Integration of care is one of the touchstones of the health care reform conversation. It's a big and complicated task, though, to integrate health care for the 7.5 million Californians on Medi-Cal.
The state is taking a big step toward that goal by shifting Medi-Cal mental health benefits away from the Department of Mental Health and into the Department of Health Care Services by July 1 of next year. The idea is to incorporate mental health care and substance abuse treatment into people's overall health care, so that it's not a segmented benefit.
The tricky part is the transition, because you don't want a disruption in care while you're changing that organizational structure, according to Toby Douglas, director of DHCS.
"The biggest challenge that we face is ensuring that, as we move it over, we are continuing to provide the same level of services," Douglas said. "We want to make sure we're bringing over the institutional knowledge, and integrating that culture into our department. Because I think we have a lot of expertise in providing Medicaid funding to the counties."
Cliff Allenby, acting director at DMH, said the move makes a lot of sense, administratively.
"The Department of Health Care Services were always the ones we had to go through, anyway," Allenby said. "They did all of the negotiations with CMS. So now they will still do that, but those services will be better integrated, and some of the systems will be improved, because they'll all be under one roof."
In terms of patient benefit, the level of care could rise dramatically, Allenby said.
"My sense is it will be enormously improved," he said, "because part of the transfer includes alcohol and drug abuse. And the second area that hasn’t been discussed much is, with parity coming on, everyone's going to work hard to get physical and mental health working together. And that includes parity in the private sector, as well."
Allenby is referring to the idea that mental and behavioral health should be considered on equal footing with overall health care.
Allenby expects the weight and authority of having mental health interests represented by the separate agency of DMH will be retained by having a deputy director within DHCS overseeing mental and behavioral health issues.
"Mental health will keep a high profile, because the DHCS director will have a deputy director representing both alcohol and drug abuse and mental and behavioral health," Allenby said. "I think that person's going to be inside the tent, and that's going to be important."
Douglas said that the transition plan is in place now and that his department has been working with stakeholders to clear all of the possible hurdles for the July move.
"We have put an implementation plan together -- a comprehensive plan -- to ensure there's no disruption in services," Douglas said. "We want to take a strategic approach so we have a comprehensive plan to provide the right services at the right time."
Allenby said there has sometimes been a convoluted interaction between the counties that provide services and the different agencies in the state that all need to sign off on that provision of services. He said consolidating the administration into a single department will help, as will the effort at county/state realignment, he said.
"I look on this as a positive, because the counties are still under law to do the same things they did before, but instead of needing to get everything OK'd through the state, they can go through their own board of supervisors to get things done," Allenby said. "That will work better, locally, rather than having the state need to know what's best for Butte County, and what's best for Los Angeles County."