Reimagining Medi-Cal: Building a More Connected Future for Behavioral Healthcare

California's Behavioral Health programs, heavily funded by Medi-Cal, have undergone significant transformation over the past several years through initiatives like CalAIM and the Behavioral Health Services Act. These reforms have expanded access to services and accelerated the shift toward whole-person care. Now, state leaders are looking beyond implementation and asking a larger question: What should Medi-Cal look like over the next decade? 

That question is driving the work of the Future of Medi-Cal Commission, a 29-member body charged with developing a long-term vision for one of the nation's largest Medicaid programs. During a recent discussion, Dr. Veronica Kelley, Commissioner, The Future of Medi-Cal Commission, and Director of the Orange County Health Care Agency, outlined several priorities she believes will shape that future. Dr. Kelley’s perspective points toward a healthcare system that is more integrated, more flexible and better aligned around the needs of the individual rather than the structure of the programs themselves. 

Moving beyond incremental reform 

According to Dr. Kelley, one of the commission's greatest strengths is the diversity of expertise represented around the table. Members bring perspectives from county agencies, provider organizations, commercial healthcare and public policy, creating opportunities to challenge long-held assumptions about how Medi-Cal should operate. 

“California is so diverse in population sizes and needs,” Dr. Kelley said. “Having diversity in voice is absolutely essential.” 

Rather than focusing exclusively on improving existing policies, the commission is examining how the healthcare system would be designed if it were built today. That distinction is significant. Medi-Cal has evolved through decades of legislative changes, funding models and regulatory requirements, many of which were developed independently. While individual programs may function well, they do not always operate as a cohesive system. The commission's work reflects a broader effort to create a model that is better equipped to support providers while improving outcomes for beneficiaries. 

“[We’re striving to] create a fail proof system that would support overall health for Californians,” Dr. Kelley said. 

Technology's role in advancing whole-person care 

Achieving the Future of Medi-Cal Commission's vision will require more than policy changes; it will rely on technology that enables providers across the care continuum to operate from the same vantage point of an individual's health. 

As California continues advancing whole-person care, interoperability will become increasingly essential to connecting behavioral health, primary care, specialty care and community-based services. Qualified Health Information Networks (QHINs) are helping make that possible by establishing a secure, nationwide framework for exchanging health information across organizations and electronic health record systems. Rather than requiring providers to operate in disconnected environments, QHIN-enabled data exchange gives clinicians access to more complete patient information at the point of care, supporting better clinical decisions and reducing fragmentation.  

Technology also plays a critical role in turning information into action. Care coordination platforms that integrate interoperability directly into clinical workflows allow providers to manage referrals, share care plans and coordinate services across organizations without creating additional administrative burden. Combined with a unified view of behavioral, physical and social health data, these capabilities support the kind of collaborative care model envisioned by CalAIM and the Future of Medi-Cal Commission.  

Whole-person care requires system-wide integration 

Behavioral health remains central to that vision. Dr. Kelley emphasized that mental health, substance use treatment and physical healthcare cannot continue operating as separate systems when patients experience them as a single healthcare journey. 

Individuals with serious mental illness or substance use disorders frequently live with chronic medical conditions that require coordinated care. At the same time, medications that successfully manage behavioral health symptoms can contribute to other health challenges, underscoring the importance of treating the whole person rather than isolated conditions. Future reforms, she argued, should continue advancing payment models and care delivery strategies that encourage collaboration across specialties instead of reinforcing traditional divisions between behavioral and physical healthcare. 

Simplifying care delivery 

That philosophy aligns closely with the original goals for CalAIM, but Dr. Kelley acknowledged that implementation has not always matched the vision. While the initiative sought to improve coordination and address social drivers of health, providers and counties have also experienced increasing administrative complexity through new billing requirements, documentation standards and compliance expectations. 

For future reforms to succeed, integration must be accompanied by simplification. Accountability and oversight will always be necessary, but operational processes should support clinical care rather than compete with it. Reducing administrative burden allows organizations to devote more time and resources to improving patient outcomes, making system transformation more sustainable over the long term. 

“Everybody deserves health care,” Dr. Kelley added passionately. “Everyone deserves an opportunity to get better. That's the mission.” 

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