California has invested once in the mental health of young people during the Covid-19 pandemic as the incidence of depression, anxiety and eating disorders skyrocketed among children and teens. One of the state’s plans included ways to flow money to schools that wanted to expand mental health services for their students.
It included allowing K-12 schools and universities to claim MEDI-CAL and private health insurance for behavioral health care provided on campus.
But the efforts have come off a slow start among the first kind in the country, slowing down dollars and resources for schools to help students with mental health challenges. According to state health officials, only 14 school districts and counties have begun billing for behavioral health services under the Children and Youth Behavioral Health Initiative Fee Schedule Program. The 46 school districts and county offices of education began the implementation process in January 2024 and were scheduled to begin billing in July last year. A total of 494 school districts, county offices of education, and universities have signed up to participate in the new billing program.
Some school officials are unhappy with the delay in the program. They say the state was slow to release guidance and necessary training to file a request for mental health services provided. School staff who hired mental health staff say they may have to lift recent employment immediately as payments for services offered aren’t coming in as expected. This means that students may lose new gains of access to the service.
“There’s so many unknowns and the timeline continues to be pushed,” said Trina Frazier, student services aide with the Fresno County Education Department. “And that’s really sad because there’s so many possibilities.”
The California Department of Healthcare Services, which oversees the implementation of the program, told Calmatters via email that while Target will begin billing in mid-2024, “the size and complexity of implementation will require adjustments needed to provide additional flexibility for schools.” “Major reforms of this type require time, adjustments and gradual implementation,” the department said in an email.
The department said it continues to work with the school to address unresolved challenges. The new goal is for the first group of 46 districts and the Department of Education to begin claims by the end of the current academic year.
Supporting school mental health
California and the country have seen a surge in mental disorders among students. For example, the state estimates show that around 284,000 California children and teens deal with major depression, with two-thirds of whom are not receiving treatment.
Despite the start of the new school billing program, other mental health initiatives are underway through other components of the state’s $4.7 billion child and youth behavioral health initiative launched in 2021. Approximately $400 million of that money was allocated in the form of a one-time grant to educational institutions to hire providers and prepare for this new claims program.
In response to the delay in the billing program, a group of lawmakers recently sent a letter to Gov. Gavin Newsom requesting funding for the bridge, saying that schools will allow them to continue building mental health services while the program is speeding up. The letter does not specify the amount of dollars.
Through the past 30 years and another program, California schools have been able to be reimbursed to Medi-Cal, the state Medicaid program for low-income residents, for certain physical and mental health services. However, there has been a long gap between private insurance children. The new billing programme is supposed to address that and allow schools to expand the types of mental health services they can offer and claim.
Mental health professionals see school as the ideal environment for children to receive help. They spend most of the weekday and generally feel safe. Sullabroom, the school’s Medicaid consultant, is also a “logistics problem solver” as the school resolves potential barriers that care for potential barriers, such as transportation to appointments. Also, teachers and staff can look at the kids every day and realize when things are off.
Bloom said the challenges the state and schools face with rolling out this new fee schedule program are somewhat predictable as what California is doing because of new things. “So you’re calling your peer status and saying, ‘Hey, how did you find out how to do this?’ You’re creating a lot of this as you go.
What’s behind the delay?
State lawmakers have heard about the delayed billing from disgruntled local officials. The Fresno County Education Department filed its initial claim for a refund on February 28th, but as of last week, Frasier said it continues to face challenges.
Frazier told lawmakers at last week’s hearing that the program “feels like building planes while flying.”
In Santa Clara County, the local education department has established 25 wellness centers throughout the school, hiring 50 new mental health workers, including clinicians and wellness coaches. However, the delay has led to Amanda Dicky, executive director of government relations at the Santa Clara County Education Department, told lawmakers at the hearing.
“I didn’t get a single bill refund until 15 months later (starting the implementation of the program) … as of March, I was forced to do a staff pink slip 27.
Dickie told Congress that Carelon Behavioral Health, which the state and third-party administrators have contracted to process claims, did not provide school access or training to the billing software used to file claims until later last year.
Meanwhile, the Los Angeles County Education Department told Calmatters that one of the challenges is gathering student health insurance information, a new task for the school, requiring parents and caregivers to cooperate in sharing information about their health plans. (The state says mental health care provided at schools under the program should not result in family out-of-pocket expenses.)
Tanyaward, project director for the Los Angeles County Education Department, said her office has not yet filed a mental health claim under the new program, but she hopes to do so later this month.
The California Department of Healthcare Services believes there is a delay in the “learning curve” for both the state and schools.
According to the department, many factors contributed to the delay, including the fact that some schools requested the compilation of contract documents to participate in the program, while others expressed confusion about the process and that additional support was needed.
The department said that as long as these claims are filed by June 30, the district is permitted to file a retroactive claim for service dates up to July 1, 2024.
The 14 districts and the Education Department are currently able to file claims, Fall Boylan, deputy director of the state health department’s Strategic Partnerships Department, told lawmakers at last week’s hearing.
“This is a huge change for the entire system, and this magnitude of change will take time,” Boylan told lawmakers.
“We still have work to do, but I think we’re making progress,” she said.
Testimony from next door at last week’s hearing revealed that Fresno Boylan and Frasier could not agree on how much they were actually paid to the Fresno County Education Department. Of the first 40 claims processed for Fresno, 21 were denied, Frasier said. Boylan said some claims were either incomplete or have been rejected because they were not properly filed. Lawmakers questioned whether the school was making the allegations incorrectly because the school was not properly taught how to do so.
“This is brand new for the school,” Sen. Caroline Menzibal, a Democrat for Van Nuisse, said at the hearing. “As a government, if we want to take on something that is completely out of their scope, it’s essential that we lead them on the right path.”
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