Mobile crisis services are an in-person community-based intervention that provides critical de-escalation during a behavioral health crisis. Mobile crisis services can be provided in many settings, including homes, schools, or elsewhere in the community. Mobile crisis services are typically available 24/7 and 365 days a year. They have specific requirements for team composition, training, and timeliness. These crisis response teams use their unique multidisciplinary skills to meet people in crisis where they are and reduce the immediate risk of harm, while coordinating appropriate care and follow-up actions as needed. These services have been demonstrated to be effective in keep people experiencing behavioral health crises out of emergency departments, psychiatric hospitals, and law enforcement involvement.
In addition to achieving better outcomes for an individual experiencing a crisis, mobile crisis services also lead to cost savings by reducing incarceration and hospitalization. Further, those who become disconnected from mental health services are more likely to engage with them after having contact with a mobile crisis team during a crisis. Mobile crisis teams can be a crucial resource in linking and referring individuals who need mental health or substance use disorder services to additional needed services.
California specifically added community-based mobile crisis response services as a Medi-Cal State Plan statewide benefit through Section 9813 of the American Rescue Plan with an effective date of January 1, 2023. This federal law allowed states to offer community-based mobile crisis response services for a 5-year period beginning April 1, 2022 through March 31, 2027 while reimbursing states at an enhanced 85% Federal Medicaid Assistance Percentage (FMAP) for the first 12 fiscal quarters of the benefit. While this benefit was established to serve Medi-Cal clients, California has invested in and structured our mobile crisis services to respond to crises regardless of insurance status. Although the state is required to collect data on the implementation and function of mobile crisis services, this data has thus far not been publicly. The lack of implementation and utilization data has made it virtually impossible to understand how Californians have benefited from this important Medi-Cal covered benefit to date and made it impossible to track how the state has saved money more broadly through this intervention.
The Governor’s proposed budget would dramatically reduce the availability of mobile crisis services by allowing counties to stop covering these community-based mobile crisis response services after enhanced federal funding for the service expires this year. The proposed change would make this service optional in all 58 counties. The counties that opt-in to provide this service would have to agree to fund the additional costs related to the service resulting from the expiration of enhanced federal investment. This shifts the increase in the nonfederal share of the cost of mobile crisis services to counties. Counties are already experiencing significant financial strain, and this additional burden will force counties to consider reducing or eliminating coverage of this lifesaving service while the ongoing need for behavioral health crisis services continues to grow.
This proposal also fails to recognize that mobile crisis services cannot be made optional for all populations. All counties are obligated under federal and state Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) laws to provide the service to beneficiaries under the age of 21 when medically necessary to correct or ameliorate a mental health or substance use disorder condition. This mandate requires coverage regardless of whether or not a county decides to opt-out of an optional benefit. Further, it is worth noting that the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act prohibit disability-based discrimination that excludes people with behavioral health needs from receiving services. These laws are intended to ensure disabled people are not denied care and that they receive care in the least restrictive setting, such as the community-based settings where these specific mobile crisis services are provided.
Reduction or elimination of this benefit would shift the burden of addressing mental health and substance use crisis back onto law enforcement and emergency departments resulting in worse health outcomes, higher costs, longer wait times, and unnecessary incarceration and hospitalization. This would create a hole in a critical safety net for communities to provide effective crisis management for vulnerable Californians who rely on this service for de-escalation, crisis stabilization, and referral to appropriate services. Reduction or elimination of mobile crisis services also undermines the investments that have been made to date to establish the infrastructure, workforce, and system coordination necessary to deliver this benefit since January 1, 2023. Community-Based Mobile Crisis Response Services are vital to support Californians who experience behavioral health crises and this needs to remain a mandatory Medi-Cal benefit to ensure equitable access to behavioral health crisis services throughout the state.
