Early lessons from CalAIM initiatives to address behavioral health needs
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Issue brief (California HealthCare Foundation)
- Author(s):
- Fitzgerald, Hadley, author
- Contributor(s):
- California HealthCare Foundation, issuing body.
- Publication:
- [Oakland, CA] : California Health Care Foundation, September 2023
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Behavioral Medicine Medicaid Mental Health Services State Health Plans California
- Genre(s):
- Technical Report
- Abstract:
- Behavioral health conditions are widespread among Californians, and many struggle to access behavioral health treatment. One in 25 adults in the state has a serious mental illness, and the proportion of adults with substance use disorders is higher than the national average (9.2% compared to 7.7%). During the COVID-19 pandemic, rates of drug overdose rose sharply in California, as did rates of self-reported serious psychological distress among adults enrolled in Medi-Cal. People with serious mental illness (SMI) and substance use disorder (SUD) are less likely to receive preventive care, have higher rates of chronic physical conditions, and are more likely to visit emergency departments. They also have higher rates of housing and food insecurity. Initiatives that coordinate across medical, behavioral health, and health-related social needs - also known as whole-person care - are needed to improve outcomes for these populations. Historically, Medi-Cal has provided services to people with behavioral health conditions through several different, often uncoordinated, systems, making whole-person care delivery challenging. Medi-Cal managed care plans (MCPs) manage physical health services and a limited set of non-specialty mental health services for adults with mild to moderate mental health distress or impairment. The non-specialty mental health services may be delivered by primary care providers, if within their scope of practice, or by mental health providers in the MCP’s network. County behavioral health agencies - operating through mental health plans (MHPs) - manage specialty mental health services (SMHS) for adults with complex behavioral health needs including SMI. In most counties, SUD services are delivered through separate managed care plans in the Drug Medi-Cal Organized Delivery System (DMC-ODS), also under the purview of county behavioral health agencies. People with co-occurring conditions must navigate these separate systems for care, and their various providers often cannot easily access information about their diagnoses and treatment across these different systems. CalAIM (California Advancing and Innovating MediCal) is a multiyear effort of the California Department of Health Care Services (DHCS) to transform the Medi-Cal program by offering whole-person care and addressing fragmentation of care, including for people with behavioral health needs. Two recent initiatives to better support people with complex needs, including those with serious behavioral health conditions like SMI and SUD, are Enhanced Care Management (ECM) and Community Supports. These initiatives build on the Health Homes Program and the Whole Person Care pilots, previous intensive care coordination programs in Medi-Cal.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
- Extent:
- 1 online resource (1 PDF file (15 pages)).
- NLM Unique ID:
- 9918734179906676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918734179906676