel Velcoff
Hults</a>, an attorney and the director of health of the <a
href="https://youthlaw.org/">National Center for Youth Law</a>, which supported
AB 665. “This law is about ensuring when a young person needs counseling
or needs a temporary roof over their head to ensure their own safety and
well-being, that we want to make sure they have a way to access it,” she
said. Removing the parental consent requirement could also expand the
number of mental health clinicians in California willing to treat young people
on Medi-Cal. Without parental consent, under the old rules, clinicians could not
be paid by Medi-Cal for the counseling they provided, either in a private
practice or a school counselor’s office. Esther Lau struggled with mental
health as a high school student in Fremont. Unlike Lu, she had her parents’
support, but she couldn’t find a therapist who accepted Medi-Cal. As the only
native English speaker in her family, she had to navigate the health care
bureaucracy on her own. For her, AB 665 will give clinicians incentive to
accept more young people from low-income households into their practices.
“For the opposition, it’s just about political tactics and furthering their
agenda,” Lau said. “The bill was designed to expand access to Medi-Cal youth,
period.” This article is from a partnership that includes <a
href="https://www.kqed.org/">KQED</a>, <a href="http://npr.org/shots">NPR</a>,
and <a href="https://kffhealthnews.org/">KFF Health News</a>. Copy HTML

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