Managed Care Division - Medi-Cal Mental Health Services
Since 1995, the California Department of Mental Health has been expanding mental health services using the managed care model of service delivery. Under this plan, each county mental health department is responsible for the provision of mental health services for Medi-Cal recipients in their county, either providing those services or using contracted providers. In Fresno County, the Managed Care Division of the Department of Behavioral Health has been designated to manage the mental health benefits of Fresno County's Medi-Cal beneficiaries.
Before the introduction of Managed Care, Medi-Cal mental health services were administered through two programs—the state-run Fee-for-Service program and the county-run Short-Doyle program. The managed care approach consolidated these two programs with the intent of integrating services and better coordinating care, but it also provided a cost-containment strategy which would allow for increased access with the same level of funding. The development of this system assured consistent state-wide access to consumers receiving specialty mental health services.
Federal regulations require that consumers in managed care organizations have at least two organizations to chose from, but a waiver was secured from the federal government. Allowing county mental health departments to be the single managed care plan for mental health services was a natural outgrowth of the experience counties had in serving the mental health needs of their communities.
Each county Mental Health Plan contracts with the California Department of Health Care Services to provide mental health services to Medi-Cal beneficiaries in their county. Each Mental Health Plan selects and credentials their providers, negotiates rates, authorizes services, and provides payment for services in accordance with statewide criteria.
Before mental health services can be provided, several criteria must be met. The beneficiary must meet medical necessity criteria, a clearly identified set of diagnoses, functional impairments, and intervention criteria. The services must be delivered by or under the direction of a specialist in the mental health field—a Psychiatrist, a Psychologist, a Nurse Practitioner, a Registered Nurse, a Licensed Clinical Social Worker, a Licensed Professional Clinical Counselor, or a Licensed Marriage and Family Therapist.