Medi-Cal Specialty Mental Health Services
The Department of Health Care Services (DHCS) administers California’s Medicaid (Medi-Cal) program. 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 & Medicaid Services (CMS) under Section 1915(b) of the Social Security Act. As the single state Medicaid agency, DHCS is responsible for administering the Medi-Cal SMHS waiver program, which provides SMHS to Medi-Cal beneficiaries through county mental health plans (MHPs). The MHPs are required to provide or arrange for the provision of SMHS to beneficiaries in their counties that meet medical necessity criteria, consistent with the beneficiaries’ mental health treatment needs and goals.
DHCS submitted the CalAIM Section 1915(b) waiver application to CMS. The application is a renewal and amendment to the SMHS Section 1915(b) waiver – called the CalAIM Section 1915(b) waiver – that includes the SMHS program, as well as streamlined authorization for Medi-Cal managed care, dental managed care, and the Drug Medi-Cal Organized Delivery System (DMC-ODS). DHCS is requesting approval by December 2021 to enable implementation in January 2022.