California’s first-in-the-nation initiative requiring health insurance companies to reimburse schools for on-campus behavioral healthcare services has struggled to meet expectations five years after its launch, with schools citing billing challenges, delayed payments and limited state support, according to a KFF Health News report.
Here are four things to know:
- The program, part of Gov. Gavin Newsom’s $4.4 billion “Master Plan for Kids’ Mental Health,” requires insurers to reimburse eligible schools for on-campus behavioral healthcare.
- Roughly 1,000 educational institutions participate, but more than half of eligible schools do not, and fewer than one-fifth had filed claims as of June 1. California invested about $1.3 billion in school behavioral health infrastructure and awarded Boston-based Carelon Behavioral Health a $65 million contract to administer claims.
- As of June 1, about 232,100 claims totaling more than $11.3 million had been approved for 186 educational agencies, well below the state’s long-term goal of generating $500 million annually for school-based mental health services. Schools report billing complexity, incomplete infrastructure, inconsistent guidance and delayed reimbursements have slowed implementation.
- Rural districts have reported the greatest challenges, prompting lawmakers to pursue legislation that would provide additional technical assistance to participating schools. The California Department of Health Care Services said it incorporated early feedback from school districts by extending claim deadlines, loosening onboarding requirements, and hosting webinars and office hours, but noted changes of this scale take time.
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