Specialty Mental Health Services for Children and Youth
The Department of Health Care Services (DHCS) administers California’s Medicaid program (Medi-Cal). The Medi-Cal Specialty Mental Health Services (SMHS) program is “carved-out” of the broader Medi-Cal program and operates under the authority of a waiver approved by the Centers for Medicare and Medicaid Services under Section 1915(b) of the Social Security Act. DHCS is responsible for administering and overseeing the Medi-Cal SMHS Waiver Program, which provides SMHS to Medi-Cal beneficiaries through county mental health plans (MHPs). MHPs are required to provide or arrange for the provision of outpatient and inpatient SMHS to beneficiaries in their counties who meet SMHS medical necessity criteria, consistent with the beneficiaries’ mental health treatment needs and goals, as documented in their client plans. In accordance with Medicaid Early and Periodic Screening, Diagnostic, and Treatment provisions, the intervention criteria for beneficiaries under the age of 21 are less stringent than they are for adults.
If you think you or your child need specialty mental health treatment services, you can call your MHP toll-free phone number and ask for an appointment for an initial assessment.
You may also be referred to your MHP for SMHS by another person or organization, including your doctor, school, a family member, guardian, your Medi-Cal managed care health plan, or other county agencies. Usually your doctor or the Medi-Cal managed care health plan will need your permission, or the permission of the parent or caregiver of a child, to make the referral directly to the MHP, unless there is an emergency. Your MHP may not deny a request for an initial assessment to determine whether you or your child meet the criteria to receive services from the MHP.
If you are having trouble accessing services, you may call the DHCS Office of the Ombudsman.