Behavioral Health Services

Behavioral health services includes treatment for both mental health and substance use disorders. L.A. Care provides these services through PCPs, Behavioral Health Specialists from Carelon Behavioral Health, Los Angeles County Department of Mental Health, and Los Angeles County Department of Public Health. Where members can access care varies on the type and severity of symptoms and impairment. The goal is to ensure and facilitate the provision of appropriate behavioral health services to L.A. Care Members.

Mental Health Services

Mental health services include treatment for anxiety, depression, or other behavioral health concerns. These services include:

• Screening, brief intervention and referrals to treatment
• Individual and group mental health psychotherapy
• Dyadic care and family therapy
• Psychological testing
• Medication management
• Psychiatric consultation
• Maternal mental health services

National 24/7 Suicide and Mental Health related crisis lifeline

If you need mental health or addiction related crisis support, or worried about someone else, you can call or text 988 (TTY 711) or visit National Suicide and Crisis Lifeline’s chat (https://988lifeline.org/chat) for support.

Coverage for Treatment

• Medi-Cal & Medicare Plus à Carelon Behavioral Health
  • Specialty mental health services provided by the L.A. County Department of Mental Health (DMH)
  Substance Use Disorder Services

  Substance Use services include Alcohol and Drug Screening, Assessment, Brief Interventions and Referral to Treatment (SABIRT) for members 11 years old and older, including pregnant women. These services are provided by PCPs.

  • Annual screenings for alcohol and drug use (i.e., AUDIT, CAGE, etc.)
  • Brief intervention and referral to treatment

  Coverage for Treatment beyond the Scope of a PCP

  • Medi-Cal & Medicare Plus à Department of Public Health (DPH)
  • LACC, LACC-D & PASC-SEIU à Carelon Behavioral Health
  Behavioral Health Treatment (BHT)

  L.A. Care covers BHT for members under 21 years of age with a recommendation from a licensed physician, surgeon or psychologist that evidence-based BHT services are medically necessary. This includes Applied Behavior Analysis (ABA) and similar evidence-based treatments. A diagnosis of Autism Spectrum Disorder is no longer required for authorization of these services.

  Coverage for Treatment

  • Medi-Cal à The BHT Provider Network is contracted directly through L.A. Care Health Plan.
  • Medicare Plus, LACC, LACC-D & PASC-SEIU à Carelon Behavioral Health
  Transgender Health

  L.A. Care covers a variety of transgender-specific services (gender-affirming care) as a benefit when services are medically necessary. These services include:

  • Psychological assessment (to determine readiness for surgery and/or procedures)
  • Hormone therapy
  • Gender affirming surgeries and procedures.

  Coverage for Treatment

  • Primary care doctor à Routine preventative care, regardless of gender marker
  • Medi-Cal, Medicare Plus, LACC, LACC-D & PASC-SEIU à Transgender-specific care
  • Mental health therapy (unrelated to assessments for gender-affirming care) à Carelon Behavioral Health

  For more information about specific coverage for behavioral health services, please refer to your Member Handbook.

  Medi-Cal

  Mental health services may include treatment for anxiety, depression, or behavior health problems. Your doctor can provide you with some outpatient mental health services. Behavioral health services such as psychotherapy and medication management are provided to L.A. Care members by Carelon Behavioral Health.

  There are some specialized mental health services that are provided to Medi-Cal members through the Los Angeles County Department of Mental Health (LACDMH). You may receive services from Carelon Behavioral Health or from LACDMH with or without a referral from your doctor.

  See the Benefit Descriptions section of your Member Handbook to learn more about L.A. Care's Mental Health Services.
  

  L.A. Care Covered™ and L.A. Care Covered Direct™

  Mental Health and Substance Use Disorder (MH/SUD) benefits are covered through Carelon Behavioral Health. You or your PCP can call Carelon's Behavioral Health Hotline at 1-877-344-2858 (TTY 1-800-735-2929) to get an appointment. Prior authorization is not required for general outpatient health services for in-network providers. In addition, there is no limitation on the number of visits for medically necessary MH/SUD services. For information on services that do not require prior authorization and the general process for obtaining prior authorization for all other MH/SUD services, please call the Behavioral Health Hotline or review your plan's Evidence of Coverage at L.A. Care Covered™ and L.A. Care Covered Direct™.