The essential components are a single point of responsibility for the client, coordination with other involved human service agencies, and decision making based on an evaluation of outcomes. Funding for systems of care can come from a variety of sources. Federal, state and private grants are often used to establish the infrastructure. HCFA indicated that ACT services could be reimbursable through Medicaid. Medicaid is a health insurance program for low-income individuals established and funded through a state and federal partnership.
States design their program within federal requirements through state plans or waiver requests.
HCFA approves and monitors compliance with the state plans and, if applicable, waivers. Medical assistance includes inpatient hospital services and physician services, but also provides options for services such as targeted case management and rehabilitative services. California's Medicaid program is called Medi-Cal. The Medi-Cal state plan includes rehabilitative mental health services and targeted case management services for beneficiaries who have mental disorders. Beginning in November 1997, these services have been provided by Mental Health Plans, i.e., county mental health departments under contract with DMH, through an approved federal freedom of choice waiver.