The Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) initiative is designed to increase access to and strengthen the continuum of community-based behavioral health services for Medi-Cal members living with significant behavioral health needs. BH-CONNECT is comprised of a five-year Medicaid Section 1115 demonstration and State Plan Amendments (SPAs) to expand coverage of evidence-based practices (EBPs) available under Medi-Cal, as well as complementary guidance and policies to strengthen behavioral health services statewide. The implementation of BH-CONNECT across California by county behavioral health delivery systems (“counties" from this point forward, inclusive of mental health plans (MHPs), Drug Medi-Cal (DMC) programs and Drug Medi-Cal Organized Delivery System (DMC-ODS) programs) began in 2025.
The BH-CONNECT initiative includes a wide range of programs and services to support Medi-Cal members living with significant behavioral health needs. Some components of BH-CONNECT are required for all counties, including clarification of existing Medi-Cal coverage for EBPs focused on children and youth under Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirements, Activity Funds, and other initiatives for children and youth. Other components of BH-CONNECT are optional for counties, including coverage of EBPs for adults and Community Transition In-Reach Services, and participation in the MH IMD FFP Program, the Access, Reform and Outcomes Incentive Program, and the Workforce Initiative. Additional information about the components of BH-CONNECT is available on the DHCS website.
Some components of BH-CONNECT are required for all counties, and other components are optional for counties. Coverage of EBPs for adults and Community Transition In-Reach Services, and participation in the MH IMD FFP Program, the Access, Reform and Outcomes Incentive Program, and the Workforce Initiative are optional for counties. Information about how to participate in the optional components of BH-CONNECT is on the DHCS website. Counties are not required to opt in to those programs. Counties that have opted in can retract their commitment to participate in an optional component of BH-CONNECT by emailing BH-CONNECT@dhcs.ca.gov.
Yes, DHCS is committed to supporting counties in participating in BH-CONNECT with training and technical assistance. Counties will have access to training, technical assistance, and fidelity monitoring support to implement EBPs for adults and children and youth through Centers of Excellence (COEs). Additional information about COEs is available on the DHCS COE website. Counties participating in the Incentive Program may also attend optional office hours sessions with the National Committee for Quality Assurance (NCQA) to support Incentive Program submissions related to the NCQA Managed Behavioral Healthcare Organization (MBHO) standards. Counties can email BH-CONNECT@dhcs.ca.gov with other questions related to BH-CONNECT.
BH-CONNECT and BHT include many complementary programs designed to support the most vulnerable Californians living with mental health conditions and substance use disorders. BH-CONNECT and BHT both:
Additional resources will be posted on the DHCS website when available.
Counties have the option to cover some or all BH-CONNECT EBPs for adults as bundled Medi-Cal services. However, counties that participate in the option to receive federal financial participation (FFP) for short-term stays in Institutions for Mental Diseases (IMDs) must also cover ACT, FACT, CSC, IPS Supported Employment, and Enhanced CHW Services. Counties that cover Community Transition In-Reach Services must also cover ACT, FACT, CSC and IPS Supported Employment.
Yes, counties may opt in to some or all EBPs at a later date. For more information on how to opt in to cover one or more EBPs, please refer to page 4 of BHIN 25-009.
No, counties must opt to cover the EBP to claim the bundled Medi-Cal rate for that EBP.
After opting in to cover an EBP under Medi-Cal, counties must claim the bundled rate for all services delivered to members that meet the requirements in BHIN 25-009 (i.e., the minimum number of contacts were delivered to a member that month and the team delivering the EBP has achieved Fidelity Designation or is within 9 months of its first fidelity assessment). Counties should not claim for “unbundled" Medi-Cal-covered services instead of claiming for the bundled service if all requirements were met.
The bundled rates for BH-CONNECT EBPs are considered all-inclusive. Counties must submit one claim per member per month for EBP services delivered by a team of behavioral health practitioners. Counties should not submit separate claims on behalf of individual behavioral health practitioners for services delivered as part of the team-based EBP. Rates for all BH-CONNECT EBPs are posted on the Medi-Cal Behavioral Health Fee Schedule.
While ACT, FACT, CSC, IPS and Clubhouse providers are not required to staff a licensed practitioner, the California Medicaid State Plan requires that SMHS, including ACT, FACT, CSC, IPS Supported Employment, and Clubhouse Services, be provided by or under the direction of the following mental health providers functioning within the scope of their professional license and applicable state law: a physician; a licensed or waivered psychologist; a licensed, waivered or registered social worker; a licensed, waivered or registered marriage and family therapist; a licensed, waivered or registered professional clinical counselor; a registered nurse (including a certified nurse specialist, or a nurse practitioner); or a licensed occupational therapist.
DHCS has contracted with UCLA Public Mental Health Partnership (UCLA PMHP), Early Psychosis Intervention California (EPI-CAL), the IPS Employment Center, and Clubhouse International to serve as Centers of Excellence (COEs) for ACT/FACT, CSC, IPS Supported Employment, and Clubhouse Services, respectively. The COEs will provide counties and behavioral health practitioners with training, technical assistance, and fidelity monitoring or accreditation support free of charge. More information about COEs can be found on the DHCS COE website or by emailing bhcoe.info@dhcs.ca.gov.
DHCS is developing detailed guidance on the training, technical assistance, and fidelity assessment requirements for ACT, FACT, CSC and IPS Supported Employment, which will be issued in late 2025. Preliminary policy requirements and operational guidance for all EBPs is available in BHIN 25-009 and the BH-CONNECT EBP Policy Guide.
How will DHCS measure and evaluate member-reported outcomes associated with EBPs?
DHCS recognizes that member-reported data is essential to understanding if EBPs are effectively supporting the recovery of participating members. DHCS is developing guidance on reporting requirements for ACT, FACT, CSC and IPS Supported Employment, which will be issued in late 2025.
My county has limited workforce availability to implement EBPs. Is there any flexibility in the EBPs to account for workforce constraints?
Each COE will work with counties to support delivery of EBPs with fidelity to the evidence-based models. In addition, DHCS encourages counties and behavioral health providers to utilize funding available through the BH-CONNECT Workforce Initiative to support the recruitment and retention of a robust behavioral health workforce.
How do Enhanced Community Health Worker (CHW) Services differ from “regular" CHW Services?
Enhanced CHW Services include the same service components as “regular" CHW Services and are provided by CHWs with the same qualifications. Enhanced CHW Services are specifically for Medi-Cal members who meet the access criteria for SMHS and/or DMC/DMC-ODS services. The Enhanced CHW Services benefit provides a mechanism for county behavioral health delivery systems to be paid for Medi-Cal-covered services provided by CHWs.
How do Enhanced CHW Services differ from Peer Support Services?
Enhanced CHW Services are distinct from Peer Support Services. As described in BHIN 25-028, both Enhanced CHW Services and Peer Support Services are community-based interventions to support members living with significant behavioral health needs. CHWs are community members who typically act as a bridge between members and the healthcare system and provide system navigation and health education support. Peer Support Specialists, on the other hand, use their personal lived experience to support members in their recovery from a behavioral health condition and provide skill-building, coaching, and other therapeutic activities.
While both CHWs and Peer Support Specialists rely on their lived experience, lived experience is defined more broadly for CHWs. CHWs must have lived experience that aligns with and provides a connection between the CHW and the member or community being served. This may include, but is not limited to, experience related to incarceration, military service, pregnancy and birth, disability, foster system placement, homelessness, mental health conditions or substance use disorders, or being a survivor of domestic or intimate partner violence or abuse and exploitation. Lived experience may also include shared race, ethnicity, sexual orientation, gender identity, language, or cultural background with one or more linguistic, cultural, or other groups in the community for which the CHW is providing services. Peer Support Specialists must have lived experience specific to mental health and/or substance use disorder recovery.
Peer Support Specialists who are separately trained and certified as CHWs may also provide Enhanced CHW Services to eligible members, and CHWs who are separately trained and certified as Peer Support Specialists may also provide Peer Support Services. In this scenario, the individual practitioner may provide only one service at a time and all applicable Medi-Cal policies for documentation and claiming of services must be observed.
What are the requirements to provide Enhanced CHW Services?
Enhanced CHW Services are delivered by practitioners that meet the following qualifications:
- CHWs must have lived experience that aligns with and provides a connection between the CHW and the community being served.
- CHWs must demonstrate minimum qualifications through the Certificate Pathway and/or Work Experience Pathway defined in SPA 24-0052.
- CHWs must complete a minimum of 6 hours of continuing education training annually.
- CHWs must be supervised by a Medi-Cal-enrolled community-based organization, local health jurisdiction, licensed provider, pharmacy, hospital, or clinic as defined in 42 CFR 440.90.
Are counties restricted from providing multiple EBPs to members concurrently?
As outlined in BHIN 25-009, ACT, FACT, and CSC are comprehensive outpatient services. A member receiving one of these services should generally not require any additional SMHS outpatient services beyond those delivered by their ACT, FACT, or CSC team; however, other services may be provided if clinically appropriate and the provider has coordinated care to ensure services are complementary and not duplicative. ACT shall not be claimed in the same month as FACT is claimed for a member, and CSC shall not be claimed in the same month as ACT or FACT is claimed for a member. However, members may receive ACT and IPS Supported Employment concurrently, or CSC and IPS Supported Employment concurrently. Members can also receive Clubhouse Services or Enhanced CHW Services concurrently with any team-based EBPs.
I understand that a member cannot receive Medi-Cal-covered IPS Supported Employment if they also have access to IPS Supported Employment through the Department of Rehabilitation. How will providers know if a member is eligible for IPS Supported Employment through the Department of Rehabilitation?
The IPS Supported Employment COE will provide counties with technical assistance on how to effectively coordinate delivery of IPS Supported Employment across the Medi-Cal and Vocational Rehabilitation programs when IPS Supported Employment is available through both programs.
Is coverage of EBPs required for members under age 21?
Yes, consistent with Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements, counties must cover EBPs for members under age 21, if the service is medically necessary, even if the county has not opted to cover the EBP as part of BH-CONNECT.
How does coverage of ACT, FACT, CSC and IPS Supported Employment under BH-CONNECT differ from the requirements under the BHSA to offer ACT, FACT, CSC and IPS Supported Employment?
Under the BHSA, all counties are required to provide ACT, FACT, CSC and IPS Supported Employment in their Full Service Partnership (FSP) and/or Early Intervention programs by July 2026. Counties that do not opt in to cover EBPs under BH-CONNECT must still meet all BHSA requirements.
Under BH-CONNECT, counties have the option to provide ACT, FACT, CSC, and IPS Supported Employment as Medi-Cal covered services and receive federal matching funds.
All ACT, FACT, CSC and IPS Supported Employment services will be held to the same fidelity standards regardless of whether the county opts to cover the service under Medi-Cal.
Can my county use other available funds, including BHSA funds, to support implementation of EBPs?
Yes, counties may use other available funds, including BHSA funds, to support the implementation of EBPs. BHSA funds should not be used for activities that are covered by Medi-Cal. BHSA funds must comply with all BHSA requirements and must be used for activities that are not otherwise covered under Medi-Cal, including outreach and engagement to individuals not enrolled in Medi-Cal and other recovery supports (e.g., items that offer emotional support, like a musical instrument).
EBPs for Children and Youth: Multisystemic Therapy (MST), Functional Family Therapy (FFT), Parent-Child Interaction Therapy (PCIT), High Fidelity Wraparound (HFW)
Are BH-CONNECT EBPs for children and youth required or optional?
All counties are required to provide MST, FFT PCIT, and HFW to Medi-Cal members under age 21 pursuant to Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirements.
Though eligible children and youth under age 21 can already receive MST, FFT, PCIT, and HFW through Medi-Cal, DHCS is committed to ensuring that these EBPs are provided with fidelity to the evidence-based models. As part of the BH-CONNECT initiative, DHCS plans to release guidance which updates and clarifies existing Medi-Cal coverage of these EBPs to align with national practice standards and implements updated payment models within the SMHS system.
Are there bundled rates for EBPs for children and youth?
DHCS has established a monthly bundled rate for MST services. FFT and PCIT do not have bundled rates. Additional guidance on HFW, including payment information, is forthcoming. Rates for all BH-CONNECT EBPs posted on the DHCS website.
What training and technical assistance is available to support implementation of EBPs for children and youth?
DHCS has contracted with PCIT International, MST Services, and FFT, LLC to serve as COEs for EBPs for children and youth. The COEs will provide counties and behavioral health practitioners with training, technical assistance, and fidelity monitoring or certification support free of charge. DHCS also plans to contract with a COE to support implementation of HFW. More information about COEs can be found on the DHCS COE website or by emailing bhcoe.info@dhcs.ca.gov.
How do the EBPs for children and youth under BH-CONNECT intersect with the EBPs and community-defined evidence practices (CDEPs) under the Children and Youth Behavioral Health Initiative (CYBHI)?
Under CYBHI, counties may access up to $381 million in grant funding over five rounds to launch a set of EBPs and CDEPs, which include the EBPs for children and youth under BH-CONNECT. Counties may use any grant funding they receive under CYBHI to cover training start-up costs incurred while implementing MST, FFT, PCIT and HFW.
How do the EBPs for children and youth under BH-CONNECT intersect with the EBPs available through the Family First Prevention Services Act (FFPSA)?
MST, FFT, and PCIT are recognized as EBPs by both BH-CONNECT and California's FFPSA five-year implementation plan (2024-2029) and abide by the same fidelity standards and referral pathways. Counties must bill Medi-Cal first for covered services but may use Title IV-E funds available through FFPSA to cover other complementary services not covered by Medi-Cal as a “payer of last resort."
My county is very interested in participating in the MH IMD FFP Program. How do I apply to participate?
Counties must submit an IMD FFP Plan that is approved by DHCS to participate in the MH IMD FFP Program. The IMD FFP Plan can be found on the DHCS website and may be submitted to DHCS at any time.
How quickly will DHCS review and approve our county's IMD FFP Plan? If our IMD FFP Plan is not approved, will we have an opportunity to revise and re-submit it?
DHCS will review IMD FFP Plans as they are submitted. There is no set review timeframe. Counties will have the opportunity to revise and resubmit IMD FFP Plans if not approved after the initial submission.
Will there be technical assistance available if my county has questions while completing the IMD FFP Plan?
Counties can reach out to BH-CONNECT@dhcs.ca.gov with any questions that arise while completing the IMD FFP Plan.
When can my county begin billing for services provided in participating IMDs?
DHCS is updating claiming systems to allow counties to submit claims under the MH IMD FFP Program. Counties should not submit claims under this program until DHCS provides additional claiming guidance and confirms system updates are in place. Once systems updates are in place and DHCS has approved the IMD FFP Plan, counties may submit claims for qualifying IMD stays. Stays may be claimed retroactively, back to the date the county can demonstrate it provided both Peer Support Services, and Enhanced CHW Services, as indicated in claims data.
What types of IMDs are eligible for FFP?
Freestanding Acute Psychiatric Hospitals (APHs), Mental Health Rehabilitation Centers (MHRCs), and Psychiatric Health Facilities (PHFs) are the facility types eligible for FFP through the MH IMD FFP Program. These facilities that participate in the MH IMD FFP Program are collectively referred to as “Participating Psychiatric Settings."
Do I need to identify which IMDs in my county will be eligible for FFP?
Yes, as part of the IMD FFP Plan, counties must complete a Participating Psychiatric Settings List, which indicates which IMDs they would like to participate in the MH IMD FFP Program. The Participating Psychiatric Settings List must be submitted to DHCS as part of counties' IMD FFP Plan submissions. Counties can contact BH-CONNECT@dhcs.ca.gov for the Participating Psychiatric Settings List template.
My county works with an IMD that serves members from multiple counties. Can my county be paid for services provided in that IMD?
Yes, counties may claim for services provided to their member in an IMD in different county, so long as the IMD is included in the Participating Psychiatric Settings List that is submitted as part of the IMD FFP Plan.
What types of services delivered in an IMD are eligible for FFP?
All Medi-Cal-covered services provided to adult Medi-Cal members ages 21 to 64 during short-term stays in Participating Psychiatric Settings (classified as IMDs if they meet the specified requirements in 42 CFR Section 435.1010) are eligible for FFP.
If a member has an inpatient or residential stay that extends longer than 60 days, are the first 60 days of the stay eligible for FFP?
No, if a stay in an IMD exceeds 60 days, FFP is not available for any day of the treatment episode.
How often is the statewide average length of stay (ALOS) calculated? Are all stays in my county's Participating Psychiatric Settings included in the ALOS calculation, or just stays for which my county is receiving FFP?
DHCS will calculate the statewide ALOS at least annually. Only stays for which FFP is claimed – not all stays in Participating Psychiatric Settings – will be included in ALOS calculations.
Will my county become ineligible for FFP for IMD stays if our county-wide average length of stay exceeds 30 days?
Counties participating in the MH IMD FFP Program must monitor their county-wide ALOS on a regular basis. If a county is unable to maintain a county-wide ALOS of 30 days or fewer, DHCS may reduce the maximum length of stay eligible for FFP in that county from 60 to 45 days or may disallow the county from continuing to participate in the MH IMD FFP Program.
How will DHCS monitor the MH IMD FFP Program requirements related to member screenings, discharge planning, and post-discharge contact?
As part of the IMD FFP Plan, counties must describe how they will meet requirements related to screenings, discharge planning, and post-discharge contact. DHCS will use information in the IMD FFP Plan to ensure requirements are being met and may follow up with participating counties for additional information about how they meet requirements. Counties must be prepared to submit documentation that supports the new or updated policies described in the IMD FFP Plan upon request from DHCS.
Which EBPs does my county need to cover to be eligible to participate in the MH IMD FFP Program? Do these EBPs need to be fully implemented in advance of billing for services provided in mental health IMDs?
To participate in the MH IMD FFP Program, counties must opt to cover ACT, FACT, CSC, IPS Supported Employment, Enhanced CHW Services, and Peer Support Services, including the forensic specialization.
Counties must demonstrate they are delivering Enhanced CHW Services and Peer Support Services prior to claiming FFP for IMD stays, as indicated in claims data. Counties must cover ACT and Peer Support Services with a forensic specialization within 1 year of claiming FFP for IMD stays; FACT and CSC within 2 years of claiming FFP for IMD stays; and IPS Supported Employment within 3 years of claiming FFP for IMD stays.
Does my county need to complete a Letter of Commitment in advance of covering each EBP if my county is also participating in the MH IMD FFP Program?
Yes, counties must submit a letter of commitment to opt in to required EBPs in addition to the IMD FFP Plan. Letters of commitment for EBPs may be submitted on a rolling basis after initial submission of the IMD FFP Plan, so long as the county meets the timeline requirements described in the answer above and in BHIN 25-011. Letters of commitment for EBPs may be submitted on the DHCS website.
Does my county need to participate in the MH IMD FFP Program to be eligible for the Incentive Program?
No, counties that participate in the Incentive Program are not required to participate in the MH IMD FFP program. Additional information about participation in the Incentive Program is in BHIN 25-006 and information about the opportunity to receive FFP for IMD stays is in BHIN 25-011.
Does my county need to cover all BH-CONNECT EBPs to be eligible for the Incentive Program?
No, counties are not required to cover all BH-CONNECT EBPs to participate in the Incentive Program. However, counties are only eligible for incentive funding related to increased utilization of EBPs and improved member outcomes related to EBPs if they opt in to cover those EBPs. For example, a BHP must cover and implement ACT to be eligible to earn any incentive payments for measures related to ACT. BHPs cannot earn incentive dollars for measures related to an EBP until the BHP covers and implements that EBP.
Can my county receive an incentive payment tied to an EBP if we are providing the EBP under BHSA and not opting in to cover the EBP under Medi-Cal?
No, counties must cover EBPs under Medi-Cal to receive incentive payments tied to the EBPs.
Can my county still complete the targeted Managed Behavioral Healthcare Organization (MBHO) self-assessment with the National Committee for Quality Assurance (NCQA) and participate in the Incentive Program?
No, counties must have completed the NCQA MBHO self-assessment in 2024 to participate in the Incentive Program, as described in BHIN 24-019.
Can my county participate in the Incentive Program if it did not submit a letter of intent by March 31, 2025?
No, counties must have submitted a letter of commitment by March 31, 2025, to participate in the Incentive Program, as described in BHIN 25-006.
How much incentive program funding may a county earn by participating in the Incentive Program?
DHCS has received expenditure authority from CMS for $1.9 billion total computable over five years for the Incentive Program. Each participating county will be eligible to earn up to a specified, capped amount of Incentive Program funding each demonstration year based upon achievement of specified performance targets. Participating counties will receive information about their county-specific funding allocations from DHCS in summer 2025.
How were measures selected for the Incentive Program?
DHCS selected measures for the Incentive Program based on an analysis of key areas for improvement, including the results from the NCQA MBHO assessment, access to behavioral health services, outcomes among Medi-Cal members living with significant behavioral health needs, and behavioral health delivery system reforms. Where possible, measures were selected from nationally recognized sources and measure sets as well as existing DHCS initiatives. Where existing measure sets did not fully address BH-CONNECT goals, new measures were developed.
Where will detailed technical specifications be available for the Incentive Program measures?
Detailed technical specifications for each measure are under development. DHCS anticipates specifications for measures that are pay-for-performance in demonstration year 1 (2025) will be shared no later than fall 2025.
Will DHCS share how performance on each measure will be calculated?
Yes, performance benchmarks for each measure are forthcoming and will be posted publicly on the DHCS website.
Will DHCS calculate measures for the Incentive Program? Is my county expected to provide data and/or calculate measures ourselves?
Wherever possible, DHCS will calculate Incentive Program measures on behalf of participating counties. Counties will develop and submit all narrative submissions.
When are Incentive Program submissions due?
Incentive Program submissions are due every year on June 30, from 2025 through 2030, beginning with Submission 1, which was due on June 30, 2025. The full Incentive Program submission and payment timeline is outlined in BHIN 25-006.
Is my county required to complete every Incentive Program submission? Are there penalties for not completing submissions?
No, counties are not required to complete every submission and there are no financial penalties for BHPs for not completing submissions. However, counties are not eligible for Incentive Program funding for benchmarks that are not met or submissions that are not completed. DHCS strongly encourages counties to complete all Incentive Program submissions, as the Incentive Program measures are designed to build upon each other over the course of the five-year program.
What training and technical assistance is available to support my county's participation in the Incentive Program?
DHCS is actively discussing technical assistance opportunities regarding the NCQA MBHO-related components of the Incentive Program. For general questions regarding the Incentive Program, please contact BH-CONNECT@dhcs.ca.gov.
Do counties need to “opt in" to participate in the Workforce Initiative?
No, counties do not need to “opt in" to participate in the Workforce Initiative. Workforce Initiative funding will be awarded to grantees through an application process.
What are the different programs available as part of the Workforce Initiative?
The Workforce Initiative includes five workforce programs to address shortages in qualified practitioners serving Medi-Cal members and uninsured individuals who are living with or at-risk for behavioral health conditions:
- Medi-Cal Behavioral Health Student Loan Repayment Program
- Medi-Cal Behavioral Health Scholarship Program
- Medi-Cal Behavioral Health Recruitment and Retention Program
- Medi-Cal Behavioral Health Community-Based Provider Training Program
- Medi-Cal Behavioral Health Residency Training Program
Additional information about all Workforce Initiative programs is available on the HCAI website.
What does my county need to do to be eligible for funding through the Workforce Initiative?
Different entities that support the county behavioral health system may be eligible for different Workforce Initiative programs. For example, county-operated and county-contracted organizations may be eligible for recruitment and retention funding (e.g., hiring and retention bonuses; backfill costs). Educational institutions, training programs and community-based organizations that educate and train future Medi-Cal behavioral health providers may be eligible for funding through the community-based provider training program or residency training program. When available, specific eligibility criteria and application instructions for each Workforce Initiative program will be posted on the HCAI website.
When will funding for Workforce Initiative programs be available?
Some Workforce Initiative programs, including the student loan repayment and residency training programs, will launch in July 2025. Other programs will launch at the beginning of 2026. Once available, applications will be posted on the HCAI website.
Where can I learn more about the Workforce Initiative?
Counties can learn more about the Workforce Initiative on the DHCS website and the HCAI website.
Forthcoming
Forthcoming
Forthcoming
