Child Welfare Overview

Medi-Cal and Child Welfare

Purpose

Provide information to Child Welfare Agencies (CWAs) about Medi-Cal plans and the services they provide. Assist CWAs and the families they serve to gain a better understanding of Fee-For-Service (FFF) and Managed Care Plans (MCPs), and foster youth Medi-Cal mental health services so an educated choice can be made when picking a health care plan for foster youth.

Medi-Cal is the Medicaid program in California that allows low-income individuals and families access to medical providers and services. The California Department of Health Care Services (DHCS) and the Centers for Medicare and Medicaid Services (CMS) oversee the program.

Mental Health
Children and families involved in child welfare must navigate complex systems such as medical care, behavioral health, social services, intellectual and developmental services, education, and the justice system. Mental health challenges are a major concern among children and youth in the foster care system. Up to 80% of children in foster care have significant mental health challenges, compared to approximately 18-22% of the general population (“Mental Health,” 2019). Half of children and youth receiving foster care do not receive any specialty mental health services (SMHS) which could help address trauma and prevent the development of later health conditions (DHCS, 2022).

The American Academy of Pediatrics identified mental and behavioral health as the greatest unmet health need for children and youth in foster care (DHCS, 2022). Factors contributing to the mental and behavioral health of children and youth in foster care includes the history of complex trauma, frequent transitions of placement and situations, complex family relationships, inconsistent and inadequate access to mental health services and the over-prescription of psychotropic medications (DHCS, 2022).

All children who are in foster care are eligible to receive Medi-Cal that is either Fee-For-Service (FFS) or a Managed Care Plan (MCP).Access to Medi-Cal health plans depends on the California county in which the foster youth reside. Medi-Cal provides a core set of health benefits that can be viewed here: Medi-Cal Health & Dental Benefits.

The Department of Health Care Services (DHCS) added dyadic services and doula services as benefits effective January 1, 2023, for both MCP and FFS plans. Dyadic services are a family and caregiver focused model of care intended to address developmental and behavioral health conditions of children and includes services provided to parent(s)/caregiver(s) (known as a “dyad”). Doula Services are supports provided for individuals and families throughout pregnancy and one year postpartum. This includes emotional and physical supports provided during pregnancy, labor, birth, and the postpartum period, as well as support for and after miscarriage and abortion.

Fee-for-Service Plans (Straight Medi-Cal)

The FFS model, often referred to as Straight Medi-Cal, is a payment model where health care providers are reimbursed by the state of California for each individual service, they provide to Medi-Cal members (doctor visits, x-rays, etc.). With FFS plans, members can visit any provider who accepts Medi-Cal, obtain the needed service, then a claim would be submitted for payment that is determined, processed and paid (or denied) by the Medi-Cal program’s fiscal intermediary Profile of Enrolled Medi-Cal Fee-for-Service (FFS) Providers – Dataset – California Health and Human Services Open Data Portal.

Managed Care Plans

The MCPs receive a fixed per-member, per-month fee regardless of the services provided. The state contracts with MCPs to deliver a wide array of health care services to members, including primary care, specialty care, hospital services, prescription drugs and preventative services. Once a Medi-Cal MCP is selected, members will select their primary care physician (PCP) within the MCP network. The PCP is the main contact point for coordinating member's health care needs.

The MCP Health Plan Directory breaks down the available MCP services by county. MCPs are available in 37 counties, so a member must decide which MCP best serves their needs (if there is more than one option).There are 21 counties that provide the option between MCP and FFF so members must decide which best fits their needs. Child Welfare Agencies can support foster youth and their parents/caregivers by providing education and helping them the quality of providers and ensuring the key providers they need are within their health care plan.

Medi-Cal for Kids & Teens

Department of Health Care Services (DHCS) is responsible for providing full-scope early and periodic screenings, diagnostics, and treatment services to Medi-Cal beneficiaries under the age of 21. This Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit is now referred to as Medi-Cal for Kids & Teens.

Medi-Cal managed care plans (MCPs) and Fee-For-Service plans (FFS) are responsible for providing Medi-Cal for Kids and Teens, to ensure that children receive early detection, prevention, and treatments for health issues as early as possible.

What Services are Included?

  • Screening services: Health and development history, physical exam, immunizations, laboratory tests, and health education
  • Vision services: Diagnosing and treating any issues with vision
  • Dental services: Relief of pain and infections, restoring teeth, and maintaining dental health. A dental screening/oral health assessment must be performed as part of every periodic assessment
  • Hearing services: Diagnosing and treating hearing issues. This may include the provision of hearing aids

Other EPSDT Services Included

  • Behavioral health treatment that is considered medically necessary and consistent with APL 23-005
  • Case management and care coordination for medically necessary EPSDT services
  • Offering help with scheduling doctor appointments and securing transportation to and from medical appointments for medically necessary EPSDT services

Delivery of Medi-Cal behavioral health services is split between counties, and Medi-Cal managed care plans (MCPs), and Fee-For-Service plans (FFS).

Medical Necessity

Pursuant to Welfare and Institutions Code (WIC) sections 14184.402(d) and (f)(1)(A), a mental health diagnosis is no longer a prerequisite for foster youth to access Specialty Mental Health Services (SMHS), as trauma due to involvement in child welfare or juvenile justice makes children and youth under age 21 eligible for SMHS. These changes are reflected in the California Department of Health Care Services (DHCS) issued Behavioral Health Information Notice (BHIN) 21-073.

Due to these changes to medical necessity, the California Department of Social Services (CDSS) issued the All County Letter No. 24-35. The purpose of ACL 24-35 is to inform county child welfare agencies (CWA), juvenile probation departments (JPD), Tribes with a Title IV-E Agreement with the State, and county mental health plans (MHPs) that there is no longer a requirement for CWAs and JPDs to conduct a mental health screening for the purpose of determining whether to refer a child or youth to MHPs. This change is effective as of July 12, 2024. Further, in lieu of the required mental health screening, CWAs and JPDs must submit referrals to the appropriate MHPs for all children and youth within three business days of opening a child welfare case or juvenile probation placement case, and on an ongoing basis, as determined necessary by the child and family team (CFT) and as informed by the Child Adolescent Needs and Strengths (CANS) tool.

Find answers to commonly asked questions about ACL 24-35 here.

Screening and Transition Tools

DHCS developed standardized Cal-AIM Screening and Transition Tools for both adults and individuals under 21 years old for use by MHPs and MCPs to determine the appropriate delivery system(s) for members who are not currently receiving mental health services when they contact the MCP or MHP seeking mental health services. In addition, DHCS developed a standardized Transition of Care Tool to ensure that Medi-Cal members receive timely and coordinated care when completing a transition of services to the other delivery system or when adding a service from the other delivery system to their existing mental health treatment. These tools went live on January 1, 2023.

Non-Specialty Mental Health Services (NSMHS)

  • MCPs and FFS plans are responsible for outpatient services for lower-acuity patients; known as non-specialty mental health services (NSMHS)

What are NSMHS?

  • Mental health evaluation and treatment, including individual, group, and family psychotherapy
  • Psychological and neuropsychological testing, when clinically indicated to evaluate a mental health condition
  • Outpatient services for the purposes of monitoring drug therapy
  • Psychiatric consultation
  • Outpatient laboratory, drugs, supplies, and supplements

NSMHS also include some new and expanded services such as dyadic services for families, which are available to Medi-Cal members in fee-for-service (FFS) and through managed care plans (MCPs) as of January 1, 2023.

Specialty Mental Health Services (SMHS)

  • County Departments are responsible for specialty mental health and substance use disorder services

The Department of Health Care Services (DHCS) administers California’s Medicaid program (Medi-Cal). 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.

What are SMHS?

  • Intensive Care Coordination (ICC): ICC is a targeted case management service that facilitates assessment of care planning for, and coordination of services to beneficiaries under age 21 who are eligible for the full scope of Medi-Cal services and who meet medical necessity criteria for this service.
  • Intensive Home-Based Services (IHBS): IHBS are individualized, strength-based interventions designed to correct or ameliorate mental health conditions that interfere with a child or youth’s functioning and are aimed at helping the child or youth build skills necessary for successful functioning in the home and community, and improving the child or youth’s family’s ability to help the child or youth successfully function in the home and community.
  • Therapeutic Foster Care (TFC): The TFC service model allows for the provision of short-term, intensive, trauma-informed, and individualized specialty mental health services (SMHS) for children up to age 21 who have complex emotional and behavioral needs. Services include plan development, rehabilitation, and collateral. In TFC, children are placed with trained, intensely supervised, and supported TFC parents.
  • Therapeutic Behavioral Services (TBS): TBS are intensive, individualized, short-term outpatient treatment interventions for beneficiaries up to age 21 with full scope Medi-Cal. Individuals receiving these services have serious emotional disturbances, are experiencing stressful transitions or life crises, and need additional short-term, specific support services to achieve outcomes specified in their client plans.
To learn more about these SMHS services please refer to Medi-Cal Manual Third Edition and click here for more information

The California Advancing and Innovating Medi-Cal (CalAIM) and Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) creates new benefits and services, and streamlines processes with child welfare agencies, through Medi-Cal Managed Care Plans (MCPs), County Mental Health Plans (MHPs), and Non-Specialty and Specialty Mental Health Services.

MCPs can provide a variety of services and supports that can benefit the mental, physical, and environmental health of foster youth, such as:

  • Community Supports: Services that help improve Medi-Cal Managed Care Plan (MCP) members’ overall health by addressing needs like housing, meals, and personal care. View the fact sheet for a list of the supports: Community Supports Fact Sheet. The availability of each support is dependent on each county and can vary. Link to MCP Community Support Referral Pathways
  • Behavioral Health: Component of this include peer support services, CalAIM behavioral health trainings, behavioral health quality improvement program, California contingency management benefits, and Department of Health and Human Services (DHCS) behavioral health reporting. Here is additional information on the Cal-AIM reform that specifically impacts foster youth such as medical necessity, No Wrong Door, Screening and Transition Tools and Medi-Cal for Kids and Teens.
  • Dental: CalAIM aligns Medi-Cal policies with national dental care standards to improve amount of children/youth receiving their annual dental checkup and increase the overall use of dental benefits among all Medi-Cal members.
  • Population Health Management (PHM): ensures Medi-Cal members have access to a comprehensive program that leads to improved health outcomes and health equity. Under PHM, MCPs and their partners are responsive to individual member needs within the communities they serve while working within a common framework and set of expectations.

    The CalAIM: Population Health Management (PHM) Policy Guide outlines these programs in further detail.

These Population Health Management programs impact foster youth:

  • Basic Population Health Management (BPHM): BPHM is the basic set of services and supports to which all populations have access regardless of their risk tier. BPHM includes access to primary care, care coordination, navigation of referrals across health and social services, services provided by Community Health Workers (CHWs) under the new CHW benefit, wellness and prevention programs, chronic disease programs, and case management services for children via the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. CHWs may be able to address a variety of health and health-related issues, including, but not limited to: supporting members’ engagement with their Primary Care Provider, identifying and connecting members to services that address social driver of health needs, promoting wellness and prevention, helping members manage their chronic disease, and supporting efforts to improve children’s health.
  • Complex Care Management (CCM): CCM is a care management service for children and youth who need extra support to avoid adverse outcomes but who are not in the highest risk group designated for ECM. CCM can provide qualifying children and youth both episodic services or ongoing chronic care coordination and must include a comprehensive assessment of each members’ condition, available benefits and resources, development and implementation of a Care Management Plan, and assignment of a CCM Care Manager. CCM Care Managers conducts assessments of members’ needs to identify and close any gaps in care and complete case management plans for all members receiving CCM. MCPs should provide assistance with navigation and referrals, such as to CHWs, county First 5s, and/or community-based social services. CCM is administered by Medi-Cal MCPs, and a member’s MCP can be contacted for additional details.
  • Enhanced Care Management for Children and Youth: Children and youth in Child Welfare are one of the Populations of Focus that are eligible for ECM. ECM is intended to identify and close gaps in needed services, as well as ensure whole-person care coordination occurs between a child’s or youth’s medical care, behavioral health care, and social services delivery systems. This includes tribal children and youth that meet the Populations of Focus requirements. An ECM Lead Care Manager is responsible for whole-child care coordination between all participants in the care plan for a youth involved in child welfare. Link to MCP ECM Referral Pathways

Eligibility:

  • Are under age 21 and are currently receiving foster care in California or 
  • Are under age 21 and previously received foster care in California or another state within the last 12 months or
  • Have aged out of foster care up to age 26 (having been in foster care on their 18th birthday or later) in California or another state or
  • Are under age 18 and are eligible for and/or in California’s Adoption Assistance Program or 
  • Are under age 18 and are currently receiving or have received services from California’s Family Maintenance program within the last 12 months. 
  • Eligible Members may be referred to the Medi-Cal MCP ECM program by a provider, case manager, other professional already serving the child or youth, or through self-referral by caregivers. Each MCP maintains an ECM website with referral instructions.
Care Coordination: MCPs must coordinate care for enrolled members, ensuring that they receive appropriate and timely healthcare services. Members may contact their MCP if they have a care need, and MCPs are required to assist the member in accessing appropriate care. This can lead to better management of chronic conditions, preventive care, and overall improved health outcomes.  

Focus on Preventive Care and Wellness: MCPs are required to offer preventive care and wellness programs, which can help to identify and address health issues early, reducing the need for costly treatments down the line. These programs include, but are not limited to, healthy weight management, smoking cessation, and managing stress. 

Improved Access to Care: By establishing networks of providers, MCPs are required to ensure that members enrolled in Medi-Cal have access to a broader range of healthcare services and providers. This can be especially beneficial in areas where there’s a shortage of health care professionals. MCPs may pay higher rates and regulators closely monitor network adequacy. 

Member Services and 24-hour Nurse Advice Line: Managed care plans have toll- free numbers for Member services and a 24-hour nurse advice line listed on the member ID card. This Member services and the advice line can help parents and caregivers find urgent care or decide actions to take if they cannot reach their primary care office during business hours. 

Dedicated Child Welfare Liaison: Each MCP must have a dedicated Child Welfare Liaison that assists staff who coordinate care on behalf of children and youth involved in child welfare to ensure the health care needs of these Members are met and to resolve escalated issues.