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Focus on CalAIM

Behavioral Health

Many of CalAIM's programs are designed to improve care and services for people living with behavioral health needs, like mental illness and substance use disorder.
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The Medi-Cal behavioral health system today is highly fragmented. Medi-Cal enrollees must navigate three separate systems of care. They get care for serious mental health issues, such as schizophrenia, from one county agency. They are treated for substance use disorders, like alcoholism, often from a different county agency. And they receive treatment for mild-to-moderate mental health conditions, along with any physical conditions like diabetes, through their managed care plan. These divisions, and the different rules for payment and documentation surrounding them, make it difficult for patients to find the care they need, and for providers to respond in a patient-centered way.

CalAIM offers an opportunity to create a more cohesive and integrated behavioral health care system overall. CalAIM strives to improve Medi-Cal’s behavioral health system in the following ways:

  • Clarifying the division of responsibility for mental health services between managed care plans and county mental health plans and smoothing payment to ensure that patients can get treatment wherever they seek care — even before they receive a formal diagnosis
  • Providing high-touch care coordination for people with serious mental illness or substance use disorder through CalAIM’s Enhanced Care Management benefit
  • Introducing a reimbursement system for behavioral health services based on the type of care provided, rather than the cost of the care, similar to reimbursement in the physical health system
  • Streamlining clinical documentation requirements for specialty mental health and substance use disorder treatment services, with the goal of reducing administrative burden and supporting clinicians to focus more on patient care
  • Facilitating the integration of specialty mental health and substance use services at the county level into one behavioral health managed care program
  • Introducing a new benefit — contingency management — for people with stimulant use disorder
Publication

In Their Own Words: How Fragmented Care Harms People with Both Mental Illness and Substance Use Disorder

August 2021
Susan Anthony, Rebecca Catterson, Suzanne Campanella
Behavioral Health, Homelessness & Health Care
CHCF commissioned interviews with 54 people enrolled in Medi-Cal who are dually diagnosed with mental illness and substance use disorder. The paper and accompanying videos highlight what is working — and not working — for them in the health care system.
Publication

Voluntary Behavioral Health Integration in Medi-Cal: What Can Be Achieved Under Current Law

October 2019
Anil Shankar, Diane Ung
Behavioral Health, Medi-Cal
This paper was prepared by two attorneys with extensive experience in structuring Medicaid financing for safety-net providers. It explores different contracting structures through which a county could lead efforts to create opportunities for integration of physical and behavioral health care.
Publication

How California Can Build on CalAIM to Better Integrate Physical and Behavioral Health Care

March 2022
Logan Kelly
Behavioral Health
This analysis reviews CalAIM behavioral health initiatives, looks at programs from other states, and finds additional opportunities for California to advance integration in Medi-Cal.
Publication

Medi-Cal Behavioral Health Services: Demand Exceeds Supply Despite Expansions

September 2021
Blue Sky Consulting Group
Behavioral Health, Medi-Cal
This paper is the second of two cross-site analyses drawn on insights from the seven publications in the 2020 Regional Market Report series. It explores factors contributing to behavioral health access issues, including workforce shortages and the complexity of the Medi-Cal system for behavioral health services. It also highlights efforts to improve and integrate services to Medi-Cal enrollees.
Project

Drug Medi-Cal Organized Delivery System

Behavioral Health, Medi-Cal
In Medi-Cal, treatment for patients with substance use disorder has long been run out of a separate program. Now California is implementing a broad move to modernize this system of care.
Publication

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

February 2019
Logan Kelly, Allison Hamblin, Stephen Kaplan
Behavioral Health
People in Medi-Cal with complex behavioral and physical health needs face a fragmented system that is challenging to navigate. This paper offers recommendations to build an integrated system of care in Medi-Cal, bringing together physical health, mental health, and substance use services to treat the whole person.
Publication

Expanding Substance Use Care: Health Plan Teams Up with Seven California Counties

March 2022
Matthew Newman
Behavioral Health
In this regional Drug Medi-Cal Organized Delivery System program, the counties provide financial resources, and Partnership HealthPlan of California administers the program.
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