Navigating Behavioral Healthcare for Low-Income Californians Living with HIV

These are the pathways a low-income PLHIV might follow to address behavioral health issues, as described in data gathered in 2015-16. We show here only some of the most common outcomes, as we understand them, but many individuals may have a different, more complex experience.

• How severe is the individual’s mental health issue?
  • Many individuals may move between lower and higher severity.
  • Low-to-moderate 
    • Is the individual also dealing with a substance use (SU) issue?*
      • No
        • What type of insurance coverage does the individual have?
          • Medi-Cal
            • May call Medi-Cal Managed Care for referral to therapists. It may be a challenge to find an available psychiatrist. A primary care doctor may be able to prescribe medication. Ryan White may supplement payment for additional therapy or support services.
          • Uninsured
            • Can be referred to a Ryan White therapist or group. A Ryan White psychiatrist or physician can prescribe medication. It may take a while to get a slot in therapy or with a psychiatrist.
      • Yes
        • What type of insurance coverage does the individual have?
          • Medi-Cal
            • Is the SU less of an issue? May receive SU counseling, meds from Medi-Cal provider with mental health care.
            • Is the SU issue severe? May be referred to county Drug Medi-Cal treatment, without mental health care.
          • Uninsured
            • Is the SU less of an issue? May receive SU counseling, meds from Ryan White provider with mental health care.
            • Is the SU issue severe? If space exists, may be referred to county treatment, without mental health care, paid for out of SAMHSA or county general funds.
    • Severe
      • Some may be placed in an intensive, comprehensive county program for severe mental illnuss (full service partnership), paid for out of Mental Health Services Act funds (and Medi-Cal, for enrollees).
      • Is the individual also dealing with a substance use (SU) issue?*
        • No
          • What type of insurance coverage does the individual have?
            • Medi-Cal
              • May receive therapy, medication, and case management from the county under Medi-Cal. Services depend on symptom severity and are provided until severity decreases, then individuals may be referred to Medi-Cal Management Care.
            • Uninsured
              • May receive therapy, medication, and case management from the county under realignment. Services depend on symptom severity and are provided and are provided until severity decreases, then may be referred to a Ryan White provider.
        • Yes
          • What type of insurance coverage does the individual have?
            • Medi-Cal
              • Is the SU less of an issue? May receive SU counseling, meds from Medi-Cal provider with mental health care.
              • Is the SU issue severe? May be referred to county Drug Medi-Cal treatment, without mental health care.
            • Uninsured
              • Is the SU less of an issue? May receive SU counseling, meds from Ryan White provider with mental health care.
              • Is the SU issue severe? If space exists, may be referred to county treatment, without mental health care, paid for out of SAMHSA or county general funds.

* Drug Medi-Cal services may soon look different under the implementation of an Organized Delivery System Waiver.

Outcomes are not static. Many may repeat these paths later.

Medi-Cal

California’s Medicaid program, insuring healthcare for low-income residents. Since passage of the Affordable Care Act, many enrollees are in a Medi-Cal Managed Care plan. These plans are contracted with the state to provide medical are in specific counties, including mental health care for low-to-moderate needs. Counties also use a portion of Medi-Cal, called Medi-Cal Specialty Mental Health, to pay for county administered mental health care services for severe needs.

Drug Medi-Cal

A component of California’s Medicaid program that pays for use services in certified settings. The services funded by Drug Medi-Cal may be rendered in different settings and by different providers than those rendered through a client’s Medi-Cal managed care plan. The new Drug Medi-Cal Organized Delivery System Waiver will pilot new ways of creating more coordinated, integrated substance use treatment in participating counties.

Realignment

Portions of state sales tax and vehicle license fee revenue that are transferred to the counties to provide mental health services, including services for severe mental health needs among the uninsured.

Ryan White HIV/AIDS Program

A federal program that provides support services and basic medical care–including mental health care–for uninsured or under insured individuals living with HIV.

Substance Abuse and Mental Health Services Administrator (SAMHSA)

An administrative agency of the US Department of Health and Human Services that distributes grants to states, local governments, and individual organizations to support prevention and treatment of behavioral health issues.