Behavioral Health Services Program

Medi-Cal behavioral health coverage through the Health Plan of San Joaquin (HPSJ) is managed by Carelon Behavioral health (formerly known as Beacon Health Options) and is available to members in San Joaquin and Stanislaus counties.  Please review the grid below to make the appropriate referrals.

Referral Action(s)
Outpatient treatment for mild to moderate mental health conditions, for all ages:

  • Individual, family and group mental health
  •  Psychological testing to evaluate a mental health condition
  • Lab work, drugs and supplies
  • Drug therapy monitoring
Call Carelon Behavioral Health at 1-888-581-7526

Complete and submit to HPSJ the Case Management Referral Form.


Social Worker of the Day: (209) 942-6395

Behavioral Health treatment for members under 21 years of age:

  • Applied behavior analysis
  • Diagnostic evaluation
  • Psychological assessment


Call Carelon Behavioral Health at 1-888-581-7526
Specialty mental health services for serious mental health conditions:

  • Counseling
  • Psychiatric medication management
  • Crisis intervention
  • Crisis mobile response
  • Inpatient psychiatric hospitalization
  • Referrals
Medi-Cal members can self-refer, and/or providers can offer these resources to their patients so their patients can contact:

San Joaquin

ACCESS Line: 1-888-468 9370


ACCESS line: 1-888-376-6246


ACCESS line: 1-800-318-8212

El Dorado

ACCESS line: 1-800-929-1955


HPSJ and Carelon is also available to work with the member’s provider to help coordinate the above listed resources on behalf of the member.
Substance use disorder services

  • Screening, brief intervention and referral to treatment can be accessed through HPSJ’s network
  • Treatment of services can be coordinated and referred through the county access line.
San Joaquin

ACCESS Line: 1-888-468 9370


ACCESS line: 1-888-376-6246


ACCESS line: 1-800-318-8212

El Dorado

ACCESS line: 1-800-929-1955


For more information on the above services, visit their respective pages:

  • Mental Health Services
  • Maternal Mental Health
  • Substance misuse and substance use disorders screening requirements
  • Behavioral Health Treatment for Medi-Cal members under the age of 21

Social Services and support

HPSJ’s Social Services team is available to help with the following:

  1. Removing social determinants that prevent members from receiving the care they need.
  2. Conducting psychosocial assessments on referrals, connecting members to resources and services based on the patient’s care plan.
  3. Providing or arranging these services:
  • Care coordination
  • Crisis intervention
  • Discharge planning and transition of care
  • Member and family education and advocacy
  • Non-emergency medical transportation to medical, dental, mental health and substance use disorder appointments
  • Over-the-phone interpretation services

To make a referral, complete the Case Management Referral Form and send it to HPSJ Behavioral Health and Social Services Department via email or fax, as directed above.

Collaborative coordination of medical and behavioral health care services for your patients

As part of our compliance with the National Committee for Quality Assurance (NCQA) and to ensure alignment with best practices, HPSJ monitors and encourages strong collaboration in the coordination of care between medical and behavioral health care to encourage continuity.

HPSJ provides these services:

  • Interdisciplinary care team to address a member’s full spectrum of health-related needs across the care continuum
  • Comprehensive assessment to identify a member’s needs and barriers to care
  • Communication strategy such as rounds, warm handoffs, and connected electronic health records or electronic medical records (EHR/EMR) to support prevention and early intervention
  • Robust monitoring system for follow-up care
  • Methods to address polypharmacy and indiscriminate use of controlled substances
  • Activities to monitor, evaluate, and improve interventions and quality

Your practice provides these services:

  • Obtaining permission from the member to share information with the patient’s primary care physician or other designated healthcare provider(s)
  • Response to coordination of care requests
  • Follow-up with the member on any outcomes related to shared information
  • Treatment plan that best fits the member’s needs
  • Collaboration with the member’s care team to share treatment plans
  • Confirmation and alignment in medicine prescribed and/or recommended

Behavioral Health Treatment

Health Plan of San Joaquin (HPSJ) covers all medically necessary behavioral health treatment (BHT) for eligible beneficiaries under 21 years of age. This may include children with autism spectrum disorder (ASD) as well as children for whom a physician or psychologist determines it is medically necessary. Consistent with state and federal requirements, a physician or a psychologist must recommend BHT services as medically necessary based on whether BHT services will correct or ameliorate any physical and/or behavioral conditions.

BHT Services are evidenced-based and can include:

  • Applied Behavioral Analysis (ABA)
  • Behavioral Interventions
  • Cognitive Behavioral interventions
  • Parent/Guardian Training
  • Self-Management
  • Social Skills

Steps for Referral and Evaluation:

  1. Screening
    The PCP or healthcare provider completes Early Periodic Screening, Diagnosis, and Treatment (EPSDT), which should include a validated screening tool. The provider then makes a referral to HPSJ’s behavioral health services management organization, Carelon, as appropriate.
  2. Diagnostic evaluation or Direct referral for BHT or ABA
    HPSJ’s behavioral health services management organization, Carelon manages referrals for diagnostic evaluations and referrals for BHT/ABA.

Contact Carelon by calling 1-888-581-PLAN (7526)


Maternal Mental Health

Health Plan of San Joaquin offers support to members and providers through prenatal and postpartum care for our Medi-Cal members through our Me & My Baby Program in order to promote maternal wellbeing.
This includes that, Licensed Health Care Practitioners who offer prenatal and postpartum care, offer:

  • Screening for any type of mental health condition that may be occurring.
  • Referral to supportive services that may benefit the member.
  • Linkages to our Me + My Baby program.
  • For Providers, HPSJ promote the following steps to support Maternal Mental Health:

    Clinical Practice Guidelines and Resource learning
    The Centers for Medicaid and Medicare have developed a toolkit of many resources for various practices who serve the prenatal and postnatal populations. To learn more, go here.
    Importance of Maternal Mental Health
    • 1 in 5 women experience mental health concerns during pregnancy and after childbirth, but most go undetected and untreated.
    • Maternal mortality continues to rise in the U.S. and mental health is the leading preventable cause of death.
    • Maternal mental health disorders can have a significant impact on a mother’s health and wellbeing
    Recommended Tools:
    Frequency Billing Follow-Up Plan

    Required Frequency

    • At least once during each pregnancy AND
    • At least once within 12 weeks following the birth of the child

    G8431 should be applied when the screening for depression is being documented as positive and a follow-up plan is documented.
    G8510 should be applied when results of the screening for depression are documented as negative and a follow-up plan is not required.

    All members whose screening results indicate a positive identification of potential depression or other mental health condition, may be referred for mental health services.Members may refer directly to our network of providers:
    Online Provider Directory tool
    or Call:
    Mental Health Customer Service line: 888-581-PLAN (7526)


Substance Use services include Alcohol and Drug Screening, Assessment, Brief Interventions and Referral to Treatment (SABIRT) for members 11 years old and older, including pregnant women. These services are provided by PCPs.

Annual screenings for alcohol and drug use
Unhealthy alcohol and drug use screening must be conducted using validated screening tools. Validated screening tools include, but are not limited to:

  • Cut Down-Annoyed-Guilty-Eye-Opener Adapted to Include Drugs (CAGE-AID)
  • Tobacco Alcohol, Prescription medication and other Substances (TAPS)
  • National Institute on Drug Abuse (NIDA) Quick Screen for adults
  • The single NIDA Quick Screen alcohol-related question can be used for alcohol use screening
  • Drug Abuse Screening Test (DAST-10)
  • Alcohol Use Disorders Identification Test (AUDIT-C)
  • Parents, Partner, Past and Present (4Ps) for pregnant women and adolescents
  • Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) for non-pregnant adolescents
  • Michigan Alcoholism Screening Test Geriatric (MAST-G) alcohol screening for geriatric population.

Brief Assessment

When a screening is positive, validated assessment tools should be used to determine if unhealthy alcohol use or SUD is present. Validated alcohol and drug assessment tools may be used without first using validated screening tools. Validated assessment tools include, but are not limited to:

  • NIDA-Modified Alcohol, Smoking and Substance Involvement Screening Test (NM-ASSIST)

  • Drug Abuse Screening Test (DAST-20)

  • Alcohol Use Disorders Identification Test (AUDIT)

Brief intervention

  • Discussing negative consequences that have occurred and the overall severity of the problem;

  • Supporting the patient in making behavioral changes; and

  • Discussing and agreeing on plans for follow-up with the patient, including referral to other treatment if indicated.

Referral to treatment

Medi-Cal members have access for Treatment beyond the Scope of a PCP through the Access line available within their county:

San Joaquin

ACCESS Line: 1-888-468-9370


ACCESS line: 1-888-376-6246

Services within the scope of mental health providers can connect to Carelon at 1-888-581-PLAN (7526)

Transgender Services

HPSJ covers a variety of transgender-specific services (gender-affirming care) as a benefit when services are medically necessary. These services include:

  • Psychological assessment (to determine readiness for surgery and/or procedures)
  • Hormone therapy
  • Gender affirming surgeries and procedures

Coverage for treatment

  • Primary care doctor for routine preventative care, regardless of gender marker

  • Medi-Cal Transgender-specific care

  • Mental health therapy (unrelated to assessments for gender-affirming care) through HPSJ’s mental health network

For more information about specific coverage for behavioral health services
Behavioral healthcare services are coordinated through Carelon Behavioral Health at 1-888-581-7526 (PLAN)

Posted on October 11th, 2023 and last modified on February 1st, 2024.