When she was in ninth grade, Fiona Lu fell into depression. She had trouble adjusting to her new high school in Orange County, California, and felt so isolated and exhausted that she cried every morning.
Lou wanted to get help, but her Medi-Cal plan wouldn’t cover the treatment unless she had permission from a parent or guardian.
Her mother—a single parent and immigrant from China—worked long hours to care for Fiona, her brother, and her grandmother. Taking the time to explain to her mom what the treatment was and why she needed it felt like too much of a hurdle.
“I wouldn’t want her to have to sign all these forms and go to therapy with me,” said Lou, now 18 and a freshman at UCLA. “There’s a lot of rhetoric in immigrant cultures that mental health concerns and getting treatment for it is a Western phenomenon.”
By her senior year of high school, Lou turned that experience into activism. She campaigned to change state policy to allow children 12 and older living in low-income households to receive mental health counseling without their parents’ consent.
In October of last year, Governor Gavin Newsom signed a new law that expands access to young patients covered by Medicaid, called Medi-Cal in California.
Teens with commercial insurance have had that benefit in the state for more than a decade. However, parents of children who were already able to access care on their own were among the most vocal opponents of Medi-Cal expanding that coverage.
Many parents took advantage of the bill to voice complaints about the control they believe the state has over their children, especially over gender identity and care.
A mother appeared on Fox News last spring calling school therapists “catechists” and saying the bill allowed them to fill children’s heads with ideas about “transsexuals” without their parents knowing.
Those arguments were then echoed on social media and at protests held across California and other parts of the country in late October.
In the California Capitol, several Republican lawmakers voted against the bill, AB 665. One of them was Assemblyman James Gallagher of Sutter County.
“If my child is having a mental health crisis, I want to know about it,” Gallagher said while debating the bill on the House floor last spring. “This wrong, and I think wrong, trend in our politics right now that continues to exclude parents from this equation and say they don’t need to be informed is wrong.”
State legislators’ salaries are too high for them or their families to qualify for Medi-Cal. Instead, they are offered a choice of 15 commercial health insurance plans, meaning kids like Gallagher’s already have the benefits he objected to in his speech.
To Lou, this was disappointing and hypocritical. He said he felt the opponents who lined up against AB 665 at the legislative hearings were mostly middle-class parents trying to disrupt the narrative.
“It’s not authentic that they were advocating against a policy that won’t directly affect them,” Lu said. “They don’t realize this is a policy that will affect hundreds of thousands of other families.”
AB 665’s sponsors pitched the bill as a common sense update to an existing law. In 2010, California lawmakers made it easier for youths to access outpatient mental health treatment and emergency shelters without their parents’ consent, removing the requirement that they be in immediate crisis.
But at the last minute, lawmakers in 2010 removed Medi-Cal’s expansion of teen coverage for cost reasons. More than a decade later, AB 665 aims to close the gap between public and private insurance and level the playing field.
“This is about fairness,” said Assemblywoman Wendy Carrillo, D-Los Angeles, who authored the bill.
The original law, which regulated private insurance plans, passed with bipartisan support and had little substantive opposition in the Legislature, he said. The law was signed by a Republican governor, Arnold Schwarzenegger.
“Since then, the extremes on both sides have gotten so extreme that it’s really hard for us to talk about the need for mental health,” he said.
After Carrillo introduced the bill last year, her office faced death threats. He said the goal of the law is not to divide families but to encourage communication between parents and children through counseling.
More than 20 other states allow young people to consent to outpatient mental health treatment without their parents’ permission, including Colorado, Ohio, Tennessee and Alabama, according to a 2015 survey by researchers at Rowan University.
For opponents of the new law, such as Erin Friday, a San Francisco Bay Area attorney, AB 665 is part of a larger campaign to end parental rights in California, which they oppose regardless of what type of health insurance a child has. children.
Friday is a self-proclaimed lifelong Democrat. But then she discovered that her teenager had come out as transgender at school and for months he had been referred to by a different name and different pronouns by teachers, unbeknownst to Friday. He dedicated himself to fighting bills he saw as promoting “transgender ideology”. He said he plans to file a lawsuit to try to overturn California’s new law before it takes effect this summer.
“We’re giving kids autonomy they should never have,” Friday said.
Under the new law, young people will be able to talk to a therapist about gender identity without their parents’ consent. But they can’t get home treatment, medication or gender-affirming surgery without their parents’ okay, as some opponents have suggested.
Nor can minors leave their homes or be emancipated under the law, as opponents have suggested.
“This law is not about inpatient psychiatric facilities. This law is not about changing child custody laws,” said Rachel Velcoff Hults, an attorney and health director of the National Youth Center, which sponsored AB 665.
“This law is about making sure that when a young person needs counseling or needs a temporary roof over their head to ensure their own safety and well-being, we want to make sure they have a way to access it,” he said.
Eliminating the parental consent requirement could also expand the number of California mental health practitioners willing to treat youth on Medi-Cal. Without parental consent, under the old rules, clinicians could not be paid by Medi-Cal for the counseling they provided, whether in a private practice or a school counselor’s office.
Esther Lau struggled with mental health as a high school student in Fremont. Unlike Lou, she had the support of her parents, but couldn’t find a therapist who accepted Medi-Cal. As the only native English speaker in her family, she had to navigate the healthcare bureaucracy on her own.
To her, AB 665 will incentivize clinicians to accept more youth from low-income households in their practices.
“For the opposition, it’s just political tactics and promoting their agenda,” Lau said. “The bill was designed to expand access to youth Medi-Cal, period.”
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