SACRAMENTO (Calif.) — Sacramento and Solano counties are locked in a dispute with the state about mental health coverage for a small portion of Medicaid patients in their counties. This dispute threatens to disrupt treatment for almost 50,000 residents who have severe mental illness.
The Department of Health Care Services administers Medi-Cal. It says Sacramento and Solano must manage and provide specialty mental health care for the thousands of Medi-Cal patients who are enrolled in Kaiser Permanente plans. California’s 56 remaining counties operate in the same way, so it insists on shifting that responsibility. Officials in the state claim that the change would simplify the state’s fragmented mental health system. It is necessary to implement a larger transformation for Medi-Cal. CalAIM is also known..
Health officials from the state Counties were given until March 15, California will accept Kaiser Permanente patients so that they can transfer their mental health care to other counties. The two counties are not. Refusal of the transferThey argue that they cannot adequately care for the large number of Medi-Cal patients suffering from severe mental illnesses such as schizophrenia and bipolar disorder without additional funding. Medi-Cal officials are now threatening severe penalties and possibly terminating their mental health contracts with these counties.
Local officials warn that the state’s plan could result in 39,000 patients in Sacramento County, and 8,000 in Solano County being treated. Their care will be disrupted For example, you may have to look for a new psychiatrist.
“For someone with schizophrenia or other serious mental disorders, it took a long time for them to establish a trusting relationship with their provider. Now they will see that care interrupted or need to find another provider,” stated Debbie Vaughn assistant county administrator for Solano County. There will be dangers of people entering crisis.
Ryan Quist, Sacramento County’s director of behavioral health services, stated that counties require more funding and more time to provide care. He said, “The state plays chicken with their lives.”
Under state law, Responsibilities lie with the countries For administering and delivering specialist care to Medi-Cal patients suffering from severe mental illness. Medi-Cal managed care insurers are responsible to provide treatment for mild and moderate mental health conditions such as anxiety and low-level depression.
But under a This arrangement is decades old California, along with the California counties of Sacramento and Solano paid Kaiser Permanente for all its mental health care. The state has decided to end that arrangement. This will force approximately 7,000 of the county’s specialty mental health patients to leave Kaiser Permanente in favor of county-run mental healthcare plans.
Officials from the state claim that both counties have a legal obligation to care for Medi-Cal patients suffering from severe mental illness. If the counties refuse to do so, it would put patients at risk. Medi-Cal patients who are enrolled in other health plans than Kaiser Permanente receive their specialized mental healthcare directly from the counties.
Tony Cava, spokesperson for the Department of Health Care Services, stated that “Sacramento or Solano counties’ failures to engage in this process puts Medi-Cal members at danger of losing access to crucial Medi-Cal entitlement services.” If the counties refuse to comply with their obligations, DHCS will be forced to take legal action.
Cava stated that while the state may consider sanctions or ending the contracts of the counties, he said that contract termination is not DHCS preferred approach. He also declined to give more details, saying that the agency would “identify options to continue coverage for Kaiser Permanente patients.”
He stated that transferring patients to counties will create a “more consistent and seamless system of health care by reducing complexity while increasing flexibility.”
Counties receive a portion from state sales tax revenue and vehicle registration fees to help fund special mental health care. However, they are currently receiving less than the full amount. The agreement in Sacramento and SolanoThe state has been paying Kaiser Permanente out of its general fund to cover a portion the insurer’s Medi-Cal enrollments’ mental health care needs.
California would cease to distribute general-fund money to counties under the new shift. Instead, the counties would be eligible to receive a larger share of existing vehicle license fee and sales tax revenues that are set aside by a 2011 arrangement. The counties claim Kaiser Permanente’s special mental health patients were not within their jurisdiction at the time the agreement was reached. This underlines their Legal argument The state should pay for their healthcare.
The state offers $11.6 million more annually to Sacramento, and $7.7 millions to Solano each year. This would allow the state to draw down additional federal funds. This money would come from other counties’ revenue for behavioral health treatment.
Michelle Doty Cabrera is the executive director of County Behavioral Health Directors Association. “This takes money from other county,” she said. “Across California we’re experiencing a greater demand, especially after the pandemic.”
Sacramento County seeks $36 million more annually to cover an 16% rise in patients (4,836 people). For an increase of 50% in its patient load, Solano County needs nearly $17million more per year. This would be 2,091 patients.
According to behavioral health officials, counties are also having difficulty recruiting and retaining mental health professionals who can serve Medi-Cal patients.
Le Ondra Clark Harvey (CEO of the California Council of Community Behavioral Health Agencies), which represents local mental healthcare providers, stated that “our system is already bursting”
Officials from the state believe both counties have sufficient mental health professionals, with Sacramento County being the only exception. Sacramento County may need two to three more psychiatrists to care for its children.
Kaiser Permanente stated to KHN it didn’t ask for patients to be moved from its network of care, and that it informed the state that it would continue to serve them. It eventually agreed to transfer the care to the counties.
Gerri Ginsburg spokesperson stated that while she had expressed her preference to continue providing specialty care for this vulnerable population, “we respect state’s long term objectives.”
This story was created by KHNThe publication is published by. California HealthlineThe editorially independent service of The California Health Care Foundation.