Navigating the landscape of mental health services for foster youth in California has undergone significant changes, particularly with the implementation of California Advancing and Innovating Medi-Cal (CalAIM) reforms. For professionals and caregivers involved in the foster care system, understanding these updates is crucial. This article clarifies the recent policy shifts regarding mental health diagnosis prerequisites for foster youth accessing Specialty Mental Health Services (SMHS) under Medi-Cal, ensuring timely and appropriate care for this vulnerable population.
Key Policy Changes: Medical Necessity and Mental Health Screening
Recent updates in California law, specifically Welfare and Institutions Code (WIC) sections 14184.402(d) and (f)(1)(A), have eliminated the requirement for a formal mental health diagnosis for foster youth to receive SMHS. This pivotal change, detailed in the California Department of Health Care Services (DHCS) Behavioral Health Information Notice (BHIN) 21-073, recognizes trauma stemming from child welfare or juvenile justice system involvement as sufficient grounds for SMHS eligibility for children and youth under 21.
In response to these medical necessity modifications, the California Department of Social Services (CDSS) issued All County Letter No. 24-35. This letter informs county child welfare agencies (CWAs), juvenile probation departments (JPDs), Tribes with Title IV-E Agreements, and county mental health plans (MHPs) about the discontinuation of mandatory mental health screenings for referral purposes. Effective July 12, 2024, CWAs and JPDs are now required to directly refer all children and youth to appropriate MHPs within three business days of opening a case, and continuously thereafter as determined by the child and family team (CFT) and informed by the Child Adolescent Needs and Strengths (CANS) tool. This streamlined referral process aims to expedite access to necessary mental health services for foster youth without the barrier of a preliminary diagnosis-focused screening.
Understanding Medi-Cal for Kids & Teens: EPSDT and Behavioral Health
The DHCS emphasizes the comprehensive Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, now known as Medi-Cal for Kids & Teens, available to Medi-Cal beneficiaries under age 21. Medi-Cal managed care plans (MCPs) are responsible for ensuring children and teens receive these EPSDT services, focusing on early detection, prevention, and treatment of health issues.
Core Services Included Under Medi-Cal for Kids & Teens:
- Screening services: Encompassing health and development history reviews, physical examinations, immunizations, laboratory tests, and crucial health education.
- Vision services: Providing comprehensive diagnosis and treatment for all vision-related concerns.
- Dental services: Addressing pain relief, infection management, tooth restoration, and overall dental health maintenance, including mandatory dental screenings/oral health assessments as part of periodic assessments.
- Hearing services: Covering diagnosis and treatment for hearing impairments, potentially including hearing aids.
Additional EPSDT Support for Foster Youth Mental Health:
Beyond these core services, Medi-Cal for Kids & Teens extends to:
- Behavioral health treatment: Covering medically necessary behavioral health services consistent with APL 23-005.
- Case management and care coordination: Specifically for medically necessary EPSDT services, ensuring streamlined access and support.
- Appointment and Transportation Assistance: Offering help with scheduling appointments and arranging transportation to and from medical appointments related to medically necessary EPSDT services.
Policy Guidance Documents:
- APL 23-005: Outlines requirements for EPSDT service coverage for Medi-Cal members under 21.
- APL 19-014: Details responsibilities for behavioral health treatment coverage for individuals under 21.
- EPSDT Manual: Provides comprehensive information on benefit, coverage, and medical necessity policies.
Streamlining Access: Cal-AIM Screening and Transition Tools
To further enhance access to mental health services, DHCS has implemented standardized Cal-AIM Screening and Transition Tools for both adults and youth. These tools are designed for MHPs and MCPs to efficiently determine the most appropriate service delivery system for individuals seeking mental health support who are not currently receiving services. A standardized Transition of Care Tool also ensures coordinated and timely care when members transition between service delivery systems or add services. These tools have been in use since January 1, 2023, aiming to create a more seamless experience for Medi-Cal beneficiaries.
Policy Guidance Documents:
- APL 22-028: Details the implementation of Adult and Youth Screening and Transition of Care Tools for Medi-Cal Mental Health Services.
- BHIN 22-065: Further explains the use of these screening and transition tools.
No Wrong Door Policy: Ensuring Uninterrupted Mental Health Care
The DHCS Behavioral Health Information Notice No: 22-011 introduced the “No Wrong Door” policy, a crucial component of CalAIM reforms. This policy ensures that Medi-Cal beneficiaries receive timely mental health services regardless of where they initially seek care. It also aims to maintain stable treatment relationships with trusted providers, preventing disruptions in care.
Policy Guidance Documents:
- APL 22-005: Outlines the No Wrong Door for Mental Health Services Policy.
- CalAIM No Wrong Door Guide: Provides a practical guide to key implementation scenarios for the No Wrong Door policy.
Conclusion:
The CalAIM reforms, particularly the elimination of mandatory mental health diagnosis screenings for foster youth and the implementation of the No Wrong Door policy, represent a significant step forward in ensuring timely and accessible mental health services in California. By understanding these changes, professionals and caregivers can better advocate for and support the mental health needs of foster youth within the Medi-Cal system. For more detailed information, please refer to the referenced policy guidance documents and resources from the California Department of Health Care Services.
References:
BHIN 22-011. (2022, March 31). Department of Health Care Services. Retrieved June 14, 2024, from https://www.dhcs.ca.gov/Documents/BHIN-22-011-No-Wrong-Door-for-Mental-Health-Services-Policy.pdf
California Advancing and Innovating Medi-Cal (CalAIM) OVERVIEW: Behavioral Health Payment Reform. (2022). Department of Health Care Services. Retrieved June 14, 2024, from
CalAIM Behavioral Health Initiative Frequently Asked Questions. (2024). DHCS. Retrieved June 14, 2024, from https://www.dhcs.ca.gov/Pages/CalAIM-BH-Initiative-FAQ-No-Wrong-Door-And-Co-Occurring-Treatment.aspx
Difficult Bi Design. (n.d.). The Promises and Possibilities of California’s Bifurcated Mental Health System. https://cachildrenstrust.org/wp-content/uploads/2024/05/CCT-Bifurcated-Promises-Possibilities.pdf
Frequently asked questions. (2024). DHCS. Retrieved June 14, 2024, from https://www.dhcs.ca.gov/Pages/Screening-and-Transition-of-Care-Tools-FAQ.aspx
Medi-Cal for Kids and Teens. (2024). DHCS. Retrieved June 5, 2024, from https://www.dhcs.ca.gov/services/Medi-Cal-For-Kids-and-Teens/Pages/home.aspx
Medi-cal’s foster care strategies. (2022, November). DHCS. Retrieved July 17, 2024, from https://www.dhcs.ca.gov/Documents/DHCS-Medi-Cal-Foster-Care-Strategies-11-22-2022.pdf
Medi-Cal Manual. (2018). For Intensive Care Coordination (ICC), Intensive Home Based Services (IHBS), and Therapeutic Foster Care (TFC) Services for Medi-Cal Beneficiaries. https://www.dhcs.ca.gov/Documents/ChildrensMHContentFlaggedForRemoval/Manuals/Medi-Cal_Manual_Third_Edition.pdf
Mental health and foster care. (2019, November 1). National Conference of State Legislatures. Retrieved July 15, 2024, from https://www.ncsl.org/human-services/mental-health-and-foster-care
MHSUDS Information Notice 18-059. (2018, December 17). Department of Health Care Services. Retrieved from https://www.dhcs.ca.gov/services/MH/Documents/Information%20Notices/IN_18-059_Continuity_of_Care/MHSUDS_Information_Notice_18-059_Continuity_of_Care.pdf
Myers, C., Lam, N. (n.d). Foster youth access to Medi-Cal specialty mental health services: A review of policies, procedures, and beneficiary-facing materials in the California counties with the largest foster care populations. National Health Law Program. https://healthlaw.org/wp-content/uploads/2023/09/CA-Foster-Youth-SMHS-Document-Review-Report.pdf
Provider Information. (2024). DHCS. Retrieved June 5, 2024, from https://www.dhcs.ca.gov/services/Medi-Cal-For-Kids-and-Teens/Pages/Provider-Information.aspx
Screening and Transition of Care Tools for Medi-Cal Mental Health Services. (2024). DHCS. Retrieved June 14, 2024, from https://www.dhcs.ca.gov/Pages/Screening-and-Transition-of-Care-Tools-for-Medi-Cal-Mental-Health-Services.aspx
