Medi-Cal Expands Access to Mental Health, Substance Use Treatment

California is on the national front lines of making mental health and substance use disorder care easier to access for patients of Medi-Cal, its version of Medicaid.

At an Ethnic Media Services briefing, Department of Health Care Services (DHCS) leaders and community health care providers explained how Medi-Cal is helping Californians needing mental health and substance use disorder treatment lead healthier lives.

An overview of behavioral health

Behavioral health, including mental health and substance use, is just as important as physical health, and the outcomes are intertwined,” said Paula Wilhelm, interim deputy director of behavioral health services at DHCS. 

Medi-Cal, California’s Medicaid program, provides coverage for one in three — or 15 million — Californians.

To make it easier for members to access care, Medi-Cal is partnering with community organizations to provide behavioral care like mental health and substance use disorder screening, outpatient therapy and inpatient treatment.

To get these services, members can call their local county’s 24-hour access line.

“One thing we continue to hear from our MediCal members is that the complexity of navigating the healthcare system can keep people from accessing care,” said Wilhelm. 

DHCS is transforming Medi-Cal to address this through measures like the Mental Health Services Act funding substance use disorder and serious mental health conditions; expanding early intervention and housing support; and the No Wrong Door policy making appropriate, covered treatment available to all members.

Youth mental health

The youth mental health crisis is the defining public health issue of our time according to the U.S. Surgeon General, and Medi-Cal is being transformed to address it through the Children and Youth Behavioral Health Initiative, a $4.7 billion investment part of Governor Newsom’s Master Plan for Kids’ Mental Health.

“For over a decade, outcomes for youth have been worsening,” said Autumn Boylan, deputy director of the Office of Strategic Partnerships at DHCS. “Half of all lifetime cases of diagnosable mental illnesses emerge for youth by age 14, and 75 percent begin by age 24.”

In California, 284,000 kids have major depression, and 66% don’t get treatment.

To address this crisis, “we’re focusing our mental health care not only on hospitals and clinics, but also schools, where youth spend most of their time,” said Boylan. 

“We’re working with K-12, community college, University of California and California State University systems to have more reimbursed counselors; implement mindfulness and social skills programs; and invest in community interventions,” she added, “particularly for youth of color, those who are low-income, LGBTQ+, justice-involved and facing housing challenges,” she added.

Behavioral health in Humboldt County

“Our Medi-Cal contract has let us grow over the last few years to become one of the larger programs providing mental health and substance use care in Humboldt County,” said Jennifer Oliphant, director of the Chekws: Hope for Tomorrow program at Two Feathers Native American Family Services in McKinleyville. “We’ve built up intensive and rehabilitative care, workforce training with local universities, cultural workshops, peer counseling and horse therapy.”

In 2022, Two Feathers was also able to begin its youth leadership development program employing teenagers in adult-led groups to learn how to be future employees, develop social and emotional skills, go on college tours and learn about local cultural practices.

“We had one youth come in a few years ago who was struggling with substance use and on the fence about whether to seek counseling,” said Oliphant. “They entered our youth leadership program and got connected with a peer group, and then was motivated to get connected with our counselors … they’ve been with us nearly two years now and the change has been remarkable as they’ve stabilized their health issues and isolation while learning job skills and connecting with their community.”

“It’s devastating to see how impacted youth here are by the drug crisis,” she continued. In response, “We don’t have a separate substance use treatment service; rather, we’ve included it in mental health services to break down barriers to access.” 

“Expanded Medi-Cal has let us have a sustainable, growing behavioral health program with a consistent clinical roster, whereas before we’d have temporary grants here and there,” Oliphant added.

Behavioral health in Orange County

“When I first started in 2008, we didn’t have any mental health program at all, but I saw such a need for it here,” said Tricia Nguyen, CEO of Southland Integrated Services, a health clinic in Orange County which was first established as a Vietnam War refugee resettlement agency in 1979.

Orange County is the largest Vietnamese enclave outside Vietnam, currently home to over 209,000 Vietnamese people, according to the U.S. Census — over 6% of the area’s total population.

“There’s a generational mental health gaps,” Nguyen explained, “between the older generation who has suffered so much, and pass the guilt of needing to be a traditionally successful doctor, lawyer, engineer onto the kids … so we have isolation among seniors and anxiety, depression and suicide among pressured youth.”

The Centers for Disease Control reported in 2020 that suicide was the leading cause of death for AAPI Americans aged 10 to 19 and the second-leading cause of death for those aged 20 to 34.  

“Alongside programs like senior wellness classes, veteran counseling, psychiatric rehabilitation and digital literacy workshops already,” Nguyen said, “Medi-Cal grants allowed us to build six-week youth wellness workshops” incorporating arts and crafts, education around healthy sleep and eating, social media habits and parent communication strategies. 

“The parents feel that they’ve sacrificed everything for the kids’ success, while the kids feel that the parents don’t care about their wellbeing,” she continued. “Culturally, we can be open about diabetes and hypertension, but there’s still a stigma around mental health.”

“As we’ve grown our behavioral health programs, I’ve seen that stigma lessen,” Nguyen added. “Parents will come in now and ask for a therapist or screening for their child. It’s difficult to break taboos around mental health and substance abuse, but through these programs, we’re doing it.”