Medi-Cal Behavioral Health - Policy Division
Medi-Cal Behavioral Health – Policy Division (MCBH-PD) oversees the policy and program areas of the Specialty Mental Health Services, Drug Medi-Cal (DMC), and Drug Medi-Cal Organized Delivery System (DMC-ODS) programs. Specifically, MCBH-PD oversees State Plan Amendments for county behavioral health plans; behavioral health CalAIM development and implementation activities, including for Peer Support Services, No Wrong Door, Documentation Redesign, Behavioral Health Administrative Integration, and Screening and Transition of Care Tools; 988; the Mobile Crisis Services benefit; Community Assistance, Recovery, and Empowerment (CARE) Act; the California Behavioral Health Community-Based Continuum (CalBH-CBC) Demonstration waiver; Recovery Incentives Program; Family First Prevention Services Act; and Complex Care cases.
Behavioral Health Innovation Branch
The Behavioral Health Innovation Branch (BHIB), within the Medi-Cal Behavioral Health Policy Division (MCBH-PD), administers a wide variety of innovative behavioral health initiatives designed to support California's most vulnerable populations and enhance the behavioral health continuum of care. BHIB oversees State and Federal funded efforts such as the Community Assistance, Recovery, and Empowerment (CARE) Act, the California Behavioral Health Community-Based Continuum (CalBH-CBC) Demonstration, and the California Advancing and Innovating Medi-Cal (CalAIM) Justice-Involved Initiative, among others.
Care Section
The CARE Act is a new compassionate civil court process to deliver community-based behavioral health services and supports to Californians living with untreated schizophrenia spectrum or other psychotic disorders. CARE is intended to serve as an upstream intervention for the most severely impaired Californians to prevent avoidable psychiatric hospitalizations, incarceration, and Lanterman-Petris-Short Mental Health Conservatorship. CARE connects a person in crisis with a court-ordered care plan for up to 12 months, with the possibility to extend for an additional 12 months. If a participant cannot successfully complete a CARE plan, the Court may utilize existing authority under current law to ensure the participants safety.
DHCS will provide training and technical assistance to county behavioral health agencies to support the implementation of CARE including training regarding the CARE process, CARE agreement and plan services and supports, supported decision-making, the supporter role, trauma-informed care, elimination of bias, psychiatric advance directives, family psychoeducation, and data collection.
Community Care Continuum Section
The Community Care Continuum oversees the CalBH-CBC Demonstration, which takes advantage of the Centers for Medicare & Medicaid Services' (CMS) guidance and associated federal funding aimed at improving care for people living with serious mental illness (SMI) and serious emotional disturbance (SED). This demonstration opportunity is similar to California's historic commitment to creating the Drug Medi-Cal Organized Delivery System (DMC-ODS) in 2015, which was a first-in-the-nation model that provides a full continuum of care for substance use disorder treatment and recovery services. Like DMC-ODS, this opportunity allows California to make historic investments in building out the full continuum of care for behavioral health, with a special focus on the populations most at risk.
DHCS' central goal of the CalBH-CBC Demonstration is to leverage this opportunity to expand a robust continuum of community-based behavioral health care services for Medi-Cal members living with SMI or SED. It would also amplify California's ongoing behavioral health initiatives, and be informed by findings from DHCS' 2022 Assessing the Continuum of Care for Behavioral Health Services in California.
For more information, please visit the program website here.
Recovery Incentives Program
As part of the CalAIM demonstration, California became the first state in the nation to receive federal approval to cover contingency management (CM) services for substance use disorders (SUD) as part of the Medicaid program. California's program that offers the CM benefit is called the Recovery Incentives Program. CM is an evidence-based treatment that provides motivational incentives to treat individuals living with stimulant use disorder and support their path to recovery. It recognizes and reinforces individual positive behavioral change, as evidenced by drug tests that are negative for stimulants. CM is the only treatment that has demonstrated robust outcomes for individuals living with stimulant use disorder, including reduction or cessation of drug use and longer retention in treatment.
DHCS will pilot Medi-Cal coverage of CM in DMC-ODS counties that opt in to cover the service starting in 2023. DHCS' primary goal for the pilot is to determine how to scale a proven treatment for stimulant use disorder in Medi-Cal in a large, complex state, supporting DHCS' broader policy goals to:
- Address the ongoing and shifting SUD crisis in California through the implementation of evidence-based treatments and practices; and
- Improve the health and well-being of Medi-Cal beneficiaries living with stimulant use disorder, as measured by a reduction or cessation of drug use and longer retention in treatment.
To learn more about the Recovery Incentives Program, please visit the program website here.
Medi-Cal Mobile Crisis Services
Mobile crisis services are a community-based intervention designed to provide de-escalation and relief to individuals experiencing a behavioral health crisis wherever they are, including at home, work, school, or in the community. Mobile crisis services are provided by a multidisciplinary team of trained behavioral health professionals in the least restrictive setting. Mobile crisis services include screening, assessment, stabilization, de-escalation, follow-up, and coordination with healthcare services and other supports. Mobile crisis services are intended to provide community-based crisis resolution and reduce unnecessary law enforcement involvement and emergency department utilization. The mobile crisis services benefit will ensure that Medi-Cal beneficiaries have access to coordinated crisis care 24 hours a day, 7 days a week, 365 days per year. In December 2022, DHCS outlined its specific implementation guidance through BHIN 22-064.
On August 8, 2022, DHCS released a Request for Information to support training and implementation of mobile crisis services. The Center for Applied Research Solutions (CARS) was selected as the contractor to provide mobile crisis training, readiness reviews, and technical assistance. For additional information, please email mobilecrisisinfo@cars-rp.org.
For more information on Medi-Cal Mobile Crisis Services, please visit CalAIM Behavioral Health Initiative Mobile Crisis Services.
988
The National Suicide Hotline Designation Act of 2020 (NSHD) designated 9-8-8 as the new three-digit number for the national suicide prevention and mental health crisis hotline. As the nation's most populous state, California experiences the largest number of calls to 988. In 2020, about 1 out of 8 calls to the National Suicide Prevention Lifeline (NSPL) originated in California. To handle this volume, a network of 13 local California Lifeline Crisis Centers provide free and confidential emotional support to individual 988 callers from all 58 counties who are in behavioral health crisis.
Crisis line staff and volunteers facilitate suicide prevention and behavioral health crisis line services 24 hours a day, seven days a week, 365 days a year. The crisis line staff and volunteers provide an initial suicide risk screening and assessment consistent with NSPL guidelines, offer de-escalation, and provide clients with information and referrals to link the client to the appropriate community resources in the city or county of the client or person in crisis when known and available.
DHCS partners with Didi Hirsch Psychiatric Service to ensure development, implementation, and on-going management of the 988 crisis hotline at all 13 California Lifeline Crisis Centers. This includes contract management and funding oversight, technical assistance, data analysis of key performance indicators, and monitoring for compliance and sustainability. Additional Resources
California Advancing and Innovation Medi-Cal (CalAIM):
Medicaid and Medi-Cal General:
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