Specialty Mental Health Consolidation Program (SMHC)

Provides mental health services for enrollees with specified diagnoses requiring treatment by licensed mental health professionals through county mental health plans.

• Type of Waiver
• Eligibility Requirements
• Services Provided
• Funding Source
• Enrollment Cap
• Waiver Term
• Links for Additional Information
 

Type of Waiver

1915(b) Freedom of Choice Waiver

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Eligibility Requirements

All Medi-Cal beneficiaries are eligible to receive Specialty Mental Health Consolidation Program services if they meet all three of the diagnoses, impairment and intervention criteria described below:

Diagnosis Criteria – Medi-Cal beneficiaries must have one or more of the following DSM IV diagnoses (or comparable ICD-9 diagnoses):  

• Pervasive Developmental Disorders (except autistic disorder);

• Attention Deficit and Disruptive Behavior Disorders;

• Feeding & Eating Disorder of Infancy or Early Childhood;

• Elimination Disorders;

• Other Disorders of Infancy, Childhood, or Adolescence;

• Schizophrenia & Other Psychotic Disorders;

• Mood Disorders;

• Anxiety Disorders;

• Somatoform Disorders;

• Factitious Disorders;

• Dissociative Disorders;

• Paraphilias;

• Gender Identity Disorders;

• Eating Disorders;

• Impulse-Control Disorders Not Elsewhere Classified;

• Adjustment Disorders;

• Personality Disorders (excluding Antisocial Personality Disorder); or

• Medication-Induced Movement Disorders.

Impairment Criteria – Beneficiaries must have one of the following conditions resulting from the disorder(s) in "A":

• A significant impairment in an important area of life functioning; or

• A probability of significant deterioration in an important area of life functioning; or

• For children (under age 21), a probability that the child will not progress developmentally as individually appropriate.  Children covered under Early Periodic Screening, Diagnosis, and Treatment (EPSDT) qualify if they have a mental disorder which can be corrected or ameliorated (current DHS EPSDT regulations apply).

Intervention Related Criteria – Medi-Cal Beneficiaries are only eligible to receive services if: 

• The service is to address the condition identified in "B";

• It is expected that the service will significantly improve the condition identified in "B"; and 

• The condition would not be responsive to physical healthcare based treatment.

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Services Provided

• Psychiatric Inpatient Hospital Services
• Nursing Facility Care
• Individual, Group and Family Therapy and Other Therapeutic Interventions in Outpatient or Clinic Settings or in the Community
• Professional Services by Psychiatrists, Psychologists, Licensed Clinical Social Workers (LCSWs), and Marriage and Family Therapists (MFTs)
• Crisis Intervention and Stabilization Services
• Partial-Day or Day Treatment Programs
• Crisis Residential Treatment Programs for Adults
• Adult Residential Treatment Programs
• Psychiatric Health Care Facility Services
• Targeted Case Management
• EPSDT Supplemental Services Including Professional Services by Licensed Clinical Social Workers (LCSWs) and Marriage and Family Therapists (MFTs),
• Case Management Services, and Therapeutic Behavioral Services for EPSDT Eligible Beneficiaries

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Funding Source

• State General Fund
• Federal Medicaid Funds
• County Realignment Funds 

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Enrollment Cap

No cap requirements (not applicable; all Medi-Cal beneficiaries are considered enrolled)

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Waiver Term

July 1, 2007 through June 30, 2009

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Links for Additional Information

Social Security Act - Title XIX
1915(b) Freedom of Choice Waiver
Contact Information

Data Current as of May 29, 2007