To expand access to community-based mental health and crisis care relating to substance use for Medi-Cal beneficiaries, the Centers for Medicare & Medicaid Services (CMS) recently approved coverage of mobile crisis intervention teams. Through these mobile teams, behavioral healthcare providers will be available 24/7 for Medi-Cal beneficiaries who are experiencing crises.
Mobile crisis teams will consist of trained behavioral health professionals and paraprofessionals, who should rapidly respond to and individually assess individuals who are experiencing crises, while also providing de-escalation techniques.
The rapid response of mobile teams aims to provide services for Medi-Cal outside of the traditional medical setting, and to reduce the need for expensive in-patient services through facilitated handoffs, referrals to ongoing supports, and follow ups for those experiencing mental health or substance use disorder crises.
“Mobile crisis teams are required to arrive at the community-based location where the crisis is occurring within 60 minutes of the member being determined to require mobile crisis services in urban areas, and within 120 minutes of the member being determined to require mobile crisis services in rural areas,” the Department of Health Care Services (DHCS) told State of Reform.
Rural areas are defined to include spaces that have less than 50 people per square mile, DHCS said. As of May, Medi-Cal enrollment had over 15 million individuals, and while DHCS doesn’t have actual utilization data for the Medi-Cal mobile crisis services benefit, it’s estimated that there are 348,982 annual mobile crisis encounters in California.
State of Reform spoke with the County of Santa Clara Behavioral Health Services Department, which expressed how the federally approved mobile crisis intervention teams would assist county residents.
“We respond to crisis calls primarily through 988, the crisis and suicide prevention lifeline. Since the program began operation in July 2022, we have received and responded to more than 25,000 calls from people in crisis.”
— County of Santa Clara Behavioral Health Services Department
Santa Clara County is home to more than 400,000 Medi-Cal beneficiaries, and everyone—including non-Medi-Cal members—can call 988 to be connected with an appropriate crisis response. The department told State of Reform that some individuals experiencing crises may need a response team, which is available with or without law enforcement involvement, while others may require referrals from the county’s behavioral health navigators.
“Our call takers are well-trained to determine the appropriate response, and connect callers to the proper support,” the department said.
During situations where mobile crisis response is needed, units are deployed to intervene and stabilize the individual. If the Medi-Cal beneficiary experiencing a crisis requires urgent treatment in an alternative setting, the crisis teams must identify appropriate facilities or providers, and provide or arrange for transportation.
Teams will also refer individuals to ongoing supports, including ongoing behavioral health treatment, community-based supports, social services, and other supports that could minimize the risk of future crises.
“While DHCS anticipates that the implementation of Medi-Cal mobile crisis will lead to a reduction of law enforcement response to people experiencing crisis, we do not currently have estimates that quantify an expected reduction of law enforcement response to individuals experiencing crises.”
— DHCS
According to DHCS, mobile crisis teams responding without law enforcement officials—unless there are certain safety concerns that require law enforcement response—is considered national best practice. Although law enforcement officers may respond to a crisis with the mobile teams when necessary, they don’t qualify as members of the mobile crisis teams.
The referral aspect also allows crisis response teams to make appointments and assist beneficiaries with securing ongoing support. They will also conduct follow ups with beneficiaries to continue to assist with crisis resolution, provide additional crisis planning, check on the status of referrals, and provide additional referrals if needed.
Mobile crisis teams must include at least two behavioral health professionals, including at least one provider who is qualified to provide a crisis assessment. Behavioral health professionals include physicians, psychologists, licensed clinical social workers, licensed professional clinical counselors, registered nurses, and peer support specialists.
Educating the public on the services different teams provide is one of the main challenges facing the County of Santa Clara Behavioral Health Services Department, which said that it’s okay to not know.
“They may think they need to know which team to ask for before calling us, but our 988 and crisis/suicide prevention staff can inform the caller about the different teams,” the department said.
Under the mobile crisis intervention teams, authorized services for rehabilitative mental health and targeted case management include mental health services, medication support services, crisis intervention, adult residential treatment services, psychiatry health facility services, and peer support services.
The Medi-Cal Mobile Crisis Training and Technical Assistance Center (M-TAC) will support the implementation of the mobile crisis response teams by providing resources, training, and ongoing technical assistance and consultations to counties and their mobile crisis teams. M-TAC is responsible for developing core module training that is required for all mobile crisis response providers and will include training on trauma-informed care, crisis intervention and de-escalation, harm reduction, and safety planning.
Santa Clara County’s Behavioral Health Services Department said they are looking forward to continuing to inform county residents about the Mobile Crisis Continuum of Care and encourages community members to call 988 if they or someone they know appears to be in emotional distress.
“That one call can link people to the most appropriate provider—the right service at the right time. With five different community response teams and a full range of other support and resources available, our call takers and navigators can address their needs in a culturally appropriate way.”
— Santa Clara County’s Behavioral Health Services Department