Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which basic health care services are provided to qualified low-income persons. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions. Existing law provides that specialty mental health services are covered under the Medi-Cal program for eligible Medi-Cal beneficiaries and coverage for those services is provided through mental health managed care plans.

Existing law, the Bronzan-McCorquodale Act, contains provisions governing the organization and financing of community mental health services for persons with mental disorders in every county through locally administered and locally controlled community mental health programs. Existing law provides for reimbursements through the Medi-Cal program for mental health services to Medi-Cal eligible individuals receiving mental health services from county mental health programs, among other funding sources for community mental health services. Existing law requires, regardless of the funding source involved, fees to be charged in accordance with the ability to pay for specialty mental health services rendered, but not in excess of actual costs, as specified.

This bill would instead prohibit a county from charging fees for Medi-Cal specialty mental health services to Medi-Cal beneficiaries who do not have a share of cost and Medi-Cal beneficiaries who have met their share of cost, and would authorize a county to charge fees to individuals who are not Medi-Cal beneficiaries and Medi-Cal beneficiaries who have a share of cost that has not been met, in accordance with the patient’s ability to pay for community mental health services rendered, but not in excess of actual costs. The bill would also specify that these provisions shall not be construed to waive a county’s responsibility to screen for eligibility for Medi-Cal, any other insurance affordability program, or a county health program.