Will the state’s big Medi-Cal plan really fix mental health care for low-income Californians? – Oroville Mercury-Register

It’s been a year since a massive statewide effort was called in CalAIM He began to bring it up. Among the many important changes CalAIM has promised: an overhaul of the availability of mental health care for youth insured by Medi-Cal, the general insurance program for low-income Californians.

Youth mental health advocates say they remain excited about CalAIM’s potential, using words like “game-changing” and “transformative.”

But they also say that the new framework is being born at a difficult time. Three years into the pandemic, provider fatigue and heightened patient needs have combined to create a severe case The mental health workforce loss. Meanwhile, community organizations that provide many of the mental health services described in CalAIM say they feel left out in important conversations about upcoming payment reforms.

Governor Gavin Newsom budget proposal – Which would delay some behavioral health investments to combat a An expected deficit of $22 billion Also risks hindering progress in the CalAIM program.

“Our members are really terrified right now,” said Adrienne Shelton, director of public policy for the nonprofit California Federation of Children and Family Services. In September 2022, her organization was among dozens of signatories e-mail to the State Department of Health Care Services expressing concerns about the lack of transparency around the new pricing structure. “Providers must have the ability to plan and prepare alongside their partners in the county,” she said.

Shelton also co-authored Wed’s message For lawmakers, decry the delay in the proposed budget.

Shelton previously told CalMatters that other issues CalAIM aims to address, including easing onerous documentation requirements, have yet to change the reality on the ground for many providers.

CalAIM is about much more than just mental health. The initiative, which stands for California Advancing and Innovating Medi-Cal, is a five-year plan that went into effect a year ago. It aims to provide Medi-Cal-insured children and adults with better access to a range of health and mental health services. It also strives to use a “take care of a whole person” An approach to addressing social issues affecting health, including housing and food insecurity.

It is also redesigning the payment system to more seamlessly integrate county mental health plans and the managed care organizations that pay for those services.

The importance and urgency of addressing children’s mental health is particularly evident: racism. School closures. Internet bullying. Climate disaster. A pandemic filled with grief, loss and fear.

All of these factors have exacerbated a youth mental health crisis that has been going on for more than a decade. Cases of self-harm for young people steadily increase Even before the pandemic rose more in the past few years.

CalAIM hasn’t significantly changed the reality on the ground for many of these young people, experts say, but a number of important policy changes are officially in the works:

  • About 40% of the state’s children and youth are covered by Medi-Cal. They no longer need a formal diagnosis to access specialized mental health services.
  • The state has simplified behavioral health documentation requirements.
  • Our “no wrong door” policy should make it easier for children and adults to receive behavioral health care no matter where they enter the system, replacing what can feel like a bureaucratic maze that varies by county.
  • The Enhanced Care Management feature provides services and case management to members of priority populations, including those who are homeless, experiencing early onset psychosis, or engaged in childcare or criminal justice systems.

Other efforts, including changing how mental health services are paid for, are also being rolled out this year.

The Newsom administration, which early on made behavioral health a signature cause, is simultaneously revealing several other ambitious initiatives, all of which require additional staffing and funding: a statewide program to create new court systems to meet the needs of people with severe mental illnesses, known as Kerr Court Expanding crisis response services through state funding Hotline 988; And a major initiative to improve mental health care for Children and youthAnd parts thereof You will be affected by the delays proposed in the budget.

Despite belt-tightening in other areas of the proposed January portfolio budget, CalAIM funding continues. Newsom’s proposal would allocate more than $10 billion to implement CalAIM, incl $6.1 billion More than five years to improve local treatment services and pay for short stays in treatment facilities for people with serious mental and behavioral illnesses.

“We are committed. We are not dwelling on that,” he said at a news conference earlier this month.

However, the budget proposal delays more than $1.1 billion in other behavioral health investments over the next two years, including money to increase treatment capacity for adults and children in crisis, and money for workforce development. These investments were intended in part to support the goals of CalAIM, According to state documents.

“We’re concerned about the delay,” Shelton said. “This is funding outside of CalAIM but…the system is very strained. Getting this additional investment from the state has been really helpful.”

The governor’s office did not respond to questions about the proposed funding delays. He will review his budget proposal in May, based on actual state revenue, and reach a final funding agreement with lawmakers in June.

While CalAIM’s program is an important step toward meeting the mental health needs of at-risk youth, experts say staffing shortages, in particular, complicate the picture. As a result, some say, it is not yet clear how and when official policy changes will translate into better treatment for individuals’ mental health. The proposed budget would delay nearly $400 million for health care workforce training, including some social work and behavioral health programs.

“Where are the people who will provide these services?” Shelton said.

Michelle Cabrera, executive director of the Association of County Behavioral Health Administrators, calls CalAIM “a super-ambitious reform agenda that sits on top of a system that has already been through the storm.”

She said provinces are being asked to implement “comprehensive and ambitious new reforms on top of the worst workforce crisis we’ve ever seen.”

In an email response to CalMatters, the DHS said Newsom’s administration is committed to “close collaboration” with counties, health plans and others to plan, implement and monitor various “unprecedented and overlapping” initiatives.

However, community organizations that contract with counties and managed care organizations to provide mental health services say they are concerned about how much they will receive for their services and how that might affect their ability to recruit and retain necessary staff.

Judy Kurata, executive director of the Association of Community Human Service Agencies, which represents nonprofits in Los Angeles, said the groups she works with are so overwhelmed with dealing with workforce shortages that they can’t focus on the ongoing management shift.

“The system at the moment is very depleted,” she said.

She said she was concerned that inadequate rates could lead to an exodus of nonprofit mental health providers from the Medi-Cal system, a concern echoed by others.

The state says an initial draft of revised payment rates has been shared with counties. The Health Care Services Administration said it has committed to publishing the fee schedule for the first few months of this year.

Cabrera, of the Association of County Behavioral Health Administrators, said CalAIM’s new payment structure marks an important shift in that the state will now allow counties to pay providers without restriction, and will remove many onerous documentation requirements. She said provinces are now seeing the new rates, and that the administration’s “aggressive” timetable is likely to lead to a “bumpy ride this year” before ultimately leading to positive change.

When care depends on your county

Other long-standing financing problems remain unaddressed. Last fall, I published Young Minds Advocacy, a children’s mental health advocacy organization a report It shows that longstanding disparities in the way the state funds specialized mental health services in the county have translated into disparities in the types of intensive care provided to young Medi-Cal enrollees.

Patrick Gardner, the attorney who founded the advocacy organization, said that the state has underfunded certain counties for decades “and their performance has suffered accordingly, sometimes quite dramatically.”

In his report, Gardner found that counties with government funding well below average generally provide young people with less intensive services than counties with government funding well above average. According to his report, in 2019-20, poorly funded San Joaquin and Madera counties provided only 16% and 17% of the estimated needs for care, while better funded Santa Clara and Butte counties provided 86%.

Gardner said that while CalAIM is moving “in the right direction,” it fails to address this core issue. (Cabrera contends that the analysis failed to capture services provided by counties without Medi-Cal billing.)

Despite these concerns, many mental health advocates say they are already seeing important changes in the way care is provided under CalAIM.

“We’re seeing shifts already happening,” said Leticia Gallian, CEO and President of Seneca Family of Agencies. She said her organization — which serves youth and families in 14 counties — particularly sees an “immediate benefit” in terms of faster access to specialized mental health care for foster youth, homeless youth and those in the juvenile justice system.

Brian Blalock, senior attorney at the Youth Law Center, which advocates for young people in the child welfare and juvenile justice systems, called CalAIM “the most important thing California has done in a long time.”

“There is just a huge opportunity,” he said.

Now he added, “We as a country can go in any direction—either we make good on that promise, or we let it pass.”

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