Providers: Medi-cal reform threatens care for vulnerable
Existing mental health, addiction services forced to close in `seismic shift' as California overhauls its Medicaid system
David Mineta chokes up when talking about the roughly 1,500 individuals Momentum for Health — the nonprofit he runs — won't be able to help this coming year.
Momentum is one of the largest nonprofit behavioral health service providers in Santa Clara County, serving more than 4,000 adults and children annually. But because of ripple effects from CALAIM — a multiyear plan to overhaul California's Medi-cal system — the nonprofit said it closed six of its programs and laid off 85 staff members at the end of December.
“It just breaks me,” said Mineta, the president and CEO of Momentum.
California Advancing and Innovating Medi-cal, or CALAIM for short, was touted by Gov. Gavin Newsom as a “once-in-a-generation” opportunity to transform the state's Medicaid system, which covers more than one-third of Californians. Launched in 2022, CALAIM will refocus Medical over the course of five years to more of what's called a “whole person approach” that better integrates physical health, behavioral health and social services for low income residents.
CALAIM'S latest changes went into effect July 1 and dramatically reformed how organizations like Momentum bill for services and get reimbursed. While these providers used to get reimbursed for the actual costs of providing services, the new system only reimburses for a standardized set rate for each service. As a result, over the last six months, behavioral health care providers
Candace Decou holds a heart charm that she made at her home in Campbell on Dec. 27. Decou says Momentum closing some of its programs and laying off staff is “frightening.”
across the state have struggled to financially maintain more community-oriented services that put doctors, social workers and case managers out in the field — services that might not be completely covered by the new standardized model.
At Momentum, Mineta said they just couldn't sustain all the red ink triggered by the payment reform. The decision to end certain outpatient addiction programs and other intensive mental health services, as well as reduce the nonprofit's staff by 15% clearly weighs on the longtime social worker. He said it's hard for him to even talk about it.
“This is the biggest thing I'll ever do in my career is getting through this,” Mineta said.
Elisa Koff-ginsborg, the executive director of the Behavioral Health Contractors' Association of Santa Clara County, called the latest changes “the most seismic shift in the behavioral health system in over half a century.”
The association represents 30 nonprofits that make up 90% of the behavioral health
services that Santa Clara County provides. Koff-ginsborg said Momentum isn't the only provider reeling from the effects of CALAIM — a recent survey conducted by the association found that of the 18 agencies in the county that responded, 16 had significantly lost money in the last six months.
“It treats all the programs the same,” Koff-ginsborg said of CALAIM. “The danger of that long term is it incentivizes providers to only keep the services that will cover their costs, and the services that don't are often the ones folks who are served through the safety net really need.”
She called the new reforms a “one size fits all clinic-based model” that favors individuals who are able to come into an office and discourages agencies from serving populations that lack transportation, mistrust institutions or who are dealing with complex issues.
For Candace Decou, Momentum closing programs and laying off staff is “frightening.” Her 44-year-old son, Graydon, has struggled with severe drug addiction for more than half his life. But under the care of Momentum, she's started to see a “glimmer of hope.”
“What is the answer to that at the moment when you think there might be hope on the horizon?” she said of the new CALAIM changes. “If Momentum or any other community-based organization closes their doors, they'll just take their existing clients and try to push them somewhere else. We already are lacking resources to even maintain some of the existing programs.”
Decou — who serves on the county's behavioral health board — said while her son's program isn't closing, she's worried about the impacts it will have on existing staff at Momentum and whether it will jeopardize her son's care. She's also alarmed that other behavioral health care providers also might be at risk.
“They're the only who seems to be making a difference for my son right now,” she said. “But there's another organization somewhere else that may be helping somebody else's son, and that's all a mother can hope for.”
In December, the Santa Clara County Board of Supervisors took action to make sure no more behavioral health providers they contract with have to close programs.
“The county is committed to making sure that we do not lose a single client that we're serving,” board President Susan Ellenberg told The Mercury News. “It may be that other programs have to pick up these patients, but the commitment is absolutely to continue to serve those same clients.”
The county is currently reviewing modifying its own rate structures to ensure mental health and substance use providers are reimbursed properly.
Without the county stepping in, Christophe Rebboah, the CEO of Rebekah Children's Services in Campbell, worried they could suffer a similar fate as Momentum. The agency was looking at laying off a quarter of its staff due to the financial hit it's taken the last six months — a move that would impact hundreds of children and families.
“We serve those most vulnerable, those most in need, and that's something that should not be compromised and cannot be compromised,” he said.
Mineta recognizes that any change the county makes won't save the six programs Momentum has already lost, but he does hope it helps the overall system moving forward. As the nonprofit enters into the new year with fewer staffers, he said they're trying to restructure so they can be as effective as possible for clients.
“The data is pretty clear,” Mineta said. “Behavioral health is the second pandemic. We're in it, and we're going to be in it for a while. It's very important that we get CALAIM right.”