In April 1995, the San Mateo County Mental Health Department began operating as the Mental Health Plan under the provisions of a Medi-Cal managed mental health care field test waiver.  The field test authority was enacted to allow the California Department of Mental Health (DMH) to test managed care concepts in support of an eventual move to a full risk model for the delivery of Medi-Cal specialty mental health services. 

The field test began by the County assuming responsibility for both psychiatric inpatient hospital services and outpatient specialty mental health services.  In July 1998, the County’s field test was expanded to include the management of the pharmacy and laboratory services prescribed by its psychiatrist network.

For the pharmacy and laboratory services, DMH and the County initially entered into a risk sharing agreement establishing the San Mateo Pharmacy and Laboratory Services Program.  This agreement created the only County Organized Health System in the state that does not carve out drug benefits to Medi-Cal.  In 2002, the agreement between the County and DMH was modified to eliminate the 10 percent risk-sharing threshold because either the annual state General Fund allocation was more than sufficient to meet the state’s matching requirement or any state match shortfalls were covered by the Plan’s realignment.

In March 2007, DMH entered into an interagency agreement with the Department of Finance, Office of State Audits and Evaluations to perform an evaluation of the San Mateo Pharmacy and Laboratory estimation process and provide a report with recommendations for improvements. 

From this initiative, DMH has developed an on-going fiscal oversight team to collaborate with the Department of Health Care Services and San Mateo Mental Health Program.  The following documents are some products of that partnership and focused review effort:

• Office of State Audits and Evaluation (OSAE) Final Report on Review of the San Mateo County Department of Mental Health Pharmacy and Laboratory Services Estimation Processes (May 2007)
• DMH Response to OSAE’s Report (June 2007)
• DMH Action Plan for Fiscal and Administrative Oversight (August 2007)
• Assembly Bill 203, Chapter 188, Statutes of 2007, Sections 98 through 99

*NOTE: The above documents will be linked as they become available.

• Department of Health Care Services
• San Mateo County Mental Health
• Department of Finance, Office of State Audits and Evaluations

Rita McCabe
Chief, DMH Medi-Cal and Health Care Benefits
Rita.McCabe@dmh.ca.gov

Enrica Bertoldo
Staff Mental Health Specialist, DMH County Contracts and Technical Assistance
Enrica.Bertoldo@dmh.ca.gov