Medi-Cal Managed Care Plans, Mental Health And Substance Use Disorder Benefits And Your Right To Equal Coverage

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This pub tells you about “Medi-Cal Managed Health Care Plans.” It tells you what to do if the plan denies a service. It tells you what to do if the plan stops or delays a service. It tells you your plan must give you equal coverage for mental and physical health conditions. 

 

Mental Health and Substance Use Disorder Benefits: Managed Care Plans

Medi-Cal beneficiaries receive certain mental health benefits through their Medi-Cal Managed Care Plans. These benefits include individual and group mental health evaluation and treatment, psychological testing, outpatient services for monitoring medication, treatment, outpatient laboratory services, medications, supplies, and supplements. Psychiatric consultation, screening, and brief intervention are also included.

Mental Health Benefits: County Mental Health Plans

County mental health plans continue to provide specialty mental health benefits and drug benefits. Examples include intensive day treatment, inpatient psychiatric services, crisis intervention, adult residential treatment services, methadone therapy, day care rehabilitation, and naltrexone for narcotic dependence.

Mental Health Parity

Mental health benefits provided by Managed Care Plans must meet equal coverage requirements under the law.  Access to appropriate doctors and medications, prior authorization requirements, treatment limitations, number of visits, and days of coverage must be equal for mental and physical health conditions. This is "mental health parity” and it is the law. 

Your Hearing Rights

When your Medi-Cal managed care plan denies, delays or discontinues a mental health service, you have the right to request a hearing. To keep the same benefits while you wait for a hearing, you must request a hearing within 10 days of the date of the notice.

Send your hearing request to:

California Department of Social Services
State Hearing Division
P.O. Box 944243, Mail Station 9-17-37
Sacramento, CA  94244-2430

Enforcement of Parity Laws

The California Department of Managed Health Care (DMHC) oversees the Medi-Cal Managed Care Plans.  If you are not satisfied with the outcome of an internal grievance, have a clinically “urgent” situation such as a transplant, cancer, cardiac or stroke patient experiencing access to care issues, delays in surgery, or medication issues, you can contact DMHC at 1-888-466-2219, or online at https://wpso.dmhc.ca.gov/ContactForm/.

This information is provided to you through the combined effort of the following organizations:

Disability Rights California
(916) 504-5800 or (800) 776-5746

Mental Health Advocacy Project
(408) 293-4790

Legal Aid Society of San Diego, Inc.
(877) 534-2524

Mental Health Advocacy Services, Inc.
(213) 389-2077

 

 

The California Mental Health Services Authority (CalMHSA) is an organization of county governments working to improve mental health outcomes for individuals, families and communities.  Prevention and Early Intervention programs implemented by CalMHSA are funded by counties through the voter-approved Mental Health Services Act (Prop 63).  Prop. 63 provides the funding and framework needed to expand mental health services to previously underserved populations and all of California’s diverse communities.