California made a unique investment in the mental health of young people during the COVVI-19 pandemic, as a rate of depression, anxiety and food disorders, increased among children and adolescents. An element of the state plan included a means of fluctuating money for schools that wanted to extend mental health services for students.
It was a question of allowing schools and colleges from kindergarten to the 12th year to charge Medi-cal and private health insurance for behavioral health care provided on campus, a change that would allow them to provide more services and hire additional mental health staff.
But this effort – among the first of its kind in the country – is in slow start, delaying dollars and resources so that schools help students take on mental health challenges. According to children’s health and health officials for children and young people in children’s health and young people have started to charge behavioral health services in the context of behavioral health services. Forty-six school districts and the county education offices began the implementation process in January 2024 and had to start invoicing last July. In total, 494 school districts, the office of the county of education and colleges registered to participate in the new billing program.
Some school officials are frustrated by the program delays. They say that the state was slow to publish advice and training necessary to submit complaints for the mental health services provided. School officials who hired mental health personnel say they should soon have to dismiss recent hires because payments for the services provided are not as planned. This means that students could lose new access to services.
“There are so many unknowns and the deadlines keep growing,” said Trina Frazier, assistant superintendent for students at the Fresno County Education Office. “And it’s really sad because it has so much potential.”
The California Department of Health Care Services, which oversees the implementation of the program, told Calmatters in an email that, even if the objective was to start invoicing in mid-2024, “the scale and complexity of the implementation required adjustments to provide additional flexibility to schools”. “The main reforms of this type require time, coordination and progressive implementation,” said the ministry in his email.
The ministry said it continued to work with schools to meet exceptional challenges. Its new objective is that this first group of 46 districts and educational offices are starting to invoic by the end of the current school year.
A boost for mental health in schools
California and the nation have seen an increase in mental health disorders in students. For example, around 284,000 children and adolescents from California deal with major depression, and two thirds of them do not receive treatment, according to state estimates.
Despite the slow start for the new school billing program, other mental health efforts are underway through other elements of the behavioral health initiative of $ 4.7 billion for children and young people who were launched in 2021. This money paid for mental health applications, educational campaigns and mental health training programs, between a number of other efforts. About $ 400 million in this money was allocated in the form of unique subsidies to education establishments to hire suppliers and prepare for this new billing program.
In response to delays in the billing program, a group of legislators recently sent Governor Gavin Newsom a letter asking for the financing of the bridge which, according to them, would allow schools to continue to build mental health services while the program is at speed. The letter does not specify an amount in dollars.
In the past 30 years and thanks to a separate program, California schools have been reimbursed by Medi-Cal, the state Medicaid program for low-income residents, for certain physical and mental health services. But there has long been a gap for children with private insurance. This new billing program is supposed to approach this, as well as allow schools to extend the types of mental health services they can provide and invoice.
Mental health experts consider school as an ideal framework for children to receive help. This is where they spend most of their weekdays and generally feel safe. It is also a “resolver of logistics problems” because schools solve certain potential obstacles to care, such as transport to meetings, said Sarah Broome, consultant at Medicaid school. In addition, teachers and staff see children every day and can notice when things are disabled.
Broome said that the challenges that the state and schools face to deploy this new cost schedule program is somewhat predictable, partly because what California is doing is new. “So, it’s not even like you could call your peer states and be like:” Hey, how did you understand how to do that? ” You create a lot of things as you go.
What about the delays?
States legislators hear frustrated local officials about billing delays. The Fresno County Education Office filed its first repayment request on February 28, but last week continued to face challenges, according to Frazier.
Frazier told legislators at an audience last week that the deployment of the program “had the impression of building the plane while making it fly”.
In the County of Santa Clara, the Local Education Office created 25 wellness centers in its schools and hired 50 new mental health agents, including clinicians and well-being coaches. But delays prompted the office to inform its new staff of any layoffs, said Amanda Dickey, executive director of government relations at the Santa Clara County Education Office, told legislators at the hearing.
“Because we did not receive a reimbursement for a single complaint only 15 months later (implementation of the starting program) … In March, we were forced to slide pink 27 of our staff. So 27 of the approximately 50 that we hired,” she said.
Dickey told legislators that the state and third party administrator had contracted to process complaints, Carilon Behavioral Health, only gave schools or the training of the billing software were used to file complaints until the end of last year.
Meanwhile, the Los Angeles County Education Office told Calmatters that one of the challenges was to collect information on student health insurance – a new task for schools and which forces parents and caregivers to cooperate to share information on their health plan. (Mental health care provided in schools as part of this program should not result in direct costs for families, depending on the state.)
Tanya Ward, project manager at the Los Angeles County Education Office, said her office has not yet made mental health complaints as part of this new program, but plans to do it later this month.
California Department of Health Care Services attributes delays to a “learning curve” for the state and schools.
According to the ministry, a number of factors have contributed to delays, including the fact that certain schools have requested changes to contractual documents to participate in the program and that others expressed their confusion as to the process and needed additional support.
The ministry said that the districts were authorized to submit claims retroactively for the dates of service until July 1, 2024, as long as these complaints are submitted before June 30.
The 14 districts and educational offices which are now able to file complaints are starting to do so in greater numbers, said in the fall Boylan, deputy director of the strategic partnership office in the State Health Department, the legislators said at last week’s hearing.
“This is a significant change for the whole system, and changes in this magnitude take time,” Boylan told legislators.
“There is still work to do, but I think we are progressing,” she said.
Testifying some next to the other at last week’s hearing, Boylan and Frazier de Fresno could not agree on the amount of complaints which had been paid to the Education Office of the County of Fresno. Of the first 40 complaints which had been processed for Fresno, 21 were refused, said Frazier. Boylan said that certain complaints are refused because they are incomplete or not properly deposited. The legislators wondered if the schools make complaints incorrectly because they have not learned adequately to do so.
“This is new for schools,” said Senator Caroline Menjivar, a democrat of Van Nuys, during the audience. “It is imperative for us, as a government, to lead them on the right track if we want them to take something that is completely out of their reach.”