JUNE 2023 Medi-Cal Explained FACT SHEET Medi-Cal Explained: The specialty behavioral health system, operated by county governments (typically through county Administration of behavioral health departments or the equivalent), Non-Specialty Mental is responsible for providing "specialty" mental health and almost all substance use disorder (SUD) Health Services services. The range of specialty mental health ser- vices is much broader than NSMHS and includes Author: Ralph Silber crisis intervention and stabilization, day treatment, residential and inpatient treatment, medication In California, nearly all people insured through support, and psychiatric services, among many Medi-Cal are enrolled in a managed care plan. others. Populations that may use specialty behav- Medi-Cal managed care plans are responsible for ioral health services include adults who experience physical health care services and a limited set of significant distress or impairment due to their mental health services for children and adults.1 For mental health conditions, children or youth whose example, an adult with a mild or moderate depres- needs may be more complex because of their con- sion or anxiety diagnosis would receive treatment ditions or life circumstances, and people of all ages services through their managed care plan. These who need specialty SUD treatment.2 are known as "non-specialty mental health ser- Medi-Cal has implemented a "No Wrong Door vices" or NSMHS. NSMHS services include: Policy" for behavioral health services. This policy is ● Mental health evaluation and treatment, designed to ensure that Medi-Cal enrollees receive including individual, group, and family timely behavioral health services regardless of psychotherapy whether they initially seek care through the specialty ● Psychological and neuropsychological testing, when clinically indicated to evaluate a mental health condition The California Health Care Foundation is an independent, nonprofit philanthropy that works ● Outpatient services for the purposes of moni- to improve the health care system so that all toring drug therapy Californians have the care they need. We focus ● Psychiatric consultation especially on making sure the system works for ● Outpatient laboratory, drugs, supplies, and Californians with low incomes and for communi- supplements ties who have traditionally faced the greatest barriers to care. NSMHS also include some new and expanded We partner with leaders across services such as dyadic services for families (pre- the health care safety net to ventive behavioral health services for youth and/ ensure they have the data and or their caregivers), family therapy, and psychiatric resources to make care more collaborative care management (a team-based just and to drive improvement model for treating anxiety and depression). in a complex system. For more information, visit www.chcf.org. California Health Care Foundation www.chcf.org | 1 JUNE 2023 or non-specialty delivery system. The policy aims to ● Through contracts with specialized behavioral maintain continuity of care for recipients and allows health care plans, which maintain networks of for the possibility that an individual might receive behavioral health providers to deliver these ser- care simultaneously through both the specialty and vices for the plans' members. The two behav- non-specialty mental health delivery systems.3 ioral health care plans used by Medi-Cal man- aged care plans are Carelon Behavioral Health Medi-Cal managed care plans cover NSMHS in and MHN. one of two ways: Table 1 lists all the 2024 Medi-Cal managed care ● "In-house," wherein the plans contract directly plans and indicates how they cover NSMHS. with behavioral care providers and manage all aspects of providing NSMHS to their members Table 1. 2024 Medi-Cal Managed Care Plans and Their Arrangements for Non-Specialty Mental Health Services 2024 Medi-Cal Managed Care Plan NSMHS Arrangement Alameda Alliance for Health In-House Anthem Blue Cross Carelon Behavioral Health Blue Shield of California Promise Health Plan In-House CalOptima In-House CalViva Health MHN CenCal Health In-House Central California Alliance for Health Carelon Behavioral Health Community Health Group In-House Community Health Plan of Imperial Valley MHN Contra Costa Health Plan In-House Gold Coast Health Plan Carelon Behavioral Health Health Plan of San Joaquin Carelon Behavioral Health Health Plan of San Mateo In-House Health Net MHN Inland Empire Health Plan In-House Kaiser Permanente In-House Kern Health Systems In-House L.A. Care Health Plan Carelon Behavioral Health Molina Healthcare In-House Partnership Health Plan Carelon Behavioral Health San Francisco Health Plan Carelon Behavioral Health Santa Clara Family Health Plan In-House Source: Author's review and analysis of 2023 DHCS Medi-Cal documents and interviews with Medi-Cal managed care key informants. California Health Care Foundation www.chcf.org | 2 JUNE 2023 Endnotes About the Author 1. California Department of Health Care Services, "All Ralph Silber, MPH, is an independent consultant Plan Letter 22-006: Medi-Cal Managed Care Plan Responsibilities for Non-Specialty Mental Health with more than forty years of experience in the Services," April 8, 2022. community health center movement and an affiliate 2. California Department of Health Care Services, with El Cambio Consulting. He previously served "Behavioral Health Information Notice (BHIN) No: 21-073: as the CEO of the Alameda Health Consortium Criteria for Beneficiary Access to Specialty Mental Health and the Community Health Center Network, a Services (SMHS), Medical Necessity and Other Coverage Requirements," December 10, 2021. Medi-Cal managed care organization. 3. California Department of Health Care Services, El Cambio Consulting provides strategic guidance, "Behavioral Health Information Notice 22-011: No Wrong Door for Mental Health Services Policy," March 31, 2022. analysis, and management consulting to safety net health care organizations in California that are rooted in their communities and committed to improving health outcomes through persever- ance and innovation. This includes community health centers, county public health agencies and departments, Medi-Cal managed care plans, social service providers and the foundations and associa- tions that support their work. Medi-Cal Explained is an ongoing series on Medi-Cal for those who are new to the program, as well as those who need a refresher. To see other publications in this series, visit www.chcf.org/MC-explained. California Health Care Foundation www.chcf.org | 3