District to expand school-based billing for student mental health, approves contract expansion with Paradigm

The board approved staff’s recommendation to expand the district’s LEA medical-billing practice under the Children & Youth Behavioral Health Initiative (CYBHI) to include mental-health services for all students and to bill private insurance as well as Medi-Cal. The action included an expansion of the contract with billing partner Paradigm to manage file transfers and claims processing.

Kevin, who led the presentation, described two short-term "bridging" grants supporting implementation (a roughly $78,000 capacity grant and about $240,000 in certified-wellness-coach grants) and outlined reimbursement examples from the fee schedule. "This is about sustainability," he said, adding the district will use the grants to build billing infrastructure and to subsidize wages while staff learn the process. He also told trustees the DHCS-managed platform suppresses explanation-of-benefits that would otherwise go to families and that services billed through the program are carved out so they do not count against families’ deductibles.

Trustees raised privacy and consent concerns, including whether families would be asked to provide private insurance at enrollment or at point of service. Kevin said the district will initially collect insurance and consent at point of service and explore broader collection in subsequent years, holding community meetings to explain the process. The board approved moving forward with the Paradigm contract expansion and the implementation plan, with staff to begin billing on Sept. 25 pending onboarding.