By: Alexandra Parma, Senior Policy Research Associate, First 5 Center for Children's Policy
This week California released an important new policy making family therapy a covered benefit for children in Medi-Cal. This is a significant step forward in approaching children’s health from a whole-family wellness perspective.
Until now, California’s health care system has provided behavioral health services to young kids based solely on their presenting concerns, without allowing providers to strengthen the child-parent relationship. Behavioral health services have been reimbursable only when a child experiences a diagnosable impairment, leaving out young children who often don’t yet have severe enough symptoms to warrant a diagnosis.
With this new policy, California’s Medi-Cal program will now cover family therapy for children without a mental health diagnosis but at risk for later concerns, as well as those with a mental health diagnosis. Risk factors outlined in the policy are broad and include both child-oriented variables, such as trauma exposure and food insecurity, and caregiver-oriented variables, such as substance use disorder and history of incarceration.
Psychologists, Licensed Clinical Social Workers (LCSWs), Licensed Professional Clinical Counselors (LPCC), and Marriage and Family Therapists (MFTs) can now bill Medi-Cal for evidence-based family therapy models that work with the caregiver and child together, also sometimes called dyadic treatment. Reimbursable family therapy models under the policy include Child-Parent Psychotherapy (CPP), Triple P Positive Parenting Program, and Parent Child Interaction Therapy (PCIT). These models already have a state-wide presence in California, but up until this point it was challenging to finance these interventions for infants and toddlers.
While this is a significant change to behavioral health care in California, we still have a lot of work to do to make the system easier to navigate for families and ensure children receive the care they are entitled to. The Medi-Cal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit requires that Medi-Cal cover medically necessary preventive health care services. However, the delivery of these services is split between Medi-Cal health plans and county Specialty Mental Health Services (SMHS). Beyond the new family therapy policy, unless a child has a developmental disability or a behavioral health condition that is the direct result of a physical condition, SMHS continues to be the primary provider of EPSDT mental health services for children in Medi-Cal, regardless of severity. This separation is confusing for parents and providers alike.
With this widened policy, California must also focus on making sure pediatric providers receive training in early childhood mental health so they can effectively identify social-emotional risk and concerns in young children, and refer families for therapy. In addition, we know there is a shortage of mental health providers that specialize in working with children. Addressing workforce supply issues is another important part of making sure enhanced coverage is realized as improved access for California’s infants and toddlers.