Assessing the Continuum of Care for Behavioral Health Services in California
Behavioral Health Assessment Report
About the Assessment
The COVID-19 pandemic has exacerbated behavioral health challenges—both mental health and substance use disorder—and placed significant demands on the existing system of care and workforce capacity. With behavioral health a top priority of the Newsom administration and the inequities across the health care system further exacerbated by the COVID-19 pandemic, it is the optimal time for the Department of Health Care Services (DHCS) to produce an updated assessment of California's behavioral health system. While DHCS will use the assessment to inform its work on initiatives such as the BHCIP and the SMI/SED 1115 waiver application, it is not the single source of information that will be used nor is it a description of the Administration's specific positions and plans. DHCS is committed to continuing to work closely with stakeholders to implement critical initiatives underway and develop future policy as behavioral health initiatives evolve.
Specifically, this assessment aims to do the following:
Provide a framework to describe the core continuum of behavioral health care services, making it possible to compare “what is" in California to “what should be."
Review the available data and gather insights from stakeholders and experts on the need for and supply of key behavioral health services in California.
Support design and implementation of various behavioral health initiatives, including the application to the Centers for Medicare and Medicaid Services (CMS) for an SMI/SED 1115 waiver and the Behavioral Health Continuum Infrastructure Program (BHCIP).
Explore issues and opportunities for specific populations – children, adolescents, and youth; American Indian/Alaska Native (AI/AN) individuals; and individuals who are justice-involved. These populations were identified by focus group participants in the early stages of the assessment as critical to address through an equity lens, but they should not be viewed as the only groups that warrant close attention.
Discuss the implications for DHCS' work and for California's broader efforts to strengthen the behavioral health system.
The assessment was prepared between July and November 2021 using data from existing California reports and surveys as well as California-specific information from national databases and a review of Medi-Cal (the state's Medicaid program) administrative claims. To integrate the perspectives of key stakeholders, the assessment also draws from a survey of counties' behavioral health directors conducted in partnership with the County Behavioral Health Directors Association of California (CBHDA) as well as stakeholder interviews and focus groups. The assessment provides some data and information on the broader behavioral health system in California, but focuses most heavily on the services available to Medi-Cal enrollees living with serious mental illness and substance use disorders. This reflects the prominent role of Medi-Cal in serving Californians experiencing these conditions, as well as DHCS's role as the steward of the Medi-Cal program. It is important to note that this data was collected at a time when the state is implementing numerous large scale programs that seek to address many of the problems detailed in this report, and thus, the data does not reflect the impacts of these recent significant investments.
DHCS is planning a webinar on the assessment for interested stakeholders. Webinar information will be posted here as well as announced through DHCS newsletters.
Date: January 21, 2022
California Behavioral Health Continuum Infrastructure Program (BHCIP)