It’s been a year since the massive statewide effort called CalAIM was launched. Some of the key changes CalAIM has promised include: A review of the availability of mental health care for young people enrolled in Medi-Cal, a public insurance program for low-income Californians.
Youth mental health advocates say they are still enthusiastic about CalAIM’s potential, using words like “game-changing” and “transformative.”
But they also say that new frameworks are being born at difficult times. Three years into the pandemic, provider burnout combined with rising patient needs is creating a severe mental health workforce shortage. Meanwhile, community-based organizations that provide many of the mental health services outlined in CalAIM say they feel left out of the important conversations about upcoming payment reform.
Governor Gavin Newsom’s budget bill, which slows down certain behavioral health investments to address the projected $22 billion deficit, also risks impeding progress on CalAIM.
“Our members are really panicking right now,” said Adrian Shilton, public policy director for the nonprofit California Alliance for Child and Family Services. We are one of 12 organizations that have signed a letter to the State Department of Health Services expressing concern about the lack of transparency regarding our fee structure. “Providers need the ability to plan and prepare with county partners,” it said.
Shilton’s organization also co-authored a letter to lawmakers on Wednesday denouncing the delay in the proposed budget.
Shilton previously told CalMatters that other issues CalAIM seeks to address, such as easing burdensome documentation requirements, haven’t changed the reality on the ground for many providers.
CalAIM is more than mental health. The initiative, which stands for California Advancing and Innovating Medi-Cal, is his five-year plan that started a year ago. It aims to improve access to a range of health and mental health services for children and adults with Medi-Cal coverage. We also strive to use a “whole person care” approach to address social issues affecting health, such as housing and food insecurity.
We will also redesign our payment system to more seamlessly integrate county mental health plans with managed care organizations that pay for those services..
The importance and urgency of addressing children’s mental health is particularly evident. It’s racism. School closed. online bullying. climate disaster. A pandemic full of grief, loss and fear.
All these factors are exacerbating the youth mental health crisis that has been raging for more than a decade. The incidence of self-harm among young people, which had increased dramatically even before the pandemic, has surged further in recent years.
CalAIM hasn’t changed the reality on the ground for many of these young people yet, according to experts, but many important policy changes are officially underway.
- About 40% of the state’s children and youth have Medi-Cal insurance. They no longer need a formal diagnosis to access professional mental health services.
- The state has simplified behavioral health documentation requirements.
- A “No Wrong Door Policy” should replace what feels like a bureaucratic maze that varies from county to county and make it easier for children and adults to get behavioral health care wherever they enter the system. I have.
- The Enhanced Care Management benefit provides services and case management to members of priority groups, including those who are homeless, experiencing early-stage mental illness, or involved in child welfare or the criminal justice system. .
Other initiatives will roll out this year, including changes to how mental health services are paid.
Having made behavioral health a major issue early on, Newsom’s administration has simultaneously announced several other ambitious initiatives, all of which require additional personnel and funding. Known as a CARE coat. Expanded crisis response services through state funding of the 988 hotline. and major initiatives to improve mental health care for children and young people. Some of which will be affected by delays in the proposed budget.
CalAIM continues to receive funding despite the governor’s proposed January budget tightening in other areas. Newsom’s proposal would spend more than $10 billion on CalAIM’s implementation. This includes $6.1 billion over five years for him to improve local treatment services and pay for short stays in treatment facilities for people with serious mental illness and behavioral disorders.
“We are committed. We have not touched on it,” he said at a press conference earlier this month.
However, the budget does not include funding for other behavioral health issues over the next two years, including funds aimed at increasing treatment capacity for adults and children at risk, and funds for workforce development. delaying investments by more than $1.1 billion. According to state documents, these investments were intended to bolster CalAIM’s goals.
“I worry about delays,” Shilton said. “While this is funding outside of CalAIM … the system is very stressed. This additional investment from the state has been really beneficial.”
The governor’s office did not respond to questions about the proposed funding delay. We are planning to enter into a funding agreement.
CalAIM is an important step toward meeting the mental health needs of vulnerable youth, but experts say a shortage of staff in particular complicates the picture. As a result, some say it is not yet clear when and how changes in official policy will lead to better mental health treatment for individuals. It will hold back about $400 million in health worker training, including pipeline programs.
“Where are the people who are going to provide these services?” Shilton said.
Michelle Cabrera, executive director of the County Behavioral Health Director Association, calls CalAIM “a very ambitious reform agenda on top of a system that has really weathered the storm.”
The county is being asked to implement “ambitious and sweeping new reforms on top of the worst labor crisis we’ve ever seen.”
In an email reply to CalMatters, the Department of Health Care Services said the Newsom administration is “working closely” with counties, health care plans and others to plan, implement and monitor a variety of “unprecedented and intersecting initiatives.” said he promised to
Still, community-based organizations that contract with counties and managed care organizations to provide mental health services, how it affects the payments they receive for their services and their ability to recruit and retain the staff they need. He said he was worried about what to do.
Jody Kurata, chief executive of the Association of Community Human Service Agencies, which represents nonprofit organizations in Los Angeles, said her group was overwhelmed with dealing with labor shortages and unable to focus on ongoing government reform. said no.
“The current system is very depleted,” she said.
She said she worried that inadequate rates could lead to a further exodus of nonprofit mental health providers from the Medi-Cal system.
The state said preliminary draft revised payout rates are being shared with counties. The Department of Health Services said it had promised to publish a tariff in the first few months of the year.
Cabrera of the County Behavioral Health Director Association said CalAIM’s new payment structure represents a significant change in that states now allow counties to pay providers without caps and removes many onerous document requirements. said to show She said the county is seeing new rates just now, and the administration’s “aggressive” timeline is likely to lead to “a bumpy road this year” before finally bringing positive change. .
When care varies by county
Other longstanding funding issues remain unresolved. This fall, the Young Minds Advocacy, a children’s mental health advocacy group, announced that the long-term variability in how states fund specialized mental health services in counties will provide a focus for young Medi-Cal registrants. published a report showing disparities in treatment types leading to disparities. .
Patrick Gardner, the attorney who founded the advocacy group, said that for decades, states were unable to fund certain counties, and “as a result, county performance has deteriorated, sometimes quite dramatically.” .
In his report, Gardner found that counties with significantly less state funding than average generally provided less youth-intensive services than counties with significantly more state funding than average. I found He reported that in 2019-2020, underfunded San Joaquin and Madera counties provided just 16% of their estimated care needs and he 17%, while funding In rich Santa Clara and Butte counties he was offered 86%.
CalAIM is moving “in the right direction,” Gardner said, but has failed to address this fundamental problem. (Cabrera claims the analysis doesn’t capture the services the county provides without charging Medi-Cal.)
Despite these concerns, many mental health advocates say they are already seeing significant changes in the way care is delivered under CalAIM.
Leticia Galyean, CEO and President of Seneca Family of Agencies, said: She said her organization, which serves youth and families in 14 counties, provides rapid access to specialized mental health care for foster youth, homeless youth, and those involved in the juvenile justice system. In terms of access, you said you’re looking specifically at “immediate benefits.”
Brian Blalock, senior staff attorney at the Youth Law Center for Youth in Child Welfare and Juvenile Justice System, calls CalAIM “the most important thing California has done in a long time.”
“There is tremendous opportunity there,” he said.
Now he adds:
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