The California Medicaid Behavioral Health Fee Schedule is published annually by the Department of Health Care Services and covers two distinct systems: Specialty Mental Health Services, delivered through county Mental Health Plans, and the Drug Medi-Cal Organized Delivery System, delivered through county DMC-ODS entities. DHCS sets the rates it reimburses counties, but counties are not required to pay individual network providers at those same rates, which is where credentialing and enrollment with each county plan becomes essential.
Who Sets California’s Medi-Cal Behavioral Health Rates?
The California Department of Health Care Services (DHCS) publishes the fee schedules that reimburse county Mental Health Plans and DMC-ODS Counties, the managed care entities that administer these benefits under approved 1915(b) waivers.
Do Counties Have to Pay Providers the DHCS-Published Rate?
No. Mental Health Plans and DMC-ODS Counties negotiate their own rates with individual network providers and are not required to reimburse at the rates DHCS publishes.
What Two Systems Make Up California’s Medi-Cal Behavioral Health Benefit?
Specialty Mental Health Services (SMHS), covering mental health care, and the Drug Medi-Cal Organized Delivery System (DMC-ODS), covering substance use disorder treatment, each with its own fee schedule structure.
When Does the Current Fee Schedule Take Effect?
The Fiscal Year 2026-27 fee schedules are effective July 1, 2026, with several service categories carrying subsequent revision dates published throughout the year.
Key Takeaways
- California’s Medi-Cal behavioral health rates split into two systems: Specialty Mental Health Services (SMHS) and the Drug Medi-Cal Organized Delivery System (DMC-ODS).
- DHCS publishes the rates it reimburses county Mental Health Plans and DMC-ODS Counties, not a guaranteed rate to individual providers.
- Rates are developed from a county-wide average of direct and indirect costs, meaning actual county-to-county rates can vary.
- The FY 2026-27 schedules took effect July 1, 2026, across categories including outpatient, mobile crisis, inpatient, and residential services.
- Individual provider reimbursement depends on the specific contract negotiated with each county’s Mental Health Plan or DMC-ODS entity.
- A provider billing across multiple counties often needs dedicated credentialing support, since each county plan may have its own network and contracting process.
What Is Covered Under Specialty Mental Health Services (SMHS)?
SMHS fee schedules cover 24-hour services, day services, mobile crisis services, outpatient rates, psychiatric inpatient rates, therapeutic foster care, and BH-CONNECT monthly services. This benefit is delivered through county Mental Health Plans under an approved 1915(b) waiver, and is the primary billing structure for behavioral health providers serving Medi-Cal beneficiaries.
What Is Covered Under the Drug Medi-Cal Organized Delivery System (DMC-ODS)?
DMC-ODS fee schedules cover 24-hour day services, ambulatory and inpatient withdrawal management, mobile crisis, outpatient services, partial hospitalization, Narcotic Treatment Program rates, supported employment services, and traditional health care practices, delivered through county DMC-ODS entities also under a 1915(b) waiver structure, a managed care model similar to the county-level arrangements seen in New York Medicaid’s own fee schedule structure.
What Are the Key Things to Know About the California Medicaid Behavioral Health Fee Schedule?
The ten points below cover how the fee schedule is structured, updated, and applied across the state’s county-administered system.
The Two-System Structure
California splits Medi-Cal behavioral health into Specialty Mental Health Services for mental health conditions and the Drug Medi-Cal Organized Delivery System for substance use disorder treatment. A provider offering both types of services needs to understand both fee schedule structures and, often, separate contracts with the relevant county entities.
County Mental Health Plans as the Payer Intermediary
DHCS does not pay individual providers directly for most specialty mental health services. Instead, it reimburses county Mental Health Plans, which in turn contract with and pay the network providers who deliver care. The DHCS-published rate is a reference ceiling, not a guaranteed provider payment.
Rates Are Built From County-Wide Cost Averages
DHCS develops these rates using a county-wide average of direct and indirect costs, combined with other data sources, rather than a single statewide flat rate. This means the underlying cost basis can differ meaningfully from one county to another.
SMHS Service Categories
The SMHS schedule breaks into several distinct rate categories: 24-hour services, day services, mobile crisis rates, outpatient rates, psychiatric inpatient rates, therapeutic foster care rates, and BH-CONNECT monthly services, each published and revised on its own timeline within the fiscal year.
DMC-ODS Service Categories
The DMC-ODS schedule covers 24-hour day services, ambulatory withdrawal management, inpatient withdrawal management, mobile crisis, outpatient services, partial hospitalization rates, NTP rates, supported employment services, and traditional health care practices, the last of which has circulated in draft form pending final rates.
Effective Dates and Mid-Year Revisions
Fee schedules for FY 2026-27 became effective July 1, 2026, but several categories carry subsequent revision dates throughout the fiscal year. Billing teams should check the current revision date for each category rather than assuming the original July 1 rate is still current.
The 1915(b) Waiver Framework
Both SMHS and DMC-ODS operate under approved Section 1915(b) Medicaid waivers, which allow California to deliver these benefits through a managed care structure at the county level rather than a traditional statewide fee-for-service model.
How Providers Get Paid in Practice
An individual provider’s actual reimbursement depends on the specific contract negotiated with the relevant county Mental Health Plan or DMC-ODS entity, not the DHCS-published schedule directly. Two providers delivering the same service in different counties may be paid differently.
BH-CONNECT and Recent Program Changes
BH-CONNECT reflects California’s ongoing behavioral health delivery reforms, adding a monthly services rate category to the SMHS schedule. Providers should watch for continued structural changes as the state refines this newer program component.
Where to Verify Current Rates
Because rates are county-negotiated on top of a state-published reference schedule, and because mid-year revisions are common, the only reliable source for a specific rate is the current DHCS Medi-Cal Behavioral Health Fee Schedules page, combined with the provider’s own county contract.
When Does the SMHS Fee Schedule Apply?
The SMHS fee schedule applies to specialty mental health services delivered to Medi-Cal beneficiaries through a county Mental Health Plan, covering the full range from outpatient therapy to psychiatric inpatient and crisis services.
When Does the DMC-ODS Fee Schedule Apply?
The DMC-ODS fee schedule applies to substance use disorder treatment delivered through a county’s Drug Medi-Cal Organized Delivery System, covering withdrawal management, outpatient and residential-equivalent levels of care, and supported employment services.
Best Practices for Billing California Medi-Cal Behavioral Health Services
- Confirm which system, SMHS or DMC-ODS, applies to each service line before billing, since the two follow separate fee schedules and often separate contracts.
- Verify the current, most recently revised rate for the specific service category rather than relying on the original July 1 published version.
- Negotiate and document the actual contracted rate with each county Mental Health Plan or DMC-ODS entity separately.
- Track effective and revision dates for each rate category across the fiscal year.
- Confirm county-specific network enrollment status before assuming a claim will be reimbursed at the negotiated rate.
Mistakes to Avoid With California Medi-Cal Behavioral Health Billing
- Assuming the DHCS-published rate is what a specific provider will actually be paid, rather than the county-negotiated contract rate.
- Billing under the wrong system, SMHS versus DMC-ODS, for a substance use disorder service that belongs in the other category.
- Using an outdated fee schedule version after a mid-year revision was published.
- Treating every county’s network enrollment as interchangeable instead of verifying status separately through a medical billing audit for each county plan.
- Overlooking that BH-CONNECT and other newer program components may carry different billing rules than the traditional SMHS categories.
Illustrative Documentation Example
The scenario below is a hypothetical example for teaching purposes, not an actual patient billing case.
A behavioral health provider contracted with one county’s Mental Health Plan bills an outpatient therapy session under the SMHS outpatient rate category. The same provider also treats patients with substance use disorders under a separate DMC-ODS outpatient contract with the same county. Because the two services fall under different fee schedules and different county contracts, the provider tracks reimbursement for each separately rather than assuming a single blended rate applies.
Conclusion
California’s Medi-Cal behavioral health fee schedule is really two systems layered on top of county-by-county negotiation: DHCS sets a cost-based reference rate, and each county Mental Health Plan or DMC-ODS entity sets what it actually pays network providers. Getting paid correctly means tracking both layers, not just the state-published number. A provider expanding into new counties often leans on practice management consulting to navigate each county’s distinct contracting process.
FAQs
Are Medi-Cal behavioral health rates the same in every California county?
No. While DHCS publishes a statewide reference schedule, actual provider reimbursement depends on each county Mental Health Plan’s or DMC-ODS entity’s own negotiated contract, which can vary from the published figures and from county to county.
How often does DHCS update the behavioral health fee schedule?
The base fee schedule updates annually at the start of each fiscal year, but individual service categories frequently carry additional mid-year revisions.
Does Drug Medi-Cal without ODS use a different fee schedule than DMC-ODS?
Yes. Counties that have not opted into the DMC-ODS waiver structure operate under a separate, traditional Drug Medi-Cal fee-for-service fee schedule, distinct from the DMC-ODS managed care rates.
Can a provider bill Medi-Cal directly for specialty mental health services without a county contract?
Generally no. Specialty mental health services are delivered through the county Mental Health Plan structure, so providers typically need network status with the relevant county plan rather than billing DHCS directly.
What is BH-CONNECT?
BH-CONNECT is part of California’s continuing behavioral health delivery system reforms, and it added a monthly services rate category to the SMHS fee schedule; providers should confirm current program rules before billing under this category.
