BEHAVIORAL HEALTH
Behavioral health is comprised of mental health and substance use services. Today, the Medi-Cal managed care system administers the mild-to-moderate mental health and autism spectrum services, and the county mental health agencies administer the specialty mental health and substance use services. This structure splits apart the mental health benefit into the Medi-Cal managed care system, and the other part of the benefit parallels the specialty mental health, crisis and intervention, services; both systems are administered by two separate entities, and therefore have different infrastructure and people to do the work. In the case of a patient receiving treatment, it is common for a patient to be served by both organizations based on their condition, yet the information regarding treatments and progress is not shared between these systems. There are two systems of care that need to be navigated, and both systems do not speak with each other. In the future, the Medi-Cal managed care program will interlock both of these systems together for a better continuum of care, and reduce the complexity of navigating multiple systems.
The transformation of the Medi-Cal system into a whole-person care experience is reinforced by a continuum of care that spans across multiple disparate systems.
The federal agency (SAMHSA) and California's Mental Health Services Act (MHSA) have authorized transformational change through legislation and policies, and funded millions of dollars to reform the current system, such as the integration of mental health into primary care settings. CalAIM intersects with these changes by targeting specific populations of youth and adults that need better access to care. California implemented, under federal authority, the "No wrong door" policy in 2022 to improve the experience for mental health and substance use disorder treatments. And the mental health system is scheduled for a major change in the administrative in 2027, however until that time the systems need to adapt and appear as one by overlapping in certain areas (i.e. data sharing, care coordination).
CalAIM's populations of focus dovetail into the whole person care model or care, and integration of mental health, substance use, physical health, and social determinants of health services (i.e., housing, food & nutrition, workforce) is now. The justice involved initiative targets two populations of focus, the youth and eligible adults, that are transitioning from incarceration. Recidivism rates exceed 40% in three years; another way of saying, more than 40 out of 100 incarcerated individuals return to a correctional facility in three years or less. These relapses are driven by many factors, such as employment, substance use, social determinants, racial inequities, depression, and social reintegration. The continuous treatment of the mental health and substance use disorders is essential to reduce the number of incarcerated people, and the CalAIM program offers a pathway through coordinated re-entry.
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