When I joined the California Katie A Therapeutic Foster Care litigation settlement workgroup, the lead attorney quipped, “California is like the Wild-Wild West; 58 counties doing what they d***-well please!” How true. Sadly, how very true.
But it isn’t a “California” problem alone--this problem is a national one. Basically, there is no guarantee that youth with identical needs will receive the same services from state to state or from county to county. It makes no difference whether or not these are federally “entitled” services, or even if it is morally and ethically reprehensible; unequal, disparate treatment of children and youth dominates our national children’s system of care.
This bad practice came into precise, clear view under the implementation of “ObamaCare.” In states like California, Pennsylvania, New York and even Kentucky, millions of children and youth were added to the ranks of the insured. On the other hand, children in Texas, Florida, Kansas and other “red” states do not have equal access to necessary health care services.
And healthcare is only the tip of the iceberg. Unequal service delivery permeates every service delivered to children and youth. For instance, education varies not only from state to state, but from school district to school district; including the quality of education delivered, and programs such as special education, athletics, extracurricular activities, and arts and culture. Study after study covering multiple decades has also uncovered unequal treatment in the Juvenile Justice and Child Protection/Welfare systems; Behavioral/Mental Health services; and the educational and healthcare systems. These disparities are distinguishable by geography, race, gender and socioeconomic status. REALITY CHECK–this is a national problem lawmakers and power-brokers are unwilling to address!
California is one of 13 states which basically relegates the care and treatment of youth to regionalized counties or municipalities. This type of system does not promote consistency or equality, or quality for that matter. For example, a special/high needs youth can live in a progressive, conscientious California county and receive an array of appropriate, effective services while another young person with similar needs living a few miles away in another county, would not have similar access. And these “58 counties doing whatever they “d***-well please” infamously produces lawsuits (e.g., Katie A) with the state continuously losing.
Let’s explore some of the fundamental contributors to this problem and what should be done.
At the risk of stepping on a lot of people’s toes, I believe “states rights” and “local control” are huge detractors. Frankly, these slogans are code for “don’t tell us what to do; we’ll do as we d***-well please because it’s none of your business.” Unfortunately, this myopic, self-centered frame of mind is destructive to the cohesive fabric of our country; it is destructive and harmful to our children and youth; and I believe it flies in the face of the Equal Protection Clause of the 14th Amendment of the US Constitution. There must be equal access to entitled federal services, but more importantly, there must be equal access to services which are absolutely necessary for the health, safety and wellbeing of all children and youth.
I have come to the firm conclusion that most policymakers, legislators and power-brokers could care less about the plight of children and youth until there is some dramatic crisis from which they can make political hay. Foster youth, commercially sexually exploited children, mentally ill kids, children failing school and high school dropouts don’t have paid lobbyist nor can they write big checks to fund political machines. Additionally, government bureaucrats charged with overseeing service delivery to our kids are all primarily a bunch of gutless wimps. It is rare to find a state or county director or deputy-director willing to make a strong stand for children and youth, especially with the body that writes their paycheck and guarantees their pension.
Funding is another huge obstacle to equal access to services. It’s okay to grant huge tax breaks to wealthy corporations that don’t need them, to divert public funding to cover unfunded benefit packages granted for political gratuity, or squander billions on unvetted computer systems, the military-industrial complex, high-speed rail and opulent public buildings. But, ask for chump change to serve children and youth and the answer is always, “Oh no, we can’t afford that.” Cost Neutral is the modern political vernacular for it’s not important!
“Pass the buck” is the de facto practice when it comes to accountability and enforcement. A great example of this sentiment is the Federal Center for Medicare & Medicaid Services’ (CMS) recent approval of California’s requested waiver under Section 1915 of the Social Security Act which asked to deliver children’s Specialty Mental Health services on a 58 county-bases instead of statewide. CMS has made it very clear over the years, and even in the approval letter, that they don’t like California’s County-based delivery system. But instead of denying the waiver request, they approved it with some “special terms”, which in reality will not improve anything on the ground. Add to this the fact that California’s Department of Community Health Services doesn’t have the leadership, skills or willingness to effectively enforce equal access to services--even after Katie A--because they don’t want to infringe on “local-control” and you’ve got a no-win situation.
California’s 2011 Realignment Legislation is another example of “pass the buck.” By shifting revenues to the counties for local-control, the state effectively created a system which endorses and expands unequal treatment and services for children and youth.
Until we elect legislators and hire leaders with the right priorities, our most vulnerable children and youth will continue to be losers and unequally served. The wild-wild-west indeed.