People with behavioral health — mental health and/or substance use disorder — conditions often experience poor health across all domains. These individuals have higher rates of major chronic illnesses, are less likely to receive preventive care, and incur costs that are four times greater than those without behavioral health diagnoses. Among the over 13 million California residents who receive care from the Medi-Cal program, the state’s Medicaid program, five percent of enrollees account for over half of all spending — and 45 percent of this high-cost population has a serious mental illness.

This report, prepared by the Center for Health Care Strategies and Steve Kaplan Consulting for the California Health Care Foundation and Well Being Trust, proposes an ambitious framework to transform California’s fragmented system of care for Medi-Cal enrollees with complex behavioral and physical health needs. While specific to California’s landscape, these recommendations can inform efforts by other states seeking to address physical and behavioral health fragmentation.