San Mateo County Mental Health Target Adult Populations

Eligible Populations

• Medi-Cal eligible beneficiaries who meet State-defined medical necessity criteria (attached) for specialty mental health services, including the Severally Mentally Ill (SMI).
• Healthworx, Healthy Families, and Healthy Kids beneficiaries (including ages 8-21) who meet state-defined medical necessity criteria.
• Services for uninsured clients are limited to serving the Severally Mentally Ill who have a significant degree of impairment and risk as described below.

Criteria for Uninsured Adults with no other benefits or resources:

The following areas are taken into consideration to determine and individual's eligibility for County Mental Health safety net practices:

1. Axis 1, SMI Diagnosis, typically including one or more of the following:
   • Schizophrenia, or other illness with psychotic features
   • Bipolar I
   • Major Depression
   • Severe PTSD
   • Severe Personality Disorder
2. Current Degree of client's impairment:
   • There is a direct impact and correlation of severe mental illness on life functioning, seperate from social and situational stressors and unrelated to substance abuse, medical conditions or cognitive impairment.
   • Recent PES and Psych in-patient hospitalizations, unrelated to substance abuse, medical conditions, or cognitive impairment.
   • Where SMI symptoms are the primary source of decreased functioning.
3. Client degree of risk for self-injuriuos behavior, or injury to others as demostrated by:
• Recent serious thoughts of harming self or others
• Recent significant, injuriuos behaviors
• Inability to care for self due to severe mental illness
• Past or present PES and Hospitalization information that indicate a high probability of current risk unrelated to substance abuse, medical conditions or cognitive impairment

 

Continuation of Medications

San Mateo county mental health does not fill the gap of loss of private health care benefits for psychiatrists or for medications.

 

Emergency Services

Emergency Mental Health Services are provided through Psychiatric Emergency Services located in San Mateo General Hospital.

 

Population generally NOT served by San Mateo County Mental Health

1. Individuals who have private insurance.  Note the specific policy/procedure and criteria for evaluating exceptions is outlined in MH Policy 03-13 Eligibility for Planned (non-emergency) San Mateo County Mental Health Services for Individuals Who Have Private Insurance.
2. Non SMI Medicare patients.
3. Individuals whose mental health conditions are secondary to medical conditions, such as cognitive impairment due to Stroke, Demetia, or Organic Brain Syndrome, or Mental Retardation or Autism.
4. Individuals whose primary mental health care needs are a result of Substance Abuse.

Co-Occurring Disorders

Mental health can provide medical consultation for some conditions, including, clients who have Developmental disabilities, substance abuse issues, and medical conditions.  Mental Health works collaboratively with substance abuse programs in the treatment of mentally ill clients with co-occurring substance abuse issues and offers Dual Diagnosis groups for SMI clients in Regional Care.