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Approach
Medicaid Expansion: (Accelerated Phase-In) Expanding Medicaid to provide coverage for children aged 14-18 living in families below 100% of the federal poverty level (fpl). (California’s Medicaid program is know as "Medi-Cal.")
and
New Program: Creating a new program, California’s Healthy Families, to provide coverage for children living in families below 200% of the fpl. Also expanding existing program, Access for Infants and Mothers, to provide coverage for infants up to 1 year living in families between 200-250% of the fpl.
Mental Health Benefits
Medicaid ("Medi-Cal") All benefits provided under the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) requirement in Medicaid, including: screening diagnosis and assessment; testing; psychotherapy; prescription drugs; partial hospitalization; emergency care; consultation and education; day treatment; in-home services; collateral services; therapeutic foster care; early intervention services; crisis programs; and services to youth in certain residential placements.
California’s Healthy Families
Inpatient: 30 days annual maximum
Outpatient: 20 visits annual maximum ($3 copay)
Inpatient and outpatient days are convertible.
Inpatient Substance Abuse: hospitalization for alcoholism or drug abuse as medically appropriate (no copay)
Outpatient Substance Abuse: 20 visits annual maximum ($5 copay)
Wrap-around Services: A supplemental mental health benefit has been included: each child in need of additional services will be referred to the county public mental health programs, with referral and coordination with the health plans. (Federal funds will pay for 65% of the public mental health services.) If a child meets qualifications, he/she will have access to: acute psychiatric inpatient hospital services; administrative day, residential treatment; crisis residential treatment; crisis intervention and stabilization, day rehabilitation and treatment; medication support; and case management.
Prescription Drugs: no copay if administered by doctor; $5 copay for 30-34 day supply (for maintenance drugs, $5 for 90-100 day supply)
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