Youth Empowerment Services (YES) Waiver: Crisis in Texas Mental Health Funding

Nidia Heston’s journey with her son Quin highlight the struggles faced by many families dealing with pediatric mental health issues. When Quin’s school denied enrollment due to his severe mental health needs, Heston turned to the Youth Empowerment Services (YES) Waiver program. This initiative offers intensive mental health care tailored for families who cannot afford long-term inpatient care or prefer community-based treatment.

Initially hesitant, Heston’s fears materialized when Dell’s Children’s Medical Center recommended either a state hospital or a residential treatment center. To avoid handing over custody, Heston applied for the YES Waiver, only to wait a month with Quin, ensuring he remained safe. Finally, her application was approved, bringing Quin necessary care within the comfort of their home.

Launched in 2015, the YES Waiver aims to provide comprehensive care through a team of specialists, ensuring children can continue their education, participate in recreational activities, and remain at home. Despite its effectiveness, the program faces significant obstacles, particularly funding limitations that have led to provider shortages.

Funding Challenges

In 2023, inquiries for the YES Waiver surged by 53% compared to 2019, yet enrollments declined by 21%. This paradox can be attributed to financial constraints and low Medicaid reimbursement rates, which often pay only half of what providers receive privately.

Between 2020 and 2023, the program lost nearly 400 providers, exacerbating wait times. This trend signifies the need for higher Medicaid rates to attract more healthcare professionals and ensure continuity of care.

Jennifer Ruffcorn, a spokesperson for the Texas Health and Human Services Commission, acknowledged the ongoing efforts to expand the provider network and maximize existing slots.

Lack of Providers

Monica Reyes, a certified family partner and mental health peer specialist in Travis County, emphasized the undisputed success of the YES Waiver program, asserting an estimated $12,500 savings per child served. However, the system’s capacity cannot meet the high demand.

The YES Waiver is available statewide through 39 local mental health and behavioral health authorities and two comprehensive waiver providers. Despite its reach, waiting periods vary by region, with rural areas disproportionately affected.

Private providers often find higher returns accepting privately insured or self-paying clients, leaving few options for Medicaid recipients.

In Travis County, Reyes reported limited availability for nontraditional therapy services. The YES waitlist can extend up to six months, causing children and families to lose access to crucial support.

Mental Health Crisis

Texas has witnessed a sharp increase in mental health issues among youth. From 2005 to 2023, suicide attempts among Texas high school students climbed by 31%. In the 2021-2022 school year, 23% of Texas parents reported one or more mental, emotional, developmental, or behavioral problems in their children.

The escalating mental health crisis affects not only children but also their families, leading toruptions in work and daily life. Reyes observed more aggressive behavior in young people, including assaults on family members and school staff.

Impact on Foster Care

The insufficiency of mental health services often forces families to relinquish custody of their children to the state. In 2023, 108 Texas children entered foster care due to unavailable mental health or developmental services.

Additionally, 461 children were placed in foster care due to parents’ inability to accept responsibility for their mental health challenges. These situations often involve children returning from psychiatric hospitals or juvenile facilities, leaving parents unsure of their ability to manage the situation safely.

Some families agree to shared custody to access necessary services, with 1,493 such cases in the first eight months of the 2023 fiscal year. About 15% of these youth had unmet mental health needs.