Medi-Cal Services for Children and Young People
What are Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services?
EPSDT services are extra Medi-Cal services. You can get them in addition to other Medi-Cal services. You must be under age 21 and have full scope Medi-Cal to get these services. EPSDT services correct or improve medical problems that your doctor or other health care provider finds, even if the health problem will not go away entirely.
How can I get EPSDT services for my child or, if I am under age 21, for myself?
Ask your doctor or clinic about EPSDT services. You may get these services if you and your doctor, or other health care provider, clinic (such as Child Health and Disability Prevention Program [CHDP]) or county mental health department agree that you need them.
What are EPSDT mental health services?
EPSDT mental health services are Medi-Cal services that correct or improve mental health problems. These problems may be sadness, nervousness, or anger that makes your life difficult.
Some of the services you can get from your county mental health department are:
- Individual therapy
- Group therapy
- Family therapy
- Crisis counseling
- Case management
- Special day programs
- Medication for your mental health
- EPSDT mental health services to treat alcohol and drug problems you may have that affect your mental health.
You can also ask for counseling and therapy as often as once per week or more if you think you need it. You may be able to get these services in your home or in the community.
In most cases, your county mental health department, you, and your doctor or provider will decide if the services you ask for are medically necessary. County mental health departments must approve your EPSDT services. Every county mental health department has a toll-free phone number that you can call for more information and to ask for EPSDT mental health services.
What are EPSDT Therapeutic Behavioral Services (TBS)?
Therapeutic Behavioral Services (TBS) is a new EPSDT mental health service. TBS helps children and young people who:
- Have severe emotional problems
- Live in a mental health placement or are at risk of placement, or
- Have been hospitalized recently for mental health problems.
If you get other mental health services and still feel very sad, nervous, or angry, you may be able to have a trained mental health coach help you. This person could help you when you have problems that might cause you to get mad, upset or sad. This person would come to your home, group home or go with you on trips and activities in the community.
Your county mental health department can tell you how to ask for an assessment to see if you need mental health services including TBS.
Who can I talk to about EPSDT mental health services?
You can talk to your doctor, psychologist, counselor or social worker about EPSDT mental health services. For children and young people in a group home or residential facility, you can talk to the staff about getting additi6nal EPSDT services.
For children in foster care, you can also ask the child's court-appointed attorney. You can also call your county mental health department directly.
What if I don't get the services I want from my county mental health department?
You can file a grievance with the county mental health department if the county mental health department denies the EPSDT services requested by your doctor or provider. You may also file a grievance if you think you need mental health services and your provider or county mental health department does not agree. Call the MHP at 1-800-654-3937 for information and help. You may also call the county patient's rights advocate at (559) 492-1652 or the State Mental Health Ombudsman Office at I-800-896-4042.
You can ask for a State hearing at the same time. Call 1-800-952-5253, send a fax to 916-229-4110 or write to the Department of Social Services/State Hearings Division, P.O. Box 944243, Mail Station 19-37, Sacramento CA 94244-2430. You must ask for a hearing within 90 days after you learn that your request for services was denied. Protection & Advocacy, Inc. is also available to assist with complaints, appeals, and grievances.
Who can I call for more information?
For more information please contact the offices and telephone numbers below.
- Fresno County Toll-Free Access Line 1-800-654-3937
- Department of Health Care Services Mental Health Ombudsman's Office 1-800-896-4042
- Child Health and Disability Prevention (CHDP) Program Located in Your County or City Health Department Look in Your Local Phone Book.