About three years ago, a Southern California resident we'll call Jane —we’re not using her real name because of a pending trial and security concerns— and her husband found out their child had been assaulted.
“Your world is rocked. We couldn’t sleep for weeks, as parents. I couldn’t leave the house for 12 months,” Jane said.
The couple sought therapy. With the help of a local non-profit that specializes in helping with extreme trauma, they found mental health services for their child as well. In the months that followed, they saw major improvement in their child’s well-being, who was initially silent about the attack.
“It’s absolutely everything to get into those services and to find the right people,” Jane said. “There’s enough angst and fear without even having to think about how much it costs.”
Therapy sessions were covered through a program administered by the California Victims Compensation Board (CalVCB), which reimburses crime-related mental health expenses with dollars that come in through restitution from perpetrators and federal grants. Crimes covered by CalVCB include child sexual assault, murder and domestic violence.
Or at least Jane said she thought they were all covered. She said that more than two years after the fact, CalVCB told them some of the reimbursements might not have been valid since they have insurance.
The back and forth between Jane’s insurance company and CalVCB has come at a time when she and her family are still trying to recover.
“You should be able to trust the process to an extent and that process seems to be — from their side — a bit broken,” Jane said.
Several mental health treatment providers who spoke with LAist agree with Jane. For them, process changes and ongoing bureaucratic slowness with CalVCB has made serving crime victims more difficult than ever.
Dr. George Meza of Meza Mental Health Services in Lawndale said he was denied reimbursement for roughly $20,000 in mental health services that his clinic provided to dozens of clients up front.
Technically, it’s the victims’ responsibility to pay when CalVCB doesn’t, but Meza says he won’t try to collect.
“It would be inhuman to talk to somebody whose child had been murdered, that you had provided services on an emergency basis to, to then go back and say ‘you now have to pay us for these services,’” Meza said.
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The bulk of those denials came because therapists in his clinic saw patients who were in immediate crisis and needed help before a special identification number was issued for them, Meza said, a process that’s currently taking about 45 days in part because of staffing issues at CalVCB. Some claims were denied because clients had private insurance. CalVCB is a payor of last resort.
Attorney Micheal Siegel, who specializes in administrative law and is often paid by the state to represent clients who are victims of crime, pointed to a recent process change as part of the problem. A rule adopted last year requires providers to submit part of a treatment plan before the fourth session, or else reimbursement for all sessions up to then could be denied.
Siegel said he believes this change amounts to what’s known as an underground regulation, which has contributed to reimbursement denials.
“I’ve heard my agencies say ‘we might not be able to continue this,’ because we are owed $15-, $20-, $30-, $40,000,” Siegel remarked.
Those stalled or denied reimbursements can have a big impact on providers, which often continue paying their therapists counting on recouping the funds later.
“And if they don’t, then what? Then they are in the hole,” Siegel said.
It would be inhuman to talk to somebody whose child had been murdered, that you had provided services on an emergency basis to, to then go back and say ‘you now have to pay us for these services.’”
Meza, who started working with CalVCB around 2003, said helping victims of violent crime felt like a personal calling: he lost two cousins to gang violence. But due in part to the guideline changes and resulting financial loss, Meza said he can’t treat victims of crime through the state program anymore.
“In a provider forum, it was like, ‘Well, you can have the client appeal.’ Excuse me, our client was raped. Do you think that we want to go to her and do you think we want to send her a bill? And most of these people are barely struggling to eat,” Meza exclaimed.
Siegel said he’s particularly worried about how the policy changes might affect L.A.’s Spanish-speaking population if agencies stop accepting CalVCB clients.
“There’s a lot of therapists out there, but they don’t all speak Spanish, so there’s even a smaller group of agencies that are available currently for this population who will have no access or limited access,” he said. “That will create a dire situation for them.”
According to CalVCB, about 2,500 fewer claimants received mental health payments this fiscal year compared to last year. That equates to more than $5 million less spent on mental health services.
Vincent Walker, deputy executive officer of the Victim Compensation Program, said it’s unfortunate to hear about Meza’s frustrations and he’s aware of others with similar complaints.
“But we have a fund to administer. We have to go through specific audits and justify why we’re administering the funds in the way that we are,” Walker said, adding that, in the past, his agency would see providers completing dozens of sessions before a bill was issued.
Walker said CalVCB has been collecting data on challenges the guidelines have created and the goal is to revise the process based on feedback.
As for last year’s changes to provider guidelines, a CalVCB spokesperson said: “We alerted mental health providers in August 2021 to the upcoming changes, and we conducted online several trainings about the changes as well.”
Dr. Cathia Walters, a licensed clinical psychologist, said how survivors of violent crime recover psychologically is based on many factors, including personal resiliency and history of traumatic experiences. Sometimes, survivors can heal without the help of treatment like therapy.
But that’s not always the case, Walters said, and sometimes not getting treatment can be devastating.
“Oftentimes you see people with a history of trauma — behaviorally what we see — is substance abuse, addictions,” Walters said.
A few years ago, Walters herself accepted CalVCB clients, but she stopped in part because the work she had to put in collecting funds became too much.
“We are seeing more and more and more people everyday who are needing support — wanting support — and yet the places that are supposed to be providing this support are the ones who are saying ‘Oh well, we’re not going to pay you guys what you’re worth,’” Walters said.
If I were solely focused on the business aspect of this, I could tell you their names who would be dead right now if I waited for the money.
While CalVCB looks at possible changes to the process, Martha Wade, executive director of Orange County trauma recovery center A Quarter Blue, said her agency is out roughly $20,000 in reimbursements.
“If I were solely focused on the business aspect of this, I could tell you their names who would be dead right now if I waited for the money,” Wade said.
For Wade, the issues with CalVCB are indicative of a larger mental health care system that is failing to find parity with overall health care. Wade said she understands that CalVCB is a payor of last resort. “But in today’s society, a victim of crime is not going to get the help they need if they are a Kaiser patient,” Wade said.
Some 2,000 Kaiser mental health workers have been on strike for more than three weeks, calling on the company to address therapist burnout and long wait times for patients, among other concerns.
In 2013, the state fined Kaiser Permanente $4 million for failing to provide timely access to mental health care. The insurer has been cited two times since then for not fixing the problem.
A survivor of sexual assault as a child, Wade said she knows what can happen when survivors don’t get the mental health help they need.
“They stay stuck. They stay ill. And these systems are in place to help people but it’s not happening,” Wade said.
For now, Wade said she took out a line of credit against her inheritance to keep her doors open.
Stefanie Ritoper contributed reporting to this story.
KPCC and LAist are part of the Mental Health Parity Collaborative, a group of newsrooms that are covering challenges and solutions to accessing mental health care in the U.S. The partners on this project include The Carter Center, The Center for Public Integrity, and newsrooms in Arizona, California, Georgia, Illinois, Pennsylvania, and Texas.
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