Medi-Cal Expansion of Mental Health Services

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In 2011, Medi-Cal (California’s version of Medicaid) expanded their mental health services offered under the Mental Health Services Act (MHSA), allowing recipients access to group and individual mental health evaluation and treatment, outpatient services, psychiatric consultations, and psychological testing (“Medi-Cal Expansion”, 2017). Although this would allow for many low-income recipients to finally have access to mental health services, few would be able to do so because of the limited programs that would open to accept Medi-Cal insurance. Therefore, the financial resources are readily available for individuals to receive mental health care, but there are too few programs/ facilities that are willing to offer these benefits to them. Already as of 2014, there was evidence of expanded mental health care coverage penetration into the population.

An example of such penetration can be seen in the figures on emergency and urgent psychiatric care in Los Angeles, California. The data were obtained from two psychiatric emergency care centers. Both of them provide insurance in Los Angeles County. The obtained statistical data demonstrate significant growth in coverage for the medically indigent. For the first three months of 2013, the Psychiatric Emergency Care Patient Insurance Coverage division was as follows. the part of Medi-Cal was 29% compared to 71% of Indigent. A year later, during the first quarter of 2014, the percentage for Medi-Cal and Indigent was 62% and 38% correspondently (Schaper, Murphy, & Wirshing, 2014). It should also be mentioned that in general the change in the distribution of the treatment population, by primary diagnosis, was not so evident. However, coverage for patients with a primary psychotic disorder increased more than two times (Schaper et al., 2014). It proves the positive impact of the Affordable Care Act.

Broader access to mental health care is significant for California. As of 2009, about one in six adult Californians have some kind of a mental health need, and nearly 5% of them have a serious mental disease (California Health Care Foundation, 2013). The situation with children is even worse. One of thirteen minors suffers from a mental disease that not only needs expensive treatment but also changes the life quality. The situation is more serious than it seems. Approximately 50% of adults and more than 30% of teenagers with mental disorders do not get any treatment (California Health Care Foundation, 2013). As of 2009, 7.6% of children in California experience serious emotional disturbance. As for adults, 15.9% have mental disorders and 4.3% of the adult population suffer from serious mental illnesses (California Health Care Foundation, 2013). The importance of available and affordable mental health care is crucial for society. In the example of California, it is obvious that among the adult population with mental disorders 9.3% are individuals below 100% federal poverty level (FPL), and only 2.1% with 300% FPL and above (California Health Care Foundation, 2013). Thus, it is necessary to provide mental health care that can be easily reached by any citizen who needs it. Since the treatment of mental disorders is expensive, low-cost insurance plans can be the way-out.

The count of citizens receiving specialty mental health services is increasing too. Speaking of children and youth, as of the financial year 2011/12 228,815 individuals were receiving SMHS. Already in 2014/15, this figure increased to 266,915 people (California Department of Health Care Services, 2016). This increase is even higher with adults. In the financial year, 2011/12 227,705 citizens were receiving SMHS and 336,619 individuals in the financial year 2014/15 (California Department of Health Care Services, 2016).

The Specialty Mental Health Services program demands substantial financing. As of November 2016 estimated for the financial year 2016/2017, the federal financial participation in the program for children amounted to 1,096,238 dollars and 1,354,300 for adults (Department of Health Care Services, 2016).

Specialty Mental Health Services are available in all the counties of the state. They provide crisis counseling, individual, group, and family therapy, special day programs, etc. (“Guide to Medi-Cal Mental Health Services”, 2013). The majority of programs offered are through hospitals—which seem to have limited programs designated towards their mental health department and revolve around the medical model of psychiatric practice. The San Francisco Behavioral Department of Public Health offers a “full range of specialty behavioral health services provided by a culturally diverse network of community behavioral health programs, clinics and private psychiatrists, psychologists, and therapists” (“Community Behavioral Services”).

Although this department offers some of the same interpersonal psychotherapy treatments as CHFH, they are centered around treatment for the individual—limiting access of the entire family. They also specify that the majority of behavioral therapy services are only needed for a short period—exemplifying the high demand for services and lack of ability to serve the large population of recipients. By indicating that the treatment is a short process, they are assuming that treatment and recovery of all mental illnesses can be done within a limited amount of time. It is fully dependent upon the type and severity of mental illness an individual is experiencing—which does not begin to encompass the various needs of the entire family surrounding the individual with mental illness. Another center that is similar in the treatment services offered is Highland Hospital’s Behavioral Health department. They offer partial hospitalization programs, outpatient programs, and several therapy programs to ensure stabilization and recovery—a few that include Cognitive training, young adult treatment, and multiple family-based programs and therapy options (“Behavioral Therapy”, 2015).

Their treatment services are extensive and extend to ensure the well-being and recovery of the entire family, well-organized, and operated by professional doctors and fully-licensed staff. Although they offer the utmost in treatment, they lack in the provision of holistic health ensuring the overall well-being of the family. The sole focus upon treatment also does not allow them to meet the supplemental needs of the family—communion amongst similar families and access to alternative resources such as dietary classes, and job training. Because their staff is only composed of doctors (psychiatrists and psychologists), they also lack the personalized relationships formed between social workers and their clients, as they follow each family’s case until full recovery is achieved. These doctors would tend to be drawn to the medical model of study (diagnosis through the DSM-V) as opposed to the multiple other fields of therapy and diagnosis that are not being accepted and explored within the field of mental health. The last center that seems to be most similar to CHFH through the array of services offered and wide population served is East Bay Community Recovery Project. This community center is a non-profit organization; therefore, they are not reliant upon Medi-Cal, but instead upon Federal and State funding. They seek to “support the wellbeing of the community by providing comprehensive services for mental health, tobacco, alcohol, and other drug-related health problems” (“FAQs and Testimonies”).

Their services are offered to children, adolescents, women, men, and families, and a wide demographic of the population—with a focus on those that are impoverished, were once incarcerated, and the HIV/Hepatitis infected. They also provide “the tools they need to succeed, including education, adequate housing, health care, nutrition, and support” (“FAQs and Testimonies”). Even though the East Bay Community Recovery Project is currently helping a larger population than CHFH, it seems to direct much of its’ focus towards drug rehabilitation programs, as opposed to individual and family therapy treatments—an idea that falls into the realm of “deservingness”. And although it claims to offer holistic health services, they are steered towards individuals with HIV or Hepatitis, instead of the individual or family experiencing mental health. Their population may encompass a broadened population that is beyond mental health, but in doing so, it does not ensure the same level of recovery and overall well-being like CHFH does in this sector of need. CHFH also offers services, such as child-care and recreational activities to elicit friendships and comradeship to be formed. Each of these programs offers mental-health support to low-income populations, but only CHFH offers a broadened scope of services that extend beyond treatment to the ensure happiness and security of each family that enters our center.

References

California Department of Health Care Services. (2016). Statewide aggregate specialty mental health services performance dashboard. Web.

California Health Care Foundation. (2013). California Health Care Almanac. Mental health care in California: Painting a picture. Web.

Department of Health Care Services. (2016). Medi-Cal specialty mental health services. Web.

Guide to Medi-Cal Mental Health Services. (2013). Web.

Schaper, E.C., Murphy, D.L., & Wirshing, W.C. (2014). Early evidence of the Affordable Care Act’s impact on the medically indigent population consuming emergency mental health care in Los Angeles county. The American Journal of Psychiatry, 171(10), 1117-1117. Web.

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Medi-Cal Expansion of Mental Health Services

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