Nidia Heston always envisioned a hopeful future for her son, Quin, but she encountered an unexpected obstacle when his school refused to promote him to the eighth grade without a comprehensive mental health assessment. At Dell’s Children’s Medical Center, specialists informed her that Quin’s severe suicidal thoughts required immediate action, recommending he be admitted to either a state hospital or a residential treatment center. Entering such facilities would necessitate Heston ceding custody and care of Quin to the state for an indefinite period, a decision she was unwilling to entertain.
Determined not to part with her son, Heston promptly sought enrollment in an intensive state mental health program that would allow Quin to receive outpatient treatment either at home or in local offices. After a month of vigilantly watching over Quin—sleeping on the couch to ensure his safety—she finally received approval to join the program. “I could finally surrender myself to help,” she expressed.
Both Heston and Quin, who has been diagnosed with bipolar disorder, autism, and ADHD, are among numerous families benefiting from the Youth Empowerment Services (YES) Waiver, a vital mental health service tailored for families that lack the means for long-term psychiatric care or prefer treatment within their community. Presently, the program supports around 2,200 children, but it urgently requires more funding as many providers are withdrawing due to inadequate Medicaid reimbursement rates. On any given day, nearly 900 families are waiting for access to this essential mental health service.
Launched in 2015, the YES program assigns each family a team of local specialists who provide a diverse array of behavioral health and nontraditional services, encompassing adaptive support, specialized therapies, and minor home modifications. Its popularity stems from its capacity to enable children to continue attending school, participate in sports, and remain with their families. Many families, unable to secure necessary mental health services, have resorted to relinquishing partial or full custody to the state, thereby straining an already overburdened foster care system.
In 2023, 3,109 children sought evaluations for the YES program, marking a 53% increase since 2019. Yet, despite the growing demand, the number of children served has visibly decreased, with only 2,227 enrolled in 2023—down 21% from the 2,826 who received help in 2019. A report by the Texas Statewide Behavioral Health Coordinating Council highlighted that stagnant Medicaid reimbursement rates have caused the loss of 386 YES providers between 2020 and 2023. Consequently, varying wait times for the YES services are being experienced across counties, particularly affecting rural regions.
Jennifer Ruffcorn, a spokesperson for Texas Health and Human Services Commission, stated, “HHSC continues to work to expand the provider base and maximize utilization of existing YES Waiver slots as a statewide service.”
Concerns about the dwindling number of providers have been echoed by professionals such as Monica Reyes, a certified family partner and mental health peer specialist in Travis County. She has successfully helped over 100 families secure approval for the YES program, asserting that its effectiveness is proven, with the state reportedly saving approximately $12,500 for each child served. In 2023, the program assisted 2,575 children, with 95% of those aging out either transitioning to other services or graduating with a plan for ongoing care. Accessible statewide through all 39 local mental health and behavioral health authorities and two comprehensive waiver providers, the YES Waiver’s services are critically demanded. However, the infrastructure is strained and cannot adequately address the rising need, particularly as providers prioritize private insurance or self-pay clients over Medicaid patients.
Reyes shared that in Travis County, the YES program has a mere two providers for nontraditional therapy services and eight for conventional therapeutic services, resulting in waitlists spanning at least six months. This long wait exacerbates existing issues, as families may lose hope and children may fall through the cracks by the time they are able to access treatment.
Statistics show a significant rise in distress, hopelessness, suicidal thoughts, and attempts among Texas children. From 2005 to 2023, high school students reporting suicide attempts rose by 31%. A survey conducted during the 2021-2022 school year revealed that 23% of parents identified mental, emotional, developmental, or behavioral issues in their children. “It’s getting worse for sure,” Reyes observed, highlighting an increase in aggression among youth and more reported assaults on family and school staff.
Many families are trapped in a cycle of inadequate mental health support, often feeling compelled to relinquish or share custody with the state in desperate attempts to obtain necessary services. In 2023, 108 children entered Texas foster care because adequate mental health or developmental services were unavailable, according to data from the Texas Department of Family and Protective Services. Furthermore, 461 children were placed in foster care due to “refusal to accept parental responsibility,” often linked to mental health or behavioral challenges.
Typically, these cases involve children who were in psychiatric or juvenile justice facilities but were not picked up by their parents, possibly due to fears of being unable to care for them or concerns about safety. Other parents voluntarily share custody with the state to access mental health services, with records showing 1,493 such agreements in the first eight months of FY 2023—about 15% of whom faced unmet mental health needs.
“Many of these families don’t have a choice,” Reyes noted, explaining how caregivers often lose their jobs because of frequent school incidents or court hearings related to truancy. The ramifications can extend further, as children in foster care may not receive proper treatment and could be placed in unregulated environments, which can exacerbate their conditions.
The YES program was explicitly designed to combat these issues. “We need more providers, and to achieve this, Medicaid will have to increase its payment rates,” Reyes asserted.
Quin Heston’s life before entering the YES program in January 2016 was characterized by an acute emotional struggle that he found difficult to articulate. He often felt alienated in special education at school and struggled with authority figures, frequently feeling the urge to escape. Everything changed when he began intensive treatment through the YES program. Utilizing art therapy, he discovered a healthy way to articulate his feelings, while his new therapist helped him develop effective coping strategies. Nearly a year later, he transitioned to a program that would support his mental health needs for life, feeling reborn.
Reflecting on his experience, Quin, now 22, remarked, “I think the one thing I regret is not noticing it. I didn’t feel right. I didn’t feel safe. But now I do.” Today, he works at Greenleaf Neurodiversity Community Center, where he assists individuals with autism and other neurodivergent conditions in building friendships, social skills, and workplace readiness. His personal journey has ignited a passion for advocating for the YES program and other initiatives aimed at supporting individuals facing disabilities and mental health challenges.
“I think lawmakers should recognize that this need is growing and that it isn’t something that will simply disappear. Programs like the YES Waiver won’t cure mental illness, but they offer critical help,” he explained. Despite bipartisan support for proposed funding increases for the YES program during the 2023 legislative session, the initiative ultimately did not pass.
As the urgency for enhanced mental health services escalates, advocacy groups and health organizations are rallying for improvements in the YES program. The National Alliance on Mental Illness in Texas, Texans Care for Children, and the Statewide Behavioral Health Coordinating Council have advocated for additional funding in the state budget, requesting a total of $61.9 million for 2026 and 2027 to enhance essential services, including the YES program. However, it remains uncertain whether this funding will go toward increasing reimbursement rates for YES providers.
Another proposed remedy to enhance access to mental health services for young people is to ensure that Medicaid covers crisis intervention, intensive outpatient care, partial hospitalization, and home-based services. “I believe many families are interested in this type of support but may not know how to begin,” Quin Heston stated. “(My mother) showed me how complicated the navigation of the mental health system could be. More families should be informed about services available for both developmental challenges and mental health issues.”
