California health officials have received federal approval for a plan to reform the state’s sprawling public health system — moves aimed in part to better serve children in foster care.
The Dec. 29 go-ahead from the federal Centers for Medicare & Medicaid Services allows the state to launch its California Advancing and Innovating Medi-Cal (CalAIM) initiative, an effort to transform how the state delivers physical, mental and oral health care to nearly 14 million children and adults.
“CalAIM shifts Medi-Cal to a population health approach that prioritizes prevention and addresses social drivers of health to better serve communities, many of whom historically have been under-resourced and faced structural racism in health care,” said California Health and Human Services Agency Secretary Dr. Mark Ghaly in a press statement.
The CalAIM plan involves a host of restructuring and finance reforms designed to emphasize prevention, increase access to services and reduce the use of costly crisis care and hospitalization.
On the behavioral health side, advocates for vulnerable youth are pleased that eligibility criteria under the new plan could allow thousands more young people to receive intensive mental health services.
More than half of all children in the state, or about 5.5 million kids, depend on Medi-Cal. But the state’s public health care system has often failed to provide them with timely behavioral health services, such as treatment for depression, attention deficit disorders and anxiety.
In recent years, the need for such services has shot up. The hospitalization of children requiring emergency mental health issues increased by 35% during the pandemic, Ghaly said.
But state figures show that just 4% of children on Medi-Cal received intensive services in 2018, despite the federal requirements that states provide medically necessary services to low-income children and those enrolled in safety net programs.
Prior to the changes this year, California has long required a diagnosis before behavioral health services can be provided, forcing some children to reach a crisis stage before getting the help they need. Alex Briscoe, principal at the California Children’s Trust said the change is much-needed and long overdue.
“If you’re a kid in the foster care system, you can no longer be told that you don’t meet medical necessity for specialty mental health services,” Briscoe said in an interview. “We are no longer going to pathologize the Black and brown children that these systems primarily serve.”
While state officials have vowed to better serve systems-involved youth through the plan, important questions remain about how far-reaching the health reform effort will be. For example, the state has not yet answered how it will pay for the stepped-up services now granted for youth on Medi-Cal.
Changes to Medi-Cal financing won’t be considered until July 2023, leaving lingering uncertainty about how California will expand its mental health services.
“It remains an open question if an investment commensurate to the need will ever actually be made,” Briscoe said.
Meanwhile, county leaders, child welfare officials, mental health professionals and public health advocates are meeting as members of a foster care work group to create a long-term plan for the physical health, mental health, substance use disorder treatment, social services and oral health needs of children and former foster youth through age 26, as well as those with complex medical and behavioral health needs.
The California Health and Human Services Agency is also hoping to receive federal approval later this year for another Medicaid request that would open up more services to youth and adults who are preparing to exit juvenile detention facilities, jails and prisons.
The plan calls for better connections with the Medi-Cal system prior to discharge. Youth and adults who meet certain criteria — such as pregnancy or a history of mental health issues or chronic illnesses — would be enrolled 90 days before release from a detention center, with a “warm handoff” to community providers.