Of more than 30 recommendations a state council developed for the Texas Legislature on improving children's behavioral health, lawmakers made progress on eight, according to a recent report.
The Statewide Behavioral Health Coordinating Council released the Children's Behavioral Health Strategic Plan in December 2024. Texans Care for Children, an advocacy organization, found that lawmakers took steps last year to partially or fully implement less than a third of the recommendations in the plan.
"We know that six percent of Texas youth are entering the foster care system due to unmet mental health services or care," said Muna Javaid, senior policy associate for child protection with Texans Care for Children. "To avoid institutionalization or youth entering the juvenile justice system or the foster system, the more that we support and fund these community-based services, the less likely that that will be the outcome."
Javaid said one of the most concerning issues the report found was related to funding for the Youth Empowerment Services, or YES, waiver – a Medicaid program designed to help Texas "children and youth with serious mental, emotional and behavioral difficulties." YES waiver services are meant to keep children in their homes and communities, instead of an institutional setting like a residential treatment center or inpatient facility.
Among other things, the 2024 strategic plan recommended giving the Texas Health and Human Services Commission funding to increase rates for the YES waiver program and address administrative barriers. Instead, Javaid said, the legislature cut $1.3 million from the YES waiver.
"[The lost funding] is significant because we know that there has been a sharp increase in families that are asking for YES waiver services," she said.
Despite rising demand, the Texans Care for Children report said the number of kids served in the program is falling. Inquiries increased 43% between 2021 and 2023. But, during the same period, the number of children enrolled decreased by almost 20%. Nearly 900 children were left waiting for services.
In addition, the waiver lost almost 400 providers between 2020 and 2023.
"Those numbers are continuing to decline and that is partly due to financial challenges [and] low funding levels," Javaid said. "The program could help more youth, but there just aren't enough providers to deliver the services."
Javaid said advocates are hopeful reinstating and increasing YES waiver funding will be a priority for the legislature in 2027, despite not being one in 2025.
"The [2024 strategic plan] was released a month before the legislative session began, so maybe it left limited time for legislators to really fully digested and translated into policy," Javaid said. "There was also uncertainty around Medicaid policy at the federal level, so it may have created some hesitation to commit to long-term investments. But ultimately, we'd love to see ...that funding cut reinstated next session."
The report did call for further action in other areas, but Javaid said there were some good things to highlight from the 2025 legislative session.
For example, the legislature invested an additional $40 million for mobile youth crisis outreach teams.
"It's just been wonderful with the eight teams that we've had, but this session, they basically doubled that number," Javaid said. "Now, we have 16 youth crisis outreach teams, which is a huge step forward."
She also said the legislature invested $32.7 million in what's known as "multi-systemic therapy" – an internationally recognized type of therapy for children at risk of entering the juvenile justice system due to serious behavioral problems.
"It's really cost effective. It's a great intervention," Javaid said. "That investment is going to go a long way."
However, that funding only partially fulfilled the recommendation from the 2024 strategic plan.
"We have 23 multi-systemic therapy teams in Texas now, which is really exciting," Javaid said. "To meet the demand statewide would require 140 teams."
Javaid said there is still a lot more support and work needed even in areas where there were significant investments from the Texas Legislature.
She also said while many recommendations required legislative action and funding, some recommendations could be addressed through administrative action. Lawmakers filed bills related to several of the recommendations, but the measures ultimately failed.
The Texans Care for Children report identified several other areas that were missed during the 2025 legislative session – including Medicaid coverage for community-based services, strengthening the behavioral health workforce and making crisis services available 24/7.
"A lot of these recommendations are about some of those more intensive mental health services," Javaid said. "We know that Texas parents are desperately looking for services to help their children get healthy, go to school, sleep in their own beds at night instead of entering psychiatric hospitals."
Abigail Ruhman is KERA's health reporter. Got a tip? Email Abigail at aruhman@kera.org.
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