Beyond the Waitlist: Minnesota’s Struggle to Address Children’s Mental Health Needs

As I write, thousands of Minnesota’s children urgently need mental health care. And they can’t get it. That tragic fact is the result of an issue that can be solved: across the state of Minnesota, Medicaid reimbursement rates cover only 60 percent of the actual cost of mental health care. The trickle-down effect of Medicaid’s paltry coverage creates deficits for schools, hospitals, and for nonprofit health care organizations like ours. That leads to a shortage of mental health care providers due to insufficient resources to attract and retain talent, and leaves thousands of children, and their families, on years-long waiting lists, simply hoping for care that they desperately need.  

Right now, nearly 2,000 children are waiting for services at St. David’s Center: mental health, occupational and speech therapy, and other support services. The stories we hear are too frequent and too common: parents and caregivers are scared. They’re struggling to manage behavior that can be confusing and overwhelming. Many of these families are already in situations of precarity, and with a child with emerging mental health needs, it is difficult to cope. Parents call others for help when their child’s behaviors are too challenging for their school or childcare center to manage. Parents are forced to miss work. And they are alone in the struggle, in desperate need of mental health professionals to provide support and answers. The reimbursement system must be addressed to ensure these services are available to all of Minnesota’s children.  

Ilhan, a mother of a four-year-old, told me about her experience of waiting for our services. “Of course, as a mom, you feel lost, frustrated. You need to stay calm for them. But inside, you’re destroyed. You just want to fix the situation. But you can’t. I was lost. So down inside.” For many months she needed our help. But we were inhibited from providing her child and family urgently needed care for longer than anyone should have to wait. That’s because of the impact Medicaid’s reimbursement rates have on our capacity.   

According to a 2018 University of Connecticut School of Medicine study, one in four children experience or witness trauma before the age of four, and that risk doubles for children in poverty. One in 34 Minnesota children has been identified with autism spectrum disorder, according to the Centers for Disease Control. And many of these kids, the most vulnerable among us, rely on Medicaid to support the care they need. By leaving a 40 percent deficit for organizations providing services, many are left without that care.  

Our Chief Clinical Officer told me: “The needs we’re seeing today are more intense and more complex than ever. Every day I see our team of incredibly committed care professionals provide multifaceted, responsive care tailored to the unique and complex needs of every child we serve. I see children’s lives transformed and families healed. Then I look at our bottom line. I see deep deficits across the board in our mental health services. And I look at our waitlist, and I think about the thousands of kids and families forced to wait. Mental health is just as important as physical health. And when it comes to the mental health of children, early intervention is essential, to avoid serious consequences like hospitalizations, and sometimes, tragedy.  

St. David’s Center is one of the largest community mental health agencies providing intensive early childhood mental health services in the state of Minnesota. The majority of the families we serve are living in poverty and rely on Medicaid. With the significant disparity we experience between reimbursement rates and our actual costs to provide care, it’s no wonder many community mental health agencies are closing or constricting.  

The mental health crisis in Minnesota is severe. The change needed to resolve it is clear. On January 24, 2024, The Minnesota Department of Human Services released their complex analysis and recommendations on how Medicaid rates should be set in response. Medicaid reimbursement rates for mental health care must increase. If they do, mental health care organizations will then have the resources to retain highly-trained mental health professionals, and to provide care in facilities suited to the purpose. For the thousands of children on our waitlist, increased capacity, and so increased reimbursement rates, must happen now.  

There is already bipartisan support in the Minnesota legislature to enact the Department of Human Services recommendations and increase Medicaid reimbursement rates for mental health care. All we need now is the voices of Minnesotans. Together, we can help the most vulnerable children and families among us get the care they need to survive. 

Photo: St. David’s Center CEO Julie Sjordal joins other mental health leaders at the capitol, advocating for increases in mental health reimbursement rates.