Virginians receiving continuous Medicaid coverage was one of the benefits of a pandemic-era law, proving to be a lifeline to children and families and helping to bring down the overall uninsured rate. The provision however is set to expire on April 1, and the regular Medicaid renewal process will resume. Now, even eligible children could lose coverage due to difficulties in the renewal process, like staffing and lack of communication. Learn more in this “Medicaid Unwinding” vlog from Policy Analyst, Emily Moore.
Additional resources:
Medicaid and FAMIS have been valuable lifelines for kids during the pandemic. As pandemic coverage protections end, 146,452 of Virginia’s kids are at risk of becoming uninsured. Read more about the high stakes for children when the Medicaid continuous coverage protection expires in the Georgetown University Center for Children and Families 2023 Annual State Enrollment Report.
For additional help, Medicaid enrollees can visit Enroll Virginia, enrollva.org/get-help or call 888.392.5132 to make a free appointment with a navigator. Navigators can help complete renewal forms, reapply for Medicaid, or transition to new affordable coverage through the Marketplace.
Head to Facebook to watch the recording of Enroll Virginia’s Facebook live event in English and Spanish from February 16, “The End of the Public Health Emergency and Medicaid: What You Need to Know.”
Virginia will start to review Medicaid members’ health coverage beginning in March 2023. They will not cancel or reduce coverage for members without asking for updated information, but they need your help to make this a smooth process. You can take steps now to make sure you receive information you will need to renew your coverage.
What Medicaid members can do now:
Update your contact information. You can make updates:
Whether you are a young person, a parent, a mental health professional, or an educator, you have likely heard about the youth mental health crisis in the United States—it is being discussed everywhere, from kitchen tables to news stations to the Governor’s office. And while there is finally urgency around addressing the mental health needs of Virginians, we continue to see a catch-all response for adult and children’s mental health needs in our current policies. It is undoubtedly easier to design mental and behavioral health systems and services for adults and retrofit young people into them, but this results in supports that inadequately meet the needs of children and youth. To truly invest in the mental health of young people, policymakers must do so with intention. It requires centering the needs and experiences of young people—especially those who are Black, Latino, and LGBTQ+—and developing mental health services that prioritize healing and well-being.
Self-harm-related emergency department visits among Virginia youth, ages 9 to 18, more than doubled from 2016 to 2021, with the largest increase in self-harm visits occurring in 2021, according to the Virginia Department of Health, and
Youth deaths by suicide, ages 9 to 18, averaged 4.9 deaths per 100,000 youth from 2015–2019, and were 6.2 per 100,000 youth in 2020 and 5.6 per 100,000 in 2021.
This constitutes a youth mental health crisis. In order to meet this moment for youth mental health, there must be major shifts in how children and youth are prioritized in our system. Historically, new initiatives and service expansions have delayed the implementation of child- and youth-focused plans until phase two—a step that often takes too long to achieve. Mental health resources that are not intentionally designed to reach children and youth will not reach them.
Capacity to build up the infrastructure at local Community Services Boards, particularly for children and youth, is needed. The ideal system offers young people mental health support when and where they need it, but the reality is children and youth do not have access to a comprehensive array of crisis response services depending on where they live, who pays for their care, and who helps them identify resources.
Currently, there are only three Residential Crisis Stabilization Units (RCSUs) specifically for young people across the Commonwealth. One goal of Governor Youngkin’s “Right Help. Right Now.” behavioral health transformation initiativeis to add more youth RCSUs and to develop 23-hour Crisis Receiving Centers (CRCs) to serve as a “behavioral health urgent care”, both of which are critical components of the crisis services continuum. However, if the locations and services are not developed with young people’s needs in mind, they will not be as effective of a resource. Having a cross-lifespan model for RCSUs and CRCs that only incorporate child-sized recliners does not make a space child- and youth-friendly. The design of RCSUs and CRCs must be fundamentally different from the design of a traditional hospital, which are often sterile and unwelcoming environments. Young people need culturally and developmentally appropriate resources in these locations, such as places for their family members to rest, blankets, sensory toys and comfort items, and a warm and inviting environment to encourage healing and create emotional and physical safety.
Virginia lawmakers have a chance to reimagine what it means to put young people’s needs at the forefront of their decision-making during the 2023 General Assembly session. Between Governor Youngkin’s proposed budget and several budget amendments before the legislature, there are opportunities to ensure behavioral health services are available in every region and designed with the needs of children and youth in mind. This includes expanding crisis response services with components specific to children and youth and providing adequate resources to build the capacity of the system.
Build out crisis response and stabilization services that offer young people support when and where they need it.
Continue the expansion and modernization of the statewide crisis services system by investing in crisis receiving centers and crisis stabilization units. Hire a staff member to oversee Children’s Crisis Response Services.
Support the Governor’s proposed budget to increase funding for a comprehensive crisis services system | $58,345,204
Fund contracts with private providers to establish mobile crisis units in underserved areas.
Support the Governor’s proposed budget to provide one-time funds for mobile crisis units | $20 million
Prioritize young people in the design and implementation of mental health services.
Build upon the base of $8.4 million the legislature has provided since SFY2017 to expand or enhance children’s behavioral health services in all five Department of Behavioral Health and Developmental Services (DBHDS) health planning regions and keep a dedicated focus on infrastructure specific to children and youth services within DBHDS’s Office of Child and Family Services.
Support budget amendments for Children’s Behavioral Health Services: Item 313 #1h (Price)/Item 313 #6h (Seibold); Item 313 #5h (Rasoul); Item 313 #3s (Favola)
Young people can learn and thrive when they are fed and have access to healthy and nutritious foods. However, in Virginia, one in ten children are considered food insecure and may face hunger. Children are considered food insecure when their households experience limited or uncertain availability of safe, nutritious food at some point during the year.
While significant efforts to improve food security have been in place during the pandemic—such as the enhanced Child Tax Credit, expanded SNAP benefits, Pandemic EBT, and universal school meals—unfortunately, these programs were designed to be temporary. Many of the supports that helped feed young people and lift their families out of poverty have already come to an end or will end once the Federal Public Health Emergency expires.
The pandemic demonstrated that when it comes to ensuring young people have access to nutritious, healthy, and culturally appropriate food, there are programs that work. And one thing we are certain of is that school meals play a crucial role in providing the nutrition children need to support their academic success and overall well-being.
This school year, Congress did not extend the federal waiver authority that allowed all young people access to free school meals over the last two years. As a result, schools have gone back to pre-pandemic operations, requiring families to submit an application to their child’s school to determine if their child is eligible for free or reduced-price meals.
Voices is grateful to Virginia legislators who included $8.2 million in state funds over the next two years to cover the out-of-pocket costs of Virginia’s young people who qualified for reduced-price school breakfasts and lunches. The state funding will allow roughly 64,500 children from households whose incomes are between 130-149% of the poverty level to get their school meals for free rather than at reduced-price. But that still does not remove the barriers to food access created by the requirement to fill out paperwork for students to receive those meals at no cost to their families.
A program that does remove barriers is the Community Eligibility Provision (CEP). Through CEP participation, school divisions are able to offer breakfast and lunch to all students at no charge and without processing school meal applications.
How Can Schools Participate and Why Should They?
A school district, group of schools in a district, or individual school with 40% or more “identified students” can choose to participate in the CEP on a four-year cycle. Identified students are young people who are eligible for free school meals and are already identified by means other than a school meals application, such as:
students whose households participate in SNAP, TANF, and in some states (including Virginia), Medicaid benefits,
as well as students who are certified for free school meals because they are identified as homeless, migrant, runaway, enrolled in head start, or are in foster care.
The Community Eligibility Provision promotes equity, reduces stigma, and saves schools significant time by reducing administrative burdens. Some of the benefits of CEP include:
Helping economically disadvantaged students and their families
Parents are assured that students are getting two healthy meals a day at school
Families’ financial burden is eased when students eat school meals
Offering meals at no charge to all students eliminates stigma and “school lunch shaming”
Increasing efficiency and school meal participation
Families don’t encounter language and literacy barriers to access through the application process
Schools do not need to track each meal served by fee category (free, reduced-price, and paid)
School nutrition staff do not need to collect fees or lunch numbers from students, allowing the lunch line to move faster and ensuring more students can be served
Eliminates unpaid school meal debt
Virginia’s Utilization of CEP
Virginia has made significant progress to encourage school divisions to reduce barriers to offering free school meals through the Community Eligibility Provision. During the 2021-2022 school year, out of Virginia’s 145 school districts, 97 divisions (67%) were eligible to participate in CEP and 81 of those divisions participated division-wide. According to the Food Research & Action Center, Virginia had the largest growth in the number of school districts adopting CEP, increasing by 25 school districts.
Despite these numbers, there are roughly 50 school divisions that have no CEP opportunities or CEP opportunities are only available at a limited number of schools.
As inflation has hit a 40-year high, families across Virginia—especially those in areas with a high cost of living—are struggling to make ends meet. And as a result, families who do not qualify for free or reduced-price school meals are more likely to now experience food insecurity.
Virginia can work to ensure that less children experience food insecurity by expanding SNAP benefits and working to reduce the SNAP participation gap amongst families, supporting school divisions in an effort to maximize opportunities for adopting CEP, and continuing to fund and maintain the elimination of the reduced-price meal category for school meals.
Voices for Virginia’s Children is a member of the Virginia Food Access Coalition, a statewide coalition that develops policy solutions to increase economic access to healthy and nutritious foods by investing in retail infrastructures and programmatic initiatives to combat areas of food insecurity.
This blog is the second post in a two-part series that takes a deeper look into Virginia’s efforts to integrate the 9-8-8 hotline with the behavioral health crisis services continuum. Read the first blog post in the series here.
For years, communities have advocated for diverting mental and behavioral health calls away from law enforcement and for states to adopt a comprehensive crisis response system. Now, that dream is beginning to come to fruition. On July 16, the National Suicide Prevention Lifeline transitioned to the three-digit number 9-8-8. While this transition was initiated by legislation at the federal level, states are responsible for the rollout and linkages to their crisis response systems when the caller’s needs cannot be resolved over the phone. Virginia has been working on a rollout behind the scenes to link the lifeline to crisis response services that are currently being designed and implemented by state agencies and stakeholders.
The commonwealth’s plan for minimizing emergency room visits for mental health crises and providing an alternative to calling 9-1-1 is to link the crisis call centers with regionally focused resources by integrating mobile crisis response alongside the Marcus Alert protocols. However, at this moment, this is simply the goal and not the reality. The development and implementation of Virginia’s behavioral health crisis system has been a piecemeal approach, and is not yet fully prepared to deliver comprehensive, trauma-informed, and culturally responsive services to meet individuals’ mental health needs—specifically the needs of young people
The Surgeon General sounded the alarm in December 2021 by issuing an advisory on the youth mental health crisis. Despite widespread awareness, young people’s mental and behavioral health needs are often an afterthought or part of “phase two” when developing programs and services. Current resources dedicated to young people’s behavioral health make up less than 10% of Virginia’s overall behavioral health agency budget. The lack of sufficient funding and resources further the disparities that historically marginalized communities face in accessing support and services.
Due to the inconsistent mental health crisis services across regions, law enforcement is often the first point of “care” for mental health emergencies, especially for Black, Latinx, Indigenous, and LGBTQIA+ youth. While most calls to 9-8-8 can be resolved during the call, some crises will require an in-person response based on a four-level call matrix.
This new entry point for mental health support is supposed to be an alternative to law enforcement response, but a new law allows 89 of Virginia’s 133 localities with 40,000 or less residents to opt out of two protocols under the Marcus Alert System. This means that for those living in one of the 89 localities that are not required to implement all Marcus Alert protocols, an attempt to get in-person crisis support may still result in law enforcement, with or without Crisis Intervention Training, responding to your call. The criminalization of youth crises often results in further traumatization. This experience can intensify their crisis, compromise their treatment, and make them and their families less willing to call for help if another crisis occurs. Far too often children and families are met with a response that is not suited to meet their immediate or long-term needs.
At a time when young people need support the most—while their worlds have been turned upside down by COVID-19—we must ensure there are providers and services in place to provide access to timely, culturally responsive services, and address social determinants of health to support children and families’ overall wellbeing. This requires investments from lawmakers and interagency collaboration.
For 9-8-8 to be truly transformative, investments are needed now.
While all these recommendations are not immediate and some are considerations for future policy, Voices for Virginia’s Children suggests the following key recommendations:
Mobile Crisis services need to be fully funded across all regions, with an emphasis on providing services in underserved and rural communities. Voices also suggests separate mobile crisis protocols designed specifically for youth, as the intervention points at which young people receive support may include schools, parental consent, developmental appropriateness, or specifically trained professionals;
Mobile Crisis and Community Care teams should include a peer specialist, interpreter, community advocate, and child-serving mental health professional;
More small-scale children’s Crisis Stabilization Units should be placed in communities across the state;
Establish an infrastructure for language access and a culturally diverse and appropriate workforce;
Mandatory trainings should include equity-centered concepts, including implicit bias training, trauma-informed care, child and adolescent development, and training specific to special populations (i.e., LGBTQIA+ youth and youth with intellectual and/or developmental disabilities);
Stakeholders involved in implementation should include those most impacted, such as youth with lived experience and communities of color;
Ensure that crisis response protocols and services are equipped to support systems-involved youth and their family members. Protocols should be designed to avoid future involvement in the child welfare system or juvenile justice system.
Voices will continue to advocate for increased access and improved coordination of quality mental health services for all children in Virginia, regardless of where they live or at what point they seek mental health services. The future wellbeing of our state depends on how we support and invest in the next generation.
This blog is the first of two posts that will take a deeper look into Virginia’s efforts to integrate the 988 hotline with the behavioral health crisis services continuum.
**This blog contains information and statistics on suicide and mental health. If you or a loved one are experiencing a crisis or need mental health resources, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (en Español: 1-888-628-9454; deaf and hard of hearing: 1-800-799-4889) or the Crisis Text Line by texting HOME to 741-741.
On July 16, a new three-digit national hotline–988–will launch to connect callers with trained counselors through the National Suicide Prevention Lifeline to provide 24/7 call or text support for anyone experiencing a mental health crisis or in need of suicide prevention services. Though the hotline is administered through the national Lifeline, calls to 988 will be routed based on area code to regional crisis call centers that can connect individuals with crisis and emergency services that are available in their local communities.
Virginia is utilizing the national 988 hotline implementation as an opportunity to link the three-digit dialing to the broader behavioral health crisis services continuum that is being developed across the state. Eventually, this will mean that more young people and their families will have access to mental health professionals responding to a crisis instead of law enforcement. This is especially important given the compounding traumatic effects of the COVID-19 pandemic, systemic racism, LGBTQIA+ discrimination, and gun violence in this country.
The Centers for Disease Control reported that during 2020, mental health–related emergency department visits among youth aged 12 to 17 increased 31% compared to 2019. Specifically, emergency department visits for suspected suicide attempts among 12 to 17-year-old girls were 50.6% higher in February to March 2021 than during the same period in 2019; among boys aged 12 to 17, such emergency department visits increased 3.7%.
Figure 1: Percentage of Students who felt sad or hopeless almost every day for 2 weeks or more, VYS, 2011-2019
Figure 1. ED visits related to suicidal thoughts, self-harm, and suicide attempts among Virginia youth aged 9-18 years, 2016-2021
Figure 2: ED visits rates for suicidal thoughts, self-harm, or suicide attempts among Virginia youth aged 9-18 years, by sex, 2016-2021
Barriers to Accessing Mental Health Services
Although rates of mental health problems are not statistically different by race, the rate at which children of color receive mental health care is much different than white children. A National Center for Health Statistics data brief reported that non-Hispanic white children (17.7%) were more likely than Hispanic (9.2%) or non-Hispanic Black (8.7%) children to have received any mental health treatment in the past 12 months.
As noted in Voices’ Children’s Mental Health Discussion Paper, “systemic barriers such as eligibility criteria for health insurance and accessibility of services contribute to lower participation among Black and Latinx children. A history of racism and disinvestment in communities of color have made mental health services less accessible for children of color by geography, cultural fit, and language.”
LGBTQIA+ youth also often lack access to affirming spaces, which include health care and mental health care services. The Trevor Project’s 2022 National Survey on LGBTQ Youth Mental Health reported that 60% of LGBTQIA+ youth who wanted mental health care in the past year were not able to get it. Some of the reasons youth cited for wanting care but not having access include fear of discussing mental health concerns (48%), concerns with obtaining parent/caregiver permission (45%), fear of not being taken seriously (43%), and lack of affordability (41%).
LGBTQ youth who wanted mental health care but where unable to get it cited the following top ten reasons.
Of the LGBTQIA+ youth aged 13 to 17 that were surveyed, 73% reported symptoms of anxiety and 67% reported symptoms of depressive disorder in 2020. Almost half of those youth surveyed seriously considered attempting suicide in the past year.
These statistics demonstrate the clear need for appropriate and effective mental health services for young people. Lack of access can lead to serious and lasting impacts across all areas of a child’s life. Ensuring that emergency services are accessible, unintimidating, and culturally competent will take creating programs like the 988 hotline and implementing them with full funding and public support.
As lawmakers work to streamline Virginia’s mental health and behavioral health system, Voices is focused on opening these services to all our communities and addressing past harms in the way of healing.
Understanding the social determinants of health (SDOH) that impact children’s lives informs how we advocate for policies that improve the health and well-being of all children, especially children of color and economically disadvantaged children. During the 2022 General Assembly Session, Voices joined partners, advocates, and youth in asking lawmakers to invest in equity and provide access to language services across state agencies, healthy and nutritious foods, and comprehensive health care.
After months of negotiation, the legislature has reached an agreement on the state budget, including many of these initiatives. Policy changes in legislation and budget language have made progress towards holistically addressing the inequities and disparities faced by Virginia’s children and families.
Creating an Equitable Health Care System
HB 987, sponsored by Delegate Tran, was signed into law and requires the Board of Medical Assistance Services to ensure that all medical assistance program information provided to applicants is made available in a manner that is timely and accessible to individuals with limited English proficiency through language access services. This includes oral interpretation, written translations, and auxiliary aids and services for individuals with disabilities as a reasonable step to provide meaningful access to health care coverage.
HB 229, sponsored by Delegate Coyner, was signed into law and requires the Department of Health to collect and analyze information, including demographic data, regarding social determinants of health and their impact on health risks and health outcomes of Virginians.
To address Medicaid enrollment, language is included in the budget directing the Secretary of Health and Human Resources to establish a Task Force on Eligibility Redetermination. This task force will help plan and advise the Department of Medical Assistance Services on the unwinding process to ensure Virginians do not lose healthcare coverage. The language also adds American Rescue Plan Act (ARPA) funding to be used for operational challenges linked to eligibility redetermination, such as technology needs and paying staff overtime at local DSS agencies.
The legislature has directed $2.5 million in FY23 to continue the contract for an integrated e-referral system for one year. It is expected that the e-referral system will continue beyond FY23 with user fees supporting its operations. The purpose of the system is to connect government agencies, health care providers, and community-based partners to enable participants in the system to refer patients to public health and social services.
Increasing Language Access and Equity
While the funding amount was reduced from the original budget, $2.5 million per fiscal year remains in the current budget to be provided to state agencies for facilitating and improving language access. This funding will allow each state agency to designate a language access coordinator who will be responsible for making sure that agency materials and communications are accessible to all Virginians, especially those who have limited English proficiency.
Increasing Food Access and Nutrition Security
To ensure access to healthy and nutritious foods and boost the buying power of the Supplemental Nutrition Assistance Program (SNAP) benefit for fruits and vegetables at farmers markets and food stores, $1 million per fiscal year will be directed to Virginia Fresh Match.
HB 582, sponsored by Delegate Roem, was signed into law and requires public institutions of higher education to ensure that young people in college have access to information on SNAP benefits, including eligibility and how to apply. The bill also requires each institution to advertise information on the SNAP benefit process on their website and in orientation materials distributed to students.
HB 587, sponsored by Delegate Roem, was signed into law and requires every public elementary or secondary school to process web-based or paper-based applications for participation in the School Breakfast Program or the National School Lunch Program, administered by the U.S. Department of Agriculture, within five working days after the date of receipt of the application.
Creating a future where Virginia’s children can thrive will require intersectional approaches, including equitable, healing-centered policies that dismantle systemic barriers so that all young people can lead long, healthy, and successful lives. While the budget takes important steps forward, we must continue uplifting youth voices to improve policies impacting their health and well-being.
