School‑based Medi‑Cal fee schedule slow to roll out; districts press state for bridge funding after layoffs
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Summary
DHCS told a Senate subcommittee that school‑based Medi‑Cal claiming under the new CYBHI fee schedule is possible but still uneven across districts; several counties asked the Legislature for one‑time bridge funding after staff layoffs and small initial payments.
Autumn Boylan, deputy director in DHCS’s Office of Strategic Partnerships, told senators that the CYBHI fee‑schedule program (the long‑term funding mechanism for school‑based Medi‑Cal behavioral health services) has onboarded multiple cohorts of local education agencies and institutions of higher education and that claims submission and payments are possible. "The infrastructure to pay claims is in place. And claims are being paid," she told the committee.
What the department reported
- Cohort onboarding and claims: As of the hearing, DHCS said 14 LEAs had submitted claims to Carillon (the third‑party administrator), with 327 total claims submitted (not including denials) and 149 claims paid, totaling slightly more than $12,000 in reimbursement so far. DHCS said claims volume increased sharply in April and that the department expects additional claims to be processed. - DHCS said Carillon and the department are providing technical assistance and that county offices of education, LEAs and community providers can participate as contracting partners or statewide affiliated providers.
District and provider concerns
Representatives of Fresno County and Santa Clara County described their experiences as cohort 1 participants and urged additional help to avoid service disruptions:
- Fresno County Superintendent of Schools (Trina Frazier) said Fresno has operated school‑based specialty mental health services for years and has hired clinicians and support staff to implement the CYBHI model. Fresno reported having submitted hundreds of claims; recent claims activity produced over $5,600 in paid reimbursements and an additional 103 claims were adjudicated in the week before the hearing. - Amanda Dickey of the Santa Clara County Office of Education said Santa Clara opened 25 wellness centers and hired more than 50 staff in readiness for the fee schedule. She said the district received its first modest reimbursement but later had to lay off 27 staff after operational delays. “Because we didn't receive reimbursement for a single claim until 15 months after that, as of March, we were forced to pink slip 27 of our staff,” she said.
Providers said the implementation challenges include:
- A learning curve for LEAs and their billing systems to submit “clean” claims; denials overwhelmingly reflect incomplete or incorrectly formatted claims fields required under federal billing standards. - Confusion or late delivery of onboarding templates, provider participation agreements and contract language needed to finalize local vendor or EHR arrangements. - Carillon availability and technical rollout timing; DHCS and Carillon officials said onboarding support and training resources have expanded in recent months.
Calls for bridge funding
Multiple witnesses and local officials urged the Legislature to fund a one‑time bridge while the fee schedule scales up. Providers and school district leaders asked the Legislature to reauthorize or reappropriate prior “SBHIP” infrastructure dollars or to provide an interim appropriation so districts do not dismantle staff and services hired to deliver school‑based care.
DHCS response and next steps
DHCS officials said they are committed to ensuring cohort 1 LEAs complete onboarding and receive payment in the current fiscal year and that cohorts 2 and 3 complete onboarding before the 2025–26 school year. Officials said they are continuing to refine user manuals, provide recorded trainings, host weekly office hours and simplify processes where feasible.
Quotes
"The infrastructure to pay claims is in place. And claims are being paid," Autumn Boylan said.
"We were forced to pink slip 27 of our staff," Amanda Dickey said of Santa Clara County’s layoffs after delayed reimbursements.
Ending note
School districts and community providers said the policy aims to create a sustainable funding stream for school‑based behavioral health, but early implementation issues have produced a risk of service interruptions and layoffs. District officials asked the Legislature for short‑term bridge funding while DHCS, Carillon and LEAs work to scale claims submission and payment.
