State officials outline how Certified Wellness Coaches can bill under California's CYBHI fee schedule

State health officials in a webinar hosted by the Health Care Access and Information (HCAI) program said Certified Wellness Coaches (CWCs) can be reimbursed by Medi‑Cal managed care plans and commercial insurers under the Children and Youth Behavioral Health Initiative (CYBHI) fee schedule, and explained the certification, billing and documentation rules that local education agencies (LEAs) and institutions of higher education (IHEs) must follow. The webinar presenters were officials from the California Department of Health Care Services (DHCS) and HCAI.

Why it matters: The CYBHI fee schedule creates a standardized rate structure intended to expand school‑site behavioral health capacity by allowing qualified non‑licensed workers (CWCs) to deliver preclinical prevention, screening, care coordination and behavioral‑health coaching while being reimbursed through Medi‑Cal and other insurers when requirements are met.

What DHCS and HCAI said about the legal and program framework: DHCS presenters identified the statutory foundation as California Welfare and Institutions Code section 5961.4 and referenced the state plan amendment (SPA 20‑514) that defines the scope of covered school‑site behavioral health services. DHCS said participating providers must meet medical‑necessity criteria under California law for covered outpatient mental‑health and substance‑use disorder services when billing Medi‑Cal or private plans, and noted California Health and Safety and relevant insurance code language that defines medically necessary behavioral‑health care.

Who is eligible and who must pay: DHCS said the CYBHI fee schedule requires Medi‑Cal managed care plans, Medi‑Cal fee‑for‑service and applicable health care service plans and disability insurers to reimburse eligible school‑site services for students under age 26 who are covered by those insurance types. Webinar slides listed excluded payers such as federal plans, self‑funded employer plans, certain high‑deductible plans and (as presented on…