Board approves Behavioral Health rate adjustments for Drug Medi‑Cal residential providers; vote 4–1

The Fresno County Board of Supervisors on March 25 approved amendments to the county's Drug Medi‑Cal master agreement to raise reimbursement floors for multiple residential substance use disorder providers after a market adequacy review.

Susan Holt, director of the Fresno County Department of Behavioral Health, told the board the state’s payment reform required the county to shift to fee‑for‑service structures; the county performed a market analysis and concluded three of its five residential providers were reimbursed at rates substantially below local averages and market norms. Holt said county contract terms and network adequacy obligations to Medi‑Cal beneficiaries required raising the floor of the county’s residential reimbursement range for those providers.

Some supervisors sought clarity about the line‑item fee schedule included with the amendment. Supervisor Gary Bredefeld questioned apparent differences between hourly practitioner rates in county agreements and higher rates shown elsewhere for Medi‑Cal providers; Holt explained the residential programs receive a bundled daily rate for most treatment services and that the listed professional rates apply only to limited, unbundled fee‑for‑service services such as recovery services and case management.

Supervisor Bredefeld said the contract language and rates were unclear; after discussion, he asked to follow up offline with department staff to review reimbursement mechanics. The board voted to approve the amendment; the clerk recorded one no vote (Supervisor Bridal) and the motion carried 4–1.

Why it matters: The rate adjustments aim to preserve local network adequacy for residential substance use disorder treatment under state Medi‑Cal payment reforms. Department officials said the changes will allow three lower‑paid providers to remain in the network and meet the county’s contractual obligations as a Medi‑Cal behavioral health plan.

Details: Holt said outpatient rates tied to residential services were established by the state and that Fresno County, as the plan, pays a subset of the state rate. She also described intergovernmental transfer (IGT) cashflow mechanics and said the department has strengthened claims operations to manage reimbursements. Fiscal specifics for each provider and the dollar impact on county net‑county cost were not finalized during the meeting; the board approved the contract amendment as presented.

Speakers on the item included Susan Holt (Behavioral Health Director) and several supervisors who questioned clarity on rates; the board approved the amendment by recorded vote.