Finance Reform

Supporting partnerships between Managed Care Plans and Schools

During the pandemic, California’s children and youth faced endless new challenges, stressors, and trauma, exacerbating an already troubling uptick in mental health needs.

Schools must be at the heart of our efforts to connect with and heal youth, but all child-serving systems need to break through historical silos and provide a robust, coordinated response to identifying and meeting children’s needs, early and effectively.

California’s Children and Youth Behavioral Health Initiative (CYBHI), an unprecedented investment in improving mental health care for the state’s children and youth, offers an incentive program for Medi-Cal Managed Care Plans (MCPs) to foster partnerships with schools and increase access to school-based and school-linked care for students on Medi-Cal.

Issue Brief

November 2021: SCHOOL MENTAL HEALTH 101: A Primer for Medi-Cal Managed Care Plans

The goal of this primer, developed in partnership with the National Center for Youth Law (NCYL), California Health Care Foundation (CHCF), and Hopelab, is to facilitate effective partnerships between Managed Care Plans (MCPs) and Schools to address the growing mental health crisis among school-age youth.

Holding Managed Care Organizations Accountable to Vulnerable Children

Medi-Cal insures more than 5 million children in the state, and nearly all (96%) of these children get their care delivered through a Managed Care Organization (MCO). However, only 5 percent of children insured by Medi-Cal—a majority of whom are children of color— receive federally mandated early behavioral, social, and developmental screenings (EPSDT), and we still rank 44th in the nation in access to mental health services for children. The MCO re-procurement process, the first since the shift to managed care over 15 years ago, is our opportunity to require equitable access to, and coordination of, mental and behavioral health services for California’s vulnerable children and youth.

Issue Brief

September 2021: CARE COORDINATION FOR CHILDREN IN MEDI-CAL

This brief, developed with The Children’s Partnership, was prepared to support advocacy efforts during the MCO re-procurement process. The brief provides an overview of the current MCO care coordination obligation for all children in Medi-Cal, offers recommendations for improvement, and links to additional resources.

Response Letters to DHCS: Medi-Cal Managed Care Contracts and Procurement

On September 1, 2020, DHCS released a Request for Input (RFI) as the first step in soliciting public review and response in the MCO re-procurement process. In partnership with several child-serving organizations, we provided DHCS with detailed input to the RFI in October 2020. Additionally, we worked with partner organizations to provide detailed responses to the Draft Request for Proposal (RFP) in July 2021.

Capturing the Promise of Medi-Cal and EPSDT

We are committed to putting a spotlight on the unfulfilled promise of Medi-Cal funding to address the striking acuity of the children’s mental health crisis. The need to access these resources and services is critical, now more than ever, when we are seeing dramatic increases in suicide and other indicators of a mental health crisis. In a June 2020 CDC study, 1 in 4 youth ages 18 to 24 said they had “seriously considered” suicide in the past 30 days— more than twice as high as any other age group.

Issue Briefs

January 2021: MEETING THE MOMENT: UNDERSTANDING EPSDT AND IMPROVING IMPLEMENTATION IN CALIFORNIA

This report, developed in partnership with the National Center for Youth Law (NCYL) and the National Health Law Program (NHeLP), offers advocates and policymakers specific recommendations for how California can fulfill its obligation under the Medi-Cal entitlement to provide mental health services and support for our children and youth.For additional background, refer to the accompanying Primer on Medi-Cal Managed Care.


December 2020: COVERAGE OF SERVICES TO PROMOTE CHILDREN’S MENTAL HEALTH

This issue brief, developed in partnership with national experts Mental Health America and the Well Being Trust, lays out the analysis of how current state Medicaid and commercial health insurance payment policies fail to adequately reimburse for effective interventions to promote positive child and family mental health.


July 2019: FINANCING NEW APPROACHES TO ACHIEVE CHILD WELL-BEING

This brief outlines fiscal opportunities to initiate and invest in a fundamental reimagining of how public child-serving systems approach and support children’s social, emotional, mental, and developmental health in California.

Continuing What CalAIM Started

California has a generational opportunity to reform our state’s troubled Medicaid program. In October 2019 the Department of Health Care Services (DHCS) presented a reform agenda through the CalAIM proposal. We released our analysis of the proposal in November 2019.

An astonishing amount of progress has been made in a short period of time, but current events jeopardize that momentum. COVID-19 and demands for racial injustice underscore the urgent need to advance CalAIM’s children’s behavioral health reform effort.

Issue Briefs

June 2020: THE URGENT NEED TO ADVANCE CALAIM’S CHILDREN’S BEHAVIORAL HEALTH REFORM EFFORT

This brief and the accompanying presentation from CMHACY 2020 outline the path forward to realize the behavioral health sector reforms that will enable California to better serve vulnerable children and families.


November 2019: CCT’S ANALYSIS OF CALAIM

CalAIM proposes real and substantive changes for specialty mental health. It is far and away the most ambitious and courageous action by DHCS on mental health in more than 20 years. However, the proposal does not do enough to center racial justice, or properly or effectively clarify how it will promote or incentivize delivery system reform and child-serving system integration and expansion.

DHCS Updates

June 2020: DHCS SIGNALS INTENT TO REFORM MEDICAL NECESSITY AND EXPAND ACCESS

On June 19 the California Department of Health Care Services (DHCS) published a new “game-changing” Family Therapy Benefit Guide. These guidelines are the most fundamental reform to medical necessity criteria in the history of the state’s mental health system. They allow for Z codes (psychosocial concerns) and the criteria are trauma-informed and relevant to our state’s efforts to respond to the impact of adverse childhood experiences on the social and emotional health of children. These changes were an essential recommendation that the California Children’s Trust and its partners made during the CalAIM process. Read.