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Our Work: Financing & Sustainability

What We Do

Financing and sustainability services may include analysis of your existing billing infrastructure and healthcare context that includes existing contracts with payers, exploration of available billing/reimbursement options depending on your model of care and provider type, support with revenue generation modeling, consultation to guide new billing infrastructures, such as establishing contracts with payers, credentialing providers, and EMR workflows, development of billing workflows that include claiming and revenue tracking, and training of frontline providers. Our expertise is primarily in the Medi-Cal Non-Specialty Mental Health Services benefit and specifically Dyadic Services, Family Therapy and other related benefits. We are working to develop expertise in braiding new benefits with dyadic services that expand the provider class, such as through Enhanced Care Management. Pilots of Dyadic Care and ECM are currently in progress.

Why We Do It

Children 0 to 5 have the lowest behavioral health access rates of California’s 6 million children on Medi-Cal, with access rates under 3 percent. Recent California innovations have the potential to dramatically change this historically low behavioral health access rate for young children in California.

Medi-Cal now provides opportunities for families with young children to access reimbursable behavioral health promotion and prevention services, including referral and linkage to social services that mitigate social determinants of health. By leveraging existing benefits such as Enhanced Care Management, the Comprehensive Perinatal Services Program (CPSP), and new benefits including the Community Health Worker and dyadic services benefits, a team of peer specialists—CHWs, and licensed or license-eligible behavioral health specialists—can be supported to work alongside pediatric health care providers to support optimal child health and wellbeing by also serving their caregivers and families.

After a 33 percent increase in Medi-Cal enrollment over the past five years, more than half of California’s children are now covered by the same federal entitlement that successfully immunizes more than 80 percent of low-income children. This is proof that there is a path for change.

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