Two Counties Square Off With California More than Mental Well being Duties – The Vacaville Reporter

SACRAMENTO, Calif. — Sacramento and Solano counties are in a standoff with the state more than mental overall health coverage for a portion of Medicaid sufferers in these counties — a dispute that threatens to disrupt care for practically 50,000 low-revenue residents getting remedy for extreme mental illness.

The Division of Well being Care Solutions, which administers Medi-Cal, the state’s Medicaid plan, says Sacramento and Solano counties have to take more than managing and giving specialty mental overall health care for thousands of Medi-Cal sufferers enrolled in Kaiser Permanente plans. It insists on shifting the duty simply because California’s remaining 56 counties currently operate this way. State officials argue the switch would simplify the state’s disjointed mental overall health method and is necessary to implement a bigger transformation of Medi-Cal, an initiative recognized as CalAIM.

State overall health officials had till March 15 to accept Kaiser Permanente sufferers, so California can adequately transfer their specialty mental overall health care to counties by July 1. But the two counties are rebuffing the transfer, arguing that without having much more funding they can not adequately care for a key influx of Medi-Cal sufferers with extreme mental overall health circumstances, such as schizophrenia or bipolar disorder. Medi-Cal officials, meanwhile, are threatening steep penalties or potentially terminating mental overall health contracts with these counties.

Regional officials warn that if the state follows by way of with its strategy, about 39,000 sufferers in Sacramento County and about eight,000 in Solano County could see their care disrupted and, for instance, may perhaps be forced to obtain a new psychiatrist.

“For an individual who has schizophrenia or a further significant mental overall health disorder, it has taken a lengthy time to create a trusted connection with their provider, and now they are going to see that care disrupted or have to obtain a various provider,” stated Debbie Vaughn, assistant county administrator for Solano County. “There will be dangers of folks going into crisis.”

Ryan Quist, director of behavioral overall health solutions for Sacramento County, stated the counties have to have not only much more funding but also much more time to transfer the patients’ care. “The state is playing chicken with their lives,” he stated.

Beneath state law, counties are accountable for administering and delivering specialty care to Medi-Cal sufferers with extreme mental illness. Medi-Cal managed-care insurers are accountable for giving remedy for mild or moderate mental overall health circumstances, such as anxiousness or low-level depression.

But beneath a decades-old arrangement amongst the state and the counties of Sacramento and Solano, California has been paying Kaiser Permanente to give all mental overall health care for the overall health care giant’s Medi-Cal enrollees. Now the state is dissolving that arrangement, forcing roughly 7,000 specialty mental overall health sufferers in these two counties to move out of Kaiser Permanente and into county-run mental overall health plans.

State officials argue that the two counties are legally obligated to give care for Medi-Cal sufferers with extreme mental illness and that county behavioral overall health agencies would be the ones placing sufferers in danger if the counties continue refusing the shift. Medi-Cal sufferers enrolled in overall health plans other than Kaiser Permanente get their specialized mental overall health care straight from counties.

“Sacramento and Solano counties’ failure to engage in this course of action areas Medi-Cal members at danger of losing access to vital Medi-Cal entitlement solutions,” stated Tony Cava, a spokesperson for the Division of Well being Care Solutions. “DHCS will have no selection but to take action if the counties continue to refuse to fulfill their obligations.”

The state is taking into consideration sanctions or terminating the counties’ contracts, but Cava stated that “contract termination is not DHCS’ preferred method.” He declined to elaborate, adding only that the agency would “identify options to continue coverage” for Kaiser Permanente sufferers.

He stated transferring sufferers to the counties will give “a much more constant and seamless overall health method by lowering complexity and rising flexibility.”

Counties at present obtain a portion of state sales tax income and car license charges to fund specialty mental overall health care, but beneath the agreement in Sacramento and Solano, the state has been paying Kaiser Permanente from its common fund to serve a portion of the insurer’s general Medi-Cal enrollees’ mental overall health demands.

Beneath the shift, California would quit distributing common-fund dollars to the counties. Alternatively, counties would obtain a higher share of current sales tax and car license charge revenues set aside by a 2011 arrangement. But Kaiser Permanente’s specialty mental overall health sufferers, the counties argue, have been not beneath their purview at the time that agreement was reached, underscoring their legal argument that the state need to cover the fees of their care.

The state is providing an more $11.six million a year to Sacramento and $7.7 million a year to Solano, which would draw down more federal funding. That dollars would be siphoned from income other counties rely on for behavioral overall health remedy.

“The insult to injury is this requires dollars from other counties,” stated Michelle Doty Cabrera, executive director of the County Behavioral Well being Directors Association, “and across California, we’re seeing a higher demand for solutions, specifically following the pandemic.”

Sacramento County desires $36 million much more every year to cover a 16% improve in sufferers or four,836 folks. Solano County seeks practically $17 million much more every year for rising its load by 50%, or two,091 sufferers.

Behavioral overall health officials say counties are also struggling to recruit and retain mental overall health experts prepared to serve Medi-Cal sufferers.

“Our method is currently bursting at the seams,” stated Le Ondra Clark Harvey, CEO of the California Council of Neighborhood Behavioral Well being Agencies, which represents nearby mental overall health providers.

State officials think that each counties have an sufficient quantity of mental overall health providers, with the little exception of Sacramento County’s have to have for two to 3 more psychiatrists to serve youngsters.

Kaiser Permanente told KHN that it did not ask to move sufferers out of its network of care and that it told the state it wanted to continue serving them. But it in the end agreed to transfer care to the counties.

“While we had expressed our preference to continue to give specialty care to this vulnerable population,” stated spokesperson Gerri Ginsburg, “we respect the state’s lengthy-term objectives.”

This story was made by KHN, which publishes California Healthline, an editorially independent service of the California Well being Care Foundation.