Behavioral Health Integration in Medi-Cal: A Blueprint for California

People with behavioral health conditions — that is, mental illness and/or substance use disorder — often experience poor health overall. They are less likely to receive preventive care, have higher rates of major chronic illnesses, and often experience a lower quality of care for their physical health needs. Those with a diagnosis of serious mental illness or substance use disorder die on average over 20 years earlier than those without such a diagnosis, often from preventable physical illnesses.

In the face of these health needs, people who receive their health insurance through Medi-Cal and have complex behavioral and physical health issues face a fragmented system that is challenging to navigate. They often fail to receive all the care they need. Behavioral Health Integration in Medi-Cal: A Blueprint for California (PDF) provides recommendations to build an integrated system of care in Medi-Cal — one that brings together physical health, mental health, and substance use services to treat the whole person.

The goal of this integrated system of care is that by 2025, all Medi-Cal enrollees will experience high-quality, integrated care for physical health, mental health, and substance use needs, with all of a person’s care managed by a single entity accountable for payment, administration, and oversight. A companion At a Glance (PDF) document summarizes the current fragmented system and the desired integrated system of care. (If printing, please use 11″×17″ paper.)

The recommendations to achieve this goal were developed over the last year by a group of California health leaders with deep experience in county behavioral health departments, behavioral health provider organizations, state agencies, Medi-Cal managed care plans, consumer advocacy, policy research, and philanthropy. These recommendations are:

• Assign responsibility for physical and behavioral health services to Medi-Cal managed care plans, while allowing delegation to interested counties and/or regions to the extent that such partnerships meet a single statewide standard for integration, quality of care, and accountability.
• Implement statewide integrated care for Medi-Cal enrollees through a phased process beginning in 2020 and completed by 2025, to foster a transition that ensures continuity of care and promotes long-term sustainability.
• Ensure that accountable entities develop the internal capacity, expertise, and infrastructure required to effectively manage integrated physical and behavioral health care.
• Identify immediate and long-term opportunities to reform existing state and local behavioral health funding mechanisms, statutes, regulations, and other policies to promote the delivery of integrated care.
• Incorporate principles of risk and value-based payment into the financing of behavioral health services to align incentives with desired outcomes.
• Engage stakeholders to ensure that accountable entities are responsive to individual and community needs, and that the new system of integrated care delivers on the promise of improved individual and family outcomes.
• Foster integrated physical and behavioral health care for dual-eligible enrollees by promoting the alignment of Medicare and Medi-Cal benefits in accountable entities.
• Establish standard process and outcome measures and accountable, transparent systems to monitor and evaluate the ongoing impact of integration across the state.
• Strengthen the behavioral health workforce to ensure access to high-quality care during and after the transition to integrated care.