On Monday, February 4th, the Department of Health Care Services (DHCS) released MHSD (Mental Health Services Division) Information Notice 13-01 entitled, REMINDER OF MHP RESPONSIBILITY FOR PROVIDING SPECIALTY MENTAL HEALTH SERVICES TO MEDI-CAL BENEFICIARIES.
The Notice is intended to clear up any misconceptions that may have arisen due to the 2011 Realignment funding shift from state General Funds to a dedicated tax and fees revenue stream for the non-federal share of EPSDT program costs. Concerns have been voiced that the apparent limit on available funds meant that EPSDT services had become a “capped” entitlement. A capped entitlement limits services to available funds, and clients are typically served on a first-come-first-served basis. The Notice emphatically denies this, asserting that the EPSDT obligation, “is not abrogated or diminished in any way under the 2011 Public Safety Realignment.”
Additionally, the Notice reminds counties that they must provide all Medicaid-covered services even if the services are not listed in the Medicaid State Plan. While Medicaid provides flexibility in determining how to meet mental health needs, counties may not decline to provide a specific service because it is not covered under a county plan without providing an effective alternative. Moreover, DHCS states that counties must ensure that if an “equally effective alternative” is provided, it must be “with reasonable promptness and . . . sufficient in amount, duration and scope for maximum reduction of mental disability and restoration of an individual to the best possible functional level.” Waiting lists generally do not meet the requirement of “reasonable promptness.”
The important message here is that the practical impact of Realignment as experienced by individual young people and their families should be nil. The EPSDT entitlement is alive and well. If anyone tells you otherwise, give them a copy of MHSD Information Notice 13-01 [http://www.dhcs.ca.gov/formsandpubs/Documents/13-01.pdf], or our web address at Hear Me Out.