The integration of mental health and SUD services into primary care practice makes services more accessible, improves coordination of care, and supports a “whole person care” approach to serving Medi-Cal beneficiaries. Research shows that primary care is often the first point of contact for detection and treatment of mental health conditions and SUDs, which frequently accompany a substantial number of general medical illnesses, including heart disease, cancer, diabetes, and neurological illnesses. FQHCs are well regarded for their diverse workforce and language capabilities, helping to make mental health and SUDs more accessible for many underserved populations.

FQHCs have played a critical role in providing outpatient mental health services to Medi-Cal beneficiaries in many communities, both prior to and since the 2014 expansion of outpatient mental health coverage to treat those with “mild to moderate” mental health conditions. Prior to the expansion of outpatient mental health benefits in 2014, mental health services offered at FQHCs were one of the few options available to Medi-Cal beneficiaries seeking mental health care who did not meet the medical necessity criteria for specialty mental health services through the MHP due to lack of significant impairment.

CPCA has been deeply involved in working across sectors to identify best practice models that overcome common barriers for deepening behavioral health integration within the care continuum. Our hope is to support the strengthening of relationships between FQHCs, the state, private and non-profit providers, and counties in order to improve care coordination, patient experience, and outcomes for Medi-Cal enrollees with mental illness and/or substance use disorders. The following links have more information about CPCA’s work in behavioral health integration.

Leveraging Federally Qualified Health Centers in California's Behavioral Health Care Continuum

California’s extension of Medi-Cal eligibility to low-income adults up to 138% of the federal poverty line (FPL) means that these individuals, for the first time, have access to mental health and SUD treatment services through the Medi-Cal program without having to undergo a disability determination. Medi-Cal managed care plans (MCPs) and county mental health plans (MHPs) have been charged to work across payment and delivery systems to coordinate care for shared beneficiaries. In addition, implementation of California’s Drug Medi-Cal Organized Delivery System Pilot Program (DMC-ODS), under the authority of the 1115 Medi-Cal waiver, will test a new paradigm for the organized delivery of health care services for Medi-Cal beneficiaries with SUDs.

FQHCs are uniquely positioned to be an important partner for counties as healthcare delivery systems seek new methods to improve comprehensive health outcomes in diverse communities. It is imperative for counties and health centers to understand mutually beneficial collaborative models and maximize a coordinated continuum of services to targeted patients. Read more about four different modes for deepening the local behavioral health care continuum in CPCA’s report: “Leveraging Federally Qualified Health Centers in California’s Behavioral Health Continuum.”

Medication Assisted Treatment for Substance Use Disorder

Medication assisted treatment (MAT) is an evidence based intervention that combines behavioral therapy and medications to treat substance use disorders, like alcohol and opioid dependency. As state and federal governments continue to reduce barriers and infuse resources to increase MAT access throughout the country, CHCs are responding by integrating multi-disciplinary MAT care teams into their operations.

CPCA has drafted a Frequently Asked Questions about MAT within CHCs to answer common questions health centers have about financial and programmatic implications of MAT. The National Center for Complex Health and Social Needs developed a useful MAT best practices toolkit for program administrators and clinical care teams who want to establish effective opioid use disorder MAT programs in primary care settings like CHCs. The resources and data contained in the toolkit can be modified to the specific needs and dynamics of each individual clinic, and are designed to help clinicians understand the whole-person needs of their patients, challenge stigma within the walls of care, blend the best of dueling recovery ideologies, utilize evidence-based best practices, and incorporate program data for sustainability.

These Fact Sheets address two critical issues facing health centers and their delivery of behavioral health services:

1. Integrating Buprenorphine Therapy for Opioid Use Disorder into Health Centers
2. Sharing Behavioral Health Information for Treatment Purposes: Mental Health and Substance Use Disorder

For more evidence asserting the case for why outpatient primary care, including CHCs, are critical providers in the MAT movement, we recommend these articles from the New England Journal of Medicine.

• Primary Care and the Opioid-Overdose Crisis - Buprenorphine Myths and Realities
• Moving Addiction Care to the Mainstream - Improving the Quality of Buprenosphine Treatment

Questions

If you have any questions, or need more information regarding integrated behavioral health, please contact: Charlotte Labbe, Senior Administrative Coordinator, at clabbe@cpca.org.