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Medi-Cal Mental Health Benefits

Medi-Cal managed care plans are responsible for specific non-specialty mental health services. These services include individual and group mental health evaluation and treatment, psychological testing, certain outpatient services to include laboratory drugs, supplies, supplements, and psychiatric consultation. Carelon Behavioral Health manages mild-to-moderate behavioral health benefits and behavioral health therapy (BHT) benefits for all SFHP Medi-Cal members (except members assigned to Kaiser Permanente.

Mild to moderate mental health benefits include:

  • Individual and group mental health evaluation and treatment (psychotherapy)
  • Psychological testing, when clinically indicated to evaluate a mental health condition (prior authorization required)
  • Outpatient services for the purpose of monitoring drug therapy
  • Psychiatric consultation
  • Outpatient laboratory, drugs, supplies, and supplements
  • Evaluation for autism spectrum disorder
  • BHT for those under 21 diagnosed with Autism Spectrum Disorder

To refer a member for mental health services, call Carelon’s toll-free Access Line at 1(855) 371-8117.

Carelon Provider Search
Diagnostic Evaluation Referral Form for BHT referrals
(Use this form if there is a known diagnosis and/or problem behavior indicating BHT/ABA Referral)

PCP Referral Process Summary (for PCP Office Staff)
PCP Flyer
Behavioral Health Treatment for Autism Flyer
Behavioral Health Screening Form (Children 0 – 5)
Behavioral Health Screening Form (Children 6 – 17)
Behavioral Health Screening Form (Adult)
PCP Referral to Carelon Form
PCP Referral to Carelon Form (Chinese)
PCP Referral to Carelon Form (Russian)
PCP Referral to Carelon Form (Spanish)
PCP Referral to Carelon Form (Vietnamese)
Care Management Referral to Carelon Form
Carelon Primary Care Provider Training

SFHP/Carelon Behavioral Health Provider FAQ
SFHP/Carelon Behavioral Health Member FAQ

Services for specialty mental health conditions and alcohol and drug abuse are provided by San Francisco Behavioral Health Services (SF BHS). To refer a member for specialty mental health services, call SF BHS at 1(888) 246-3333.

Please contact SFHP’s Provider Relations Department at 1(415) 547-7818 ext 7084 if you have any questions.