The Youth Empowerment Services (YES) Waiver program in Texas is facing a growing demand as nearly 900 families wait for access to its intensive mental health services. The program, designed to provide treatment in the community, is crucial for families who cannot afford long-term inpatient care or those seeking to avoid the foster care system. However, low Medicaid reimbursement rates are driving providers away, leading to long wait times and a shortage of services, particularly in rural areas.
Nearly 900 Texas children are waitlisted for a mental health program billed as an alternative to foster care . Nidia Heston always had a plan for her son Quin but nothing could have prepared her when his school wouldn't enroll him in the eighth grade until his mental health was thoroughly evaluated. At Dell’s Children’s Medical Center, doctors told Heston that Quin’s suicidal ideations were so severe that he would need to be admitted into a state hospital or a residential treatment center.
To add to the heartache, entering those facilities would require her to give up parental custody and care to the state for an extended amount of time. Not wanting to say goodbye to her son, Heston quickly applied for an intensive state mental health program that would allow Quin to receive outpatient treatment at home or in offices. After a month of waiting and sleeping on the couch with Quin to make sure he didn’t hurt himself, she was approved for the program.Heston and her son, who was diagnosed with bipolar disorder, autism and ADHD, is among thousands of families who have received treatment from the Youth Empowerment Services (YES) Waiver, an intensive mental health service program for families who cannot afford long-term psychiatric inpatient care or who would rather see their child receive treatment in their own community. The program, which serves about 2,200 children, is currently in desperate need of additional funding as providers leave the program due to low Medicaid reimbursement rates. The waitlist for this mental health service is nearly 900 families on a given day. Started in 2015, the program provides a family with a team of specialists within the community who provide various behavioral health services and nontraditional services, such as adaptive support, specialized therapies, and minor home modifications. The program is in high demand because it allows kids to go to school, play on their sports teams, and stay with their families. Often, families who cannot access acute mental health services give full or partial custody to the state to obtain treatment, which taxes the state’s already overburdened foster care system. In 2023, 3,109 children inquired about being assessed for YES, a 53% increase from 2019. Despite the increased inquiries over the last five years, the number of youth served has steadily declined, with 2,227 youth enrolled in 2023 compared to 2,826 in 2019 — a 21% decrease. Because of stagnant Medicaid reimbursement rates that are at times one-half of what providers are paid in the private sector, the program lost 386 YES providers between 2020 and 2023, according to a Texas Statewide Behavioral Health Coordinating Council report on youth health. This has led to wait times for the YES program that vary by county, with rural parts of the state most affected. “HHSC continues to work to expand the provider base and maximize utilization of existing YES Waiver slots as a statewide service,” said Jennifer Ruffcorn, Texas Health and Human Services Commission spokesperson.Monica Reyes, a certified family partner and mental health peer specialist in Travis County, has helped more than 100 families get approved for the YES program. She said the program's effectiveness is undisputed, with the state saving an estimated $12,500 per child served. In 2023, 2,575 children were served in the YES program, and 95% of children who aged out of the program transitioned to other services or graduated with a transition plan for ongoing care. The YES Waiver is available statewide through all 39 local mental health and behavioral health authorities and two comprehensive waiver providers.“Our providers are making much more money not using Medicaid,” she said. In Texas, Medicaid pays between $60 and $122 for a 50-minute session with a therapist who can charge $180 or more for that visit. Since many therapists would rather accept privately insured or self-paying clients, few providers are left to treat Medicaid patients. “Now the ones that do accept Medicaid, which are very few, are already booked and never have availability because the need is so high,” Reyes said. Reyes said the YES program in Travis County has about two providers for nontraditional therapy services like art and music and eight providers for classic therapy service
Mental Health Texas YES Waiver Foster Care Medicaid Child Welfare Waitlist Rural Health Behavioral Health Services
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