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Supervisors tackle mental health needs of the “missing middle”

SAN JOSEThe Santa Clara County Board of Supervisors has approved a pilot program to ensure the “missing middle” has access to mental health treatment. The “missing middle” are residents who earn a bit too much to qualify for government-funded health care like Medi-Cal, but cannot afford to pay for care out of pocket or the high-quality insurance that would cover such services.

“The mental health needs of the missing middle in our health care system have been overlooked for far too long,” said Santa Clara County Supervisor Joe Simitian, who proposed the expanded mental health coverage in May of 2022. “We have too many people who slip through the cracks. This new effort is designed for folks who need help accessing affordable mental health services. It’s good for patients, good for families, and good for our community.”

The new plan adds mental health services to the County’s existing Primary Care Access Program (PCAP), and expands eligibility to include residents making up to 650% of the federal poverty level (FPL) that means more residents can access medical and mental health care.

Individuals earning $84,000 annually and/or $172,000 annually for a family of four could qualify. The pilot program will leverage the existing PCAP network to provide telehealth and in-person mental health services, including treatment for severe mental illness and outpatient substance use, and prescription medications. The new plan is designed to ensure that residents can easily access the right care in the right setting with the appropriate follow-up care. The launch of this pilot program will begin in the first quarter of 2023.

“It’s exceptional what our Board and departments are bringing to the community,” said Rene Santiago, Deputy County Executive of the County’s Health and Hospital System. “Our County is willing to go beyond other counties in treating mental health and physical health equally. This pilot program does more than simply provide safety net services; it is really about taking care of everyone in our community.” 

This planned expansion of PCAP comes nearly a year after Simitian announced a plan to bring primary care medical services to more than 20,000 additional County residents by increasing the eligibility cap for PCAP from 200% FPL to 400% FPL. Not only will this latest expansion of eligibility (to 650% of FPL) increase the number of residents eligible for affordable health care, it will also ensure that more residents are able to access mental health services.

“It’s tough enough for a lot of folks to even acknowledge they need help, or that someone they care about is in crisis,” said Simitian. “By ensuring mental health services and medical services are both being treated, and treated equally, we can make it easier, less time consuming, and more affordable for our residents and their families to get the mental health and substance use care they need and deserve.”

Additionally, the County plans to roll out an outreach and education effort early next year to let all residents know about their “mental health parity rights” (under state and federal law, mental health and substance use issues get equal treatment as other health conditions) and their ability to access services. This effort is being undertaken by the County in response to Simitian’s proposal to develop options to improve access to mental health care in Santa Clara County. California Senate Bill (SB) 855 established the right to mental health parity and requires insurers to cover medically necessary treatment for all mental health and substance use disorders.

“When people need mental health or substance use help—for themselves, a friend, or a family member—they need services right away. Folks often spend a lot of time trying to figure out how to access services, worrying if their insurance covers the services, and working out how to pay for it all,” said Simitian. “County residents should know their options, and be fully informed about the mental health services they can access.”