Minnesota kids forced to cross the country for mental health help

Mollie Meyer remembers when the search for a mental health treatment facility that would accept her then 10-year-old daughter got farther from home.

No place in Minnesota could take her. A Wisconsin center didn’t have the trauma-focused care she needed. Illinois and Missouri options wouldn’t accept her because of a low IQ score. Eventually, county workers found Justice Resource Institute outside of Boston.

“Just the emotional toll on her is really hard,” Meyer, who lives in Nicollet County, said of the year her daughter spent in Massachusetts. “When she’s sick or having a hard day, you can’t be there to comfort her.”

Every year, Minnesota kids with complicated behavioral and mental health challenges are placed in facilities out of state because they cannot get the treatment they need here. Other states are running into the same problem.

Some Minnesota children are taken more than 1,000 miles away from their family and community to states such as Texas, Florida, Utah and Massachusetts. The travel and distance is traumatic and expensive, families and county staff said. Sometimes a family can afford monthly visits. Many others can’t.

Minnesota children are sent to facilities outside the state for several reasons. Some, like Meyer’s daughter, are placed in residential treatment centers. Others are brought to group homes or corrections institutions. A survey of local child welfare agencies showed that the number of kids placed in facilities outside Minnesota has dropped in recent years, but the state does not have a comprehensive system to track placements.

Meanwhile, county officials working with children and families said they are seeing more kids with complex mental health challenges. They said finding appropriate places to serve those high-need children has become increasingly difficult and expensive, and they are having to look farther away for care.

“Out-of-state placement happened in the past. It was sporadic and it was maybe some of our bordering states,” said Nicollet County Health and Human Services Director Cassandra Sassenberg, who’s part of a 10-county group in south central Minnesota examining the issue. “But flying across the country, and not being able to find anything, has been very new for this region.”

For a child whom Stearns County recently placed out of state, case workers checked with 302 facilities before they found one that could take the kid, said Nicholas Henderson, the county’s human services director.

A county employee needs to fill out an intake packet that can be up to 45 pages just to get a child on a facility’s waitlist, he said.

“We’re talking 302 packets,” Henderson said. “Each packet, I would say, takes at minimum 30 minutes.”

There’s no comprehensive way to search availability at residential treatment facilities, even within Minnesota. Whether a place will accept a child often depends on a kid’s needs and the facility’s current population and staffing limits.

Families that hunted for places on their own said the process can be confusing and scattershot. Parents sometimes hire navigators to help them search, but said that help can come with a steep cost.

Some families have private insurance that covers some treatment costs. But county officials say the majority of kids they work with are on Medical Assistance, the state’s Medicaid program. To bill Medical Assistance, the provider needs to be certified by state government, which involves a fee and inspection by Minnesota officials. Only three out-of-state youth residential treatment programs are certified. One is in Wisconsin, two are in South Dakota.

“Providers don’t often go through the whole process for one youth,” Hennepin County Behavioral Health Director Leah Kaiser said. “It doesn’t make sense to them. And so the county ends up paying the cost of that young person’s care in the out-of-state program.”

When a child is placed out-of-state in Stearns County, their finance staff said it costs county taxpayers, on average, roughly $750 a day.

Counties paid, on average, $95,000 for each child in out-of-state residential treatment between 2018 and 2022, according to a Department of Human Services survey. That estimated cost doesn’t factor in potential Medicaid reimbursements.

Once a month, county officials said case workers have to drive or fly to visit children. They said that travel, and the time-consuming search for appropriate treatment facilities, leave less time for other kids on the worker’s caseload.

Having family members participate in a child’s treatment and maintaining their connection is critical, mental health advocates said. But doing so can be difficult when a child is hundreds of miles away.

With the help of an online fundraiser and a flexible employer, Meyer was able to visit her daughter about once a month during the year she spent in Massachusetts. Each visit ended with heartache as she left her child halfway across the country.

The number of residential treatment beds in Minnesota has shrunk, and the facilities that do exist struggle to find enough staff to operate at full capacity. Treatment providers said they must determine whether they can adequately handle each child’s particular needs and balance those with other kids in their care.

Kids who cannot find timely placement in Minnesota’s residential mental health treatment facilities often also have an intellectual disability, aggressive or sexually problematic behaviors or a physical health condition, county workers said.

Stories of children stuck in emergency rooms and juvenile detention centers have put a spotlight on Minnesota’s lack of residential treatment beds. But county officials, state lawmakers and child welfare advocates also stressed the need for more preventative resources to help kids stay in their homes and services to keep them stable after they leave a treatment center.

Minnesota has an array of intensive community-based and residential services for youth with high needs, DHS said in a statement. The agency said it continues to identify and respond to gaps and accessibility issues, which could be due to workforce shortages, low Medical Assistance reimbursement rates and a lack of uniform access to services statewide.

“There is a growing need to address systemic challenges impacting children’s intensive behavioral health services and the lack of treatment options within Minnesota,” DHS Assistant Commissioner Teresa Steinmetz said in a statement. “It takes every member of the system – the state, counties, Tribes, providers and community partners – working collaboratively to alleviate these challenges.”

The day a child leaves a facility, services should be in place to help them live at home, such as an individualized education program, respite services for the family and a youth behavioral health worker and therapist, said Rep. Kim Hicks, DFL-Rochester, who is also a DHS employee.

Without those, she said the outcome is: “Go to facility, come home, fail. Go to a facility, come home, fail.”

“You cannot just go from an institution to just, ‘You’re fine at home with weekly therapy, right?’” Hicks said. “But that is what we are doing to families over and over and over again.”

Families often don’t know how to access help, she said, and hurdles and long wait times prevent people from getting a Medicaid waiver to cover disability services when they need them most.

Minnesota uses a State Medical Review Team and MnChoices assessments to determine whether someone is eligible for such support. It takes nine months to get a review team to certify someone as disabled, and DHS can’t do a MnCHOICES assessment until a kid is back in Minnesota, Hicks said.

On a recent evening, Meyer and her daughter baked pumpkin bread and played a spinoff of Uno, leaning into each other and giggling as the girl made up new rules on the fly. That afternoon they had toured a potential new home. With rising health care costs and bills, Meyer said they need to downsize.

The year Meyer’s daughter spent in residential treatment in Massachusetts helped her stabilize, but that stability didn’t last long. She had to be repeatedly hospitalized this spring and was forced to leave the hospital before she was ready because her insurance wouldn’t cover a longer stay, Meyer said.

Her daughter is on waitlists for several residential treatment facilities in Minnesota. As they wait for a place to let her in, Meyer said they are not getting therapy services at home.

“What it comes down to is a kiddo with complex trauma who needs a higher level of care,” she said. “And as a state we’re not able to provide it.”