Jennifer Kent: Integration requires a “constitutional amendment”

In a recent interview with Politico, Jennifer Kent, California’s Director of the Dept. of Health Care Services, offered her thoughts on what it might take to integrate behavioral and physical health.

The topic has gained increasing traction as health care and health policy leaders recognize the importance of ending artificial silos separating the head from the rest of the body.


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However, in the interview, Kent suggested such an approach might not be feasible.

Politico:  There’s a big push right now, in the legislature and by the governor, to better integrate behavioral and physical health.  What in your mind does integration mean?

Kent:  It’s different for different people.

Politico:  Would it require legislation?

Kent: It would need a constitutional amendment.

We in the state have had two significant financing arrangements with the counties — 1991 realignment and 2011 realignment.

Realignment essentially means the state and the counties sit down and say, we’re going to require you to do things statutorily and in exchange we’re going to give you a dedicated tax revenue source to do that. So if you were going to do an integration at the state level, the counties still get the money from a constitutional standpoint, so you have to change the constitution if you’re going to change the responsibility.

I always like to make sure people understand that, because it’s not as simple as saying, oh sure, we’ll take responsibility back for those.

The counties would love it if we took the drug and alcohol responsibility back but they get to keep the money. But if you don’t change the constitution, you can’t really do it from a financial standpoint.

Right now there’s a nice collision of two waivers coming due that the same time, in 2020, and so what I like to tell people is it’s up to us to figure out as much as possible, how do we align county mental health services with the rest of the Medi-Cal managed care program and figure out how to make the financing work.

At our 2019 Northern California State of Reform Health Policy Conference, host DJ Wilson asked Assembly member Jim Wood, Chair of the Assembly Committee on Health, about Kent’s comments and the need for a constitutional amendment.

Wood suggested that Kent’s comments were different from his understanding of the legal hurdles ahead of integration.

“Wow, well that’s kind of shocking. It shouldn’t. You know, it’s like saying, do we need to do that for dental health too or chiropractic? I don’t know, that’s very, very interesting. I haven’t heard that but I think I’m going to need to have coffee with Jennifer and talk about that a little bit more.”