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Non-Specialty Mental Health vs. Specialty Mental Health Services

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

Non-Specialty Mental Health Services (NSMHS)

  • Managed Care plans (MCPs) 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.

How to Find These Services:

If you think you or your child need specialty mental health treatment services, you can call your MHP toll-free phone number and ask for an appointment for an initial assessment.

You may also be referred to your MHP for SMHS by another person or organization, including your doctor, school, a family member, guardian, your Medi-Cal managed care health plan, or other county agencies. Usually your doctor or the Medi-Cal managed care health plan will need your permission, or the permission of the parent or caregiver of a child, to make the referral directly to the MHP, unless there is an emergency. Your MHP may not deny a request for an initial assessment to determine whether you or your child meet the criteria to receive services from the MHP.

If you are having trouble accessing services, you may call the DHCS Office of the Ombudsman.

References:

Medi-Cal for Kids and Teens. (2024). DHCS. Retrieved June 5, 2024, from https://www.dhcs.ca.gov/services/Medi-Cal-For-Kids-and-Teens/Pages/home.aspx

Non Spec Mental. (2022). Non-Specialty Mental Health Services: Psychiatric and Psychologic Services. https://mcweb.apps.prd.cammis.medi-cal.ca.gov/assets/D84845A9-9DA6-434D-8B97-00CD24F101E7/nonspecmental.pdf?access_token=6UyVkRRfByXTZEWIh8j8QaYylPyP5ULO

Silber, R. (June 2023). Medi-Cal Explained: Administration of Non-Specialty Mental Health Services. California Health Care Foundation. https://www.chcf.org/wp-content/uploads/2023/06/MediCalExplainedAdminNonSpecialtyMHServices.pdf

Specialty mental health services for children and youth. (n.d.). DHCS. Retrieved May 20, 2024, from https://www.dhcs.ca.gov/services/MH/Pages/Specialty_Mental_Health_Services.aspx

Specialty mental health services for children and youth. (n.d.). DHCS. Retrieved May 20, 2024, from https://www.dhcs.ca.gov/services/MH/Pages/Specialty-Mental-Health-Services-for-Children-and-Youth.aspx