Expanded Medi-Cal Behavioral Health Benefits Still Awaiting CMS Approval

January 3, 2014

On January 1, the Medi-Cal program expanded eligibility to include all citizens and legal permanent residents (LPRs) at or below 138% of federal poverty (roughly $16,000 for an individual and $32,500 for a household of four). However, one central piece of California’s expansion of Medi-Cal remains on hold. Last year, when Governor Jerry Brown and the California Legislature authorized expansion of the Medi-Cal program, they also wisely expanded behavioral health benefits (both mental health and substance use disorder (SUD) services). These benefits are not yet available because California is still waiting for approval from the federal Centers for Medicare and Medicaid Services (CMS) for its plan to implement the expanded benefits.

Expanded services include outpatient mental health treatment, intensive outpatient SUD services, residential SUD treatment, and voluntary inpatient detox. These services were previously restricted to certain groups of beneficiaries, such as pregnant women or children, and the expansion makes them available to all program beneficiaries, newly and previously eligible.

CMS’ should promptly expedite consideration of California’s plan for expanding Medi-Cal behavioral health benefits, known as a Medicaid State Plan Amendment (SPA). Many enrollees would benefit from these potentially life-changing services, and mental health and SUD service providers should be sure that they will receive payment for delivering them. California took a great step forward by authorizing expanded behavioral health benefits in the Medi-Cal program, and the delivery of the newly available services should begin as soon as possible.