San Diego students can now walk into a school wellness center, get screened, talk to a therapist, or meet with a case manager, and walk back to class without paying a cent. Behind the scenes, schools can bill health insurance for many of those on-campus services, which district leaders say will help keep counselors and wellness centers open while keeping care free for families. The rollout is already underway at Mission Bay High, and officials expect more campuses to join in the coming months.
State push and new rules
The change grows out of the Children and Youth Behavioral Health Initiative, a multi-year state effort backed by more than $4 billion to expand behavioral health services for young people, and from new rules that let schools seek reimbursement from health plans. According to the California Department of Health Care Services, the CYBHI Fee Schedule Program allows local educational agencies and school-linked providers to bill Medi-Cal managed care plans and state-regulated commercial plans at published rates for eligible services delivered at school sites.
The department explains that the fee schedule is meant to strip away some of the red tape that has kept districts from tapping into health coverage in the past and to ensure that covered services are not subject to copays, coinsurance, deductibles, or prior authorization.
What counts as billable care
State materials and budget documents group reimbursable services into several broad categories, including psychoeducation, screening and assessment, therapy, and case management. They also set age and provider eligibility rules for what can be billed.
As outlined by the Assembly Budget Committee, the fee schedule applies to students up to age 25 and is payable to local educational agencies and school-linked providers regardless of network status. Advocates say the standardized rates are intended to create a predictable, sustainable funding stream for school-based behavioral health services across districts.
On the ground in San Diego
At Mission Bay High, wellness center coordinator Gloria Cota is seeing what those policies look like in real life. She says students are arriving with rising levels of anxiety and grief and telling staff, "I can't breathe. I lock up. I can't focus. It's fog," a line Cota shared with NBC 7 San Diego.
County officials told the station the program is already active across multiple campuses. Heather Nemour, the county's student wellness coordinator, told NBC 7 San Diego that 87 San Diego school districts are implementing the program and eight districts have already received reimbursements. District staff say the new billing option gives them a better chance of holding on to positions that might otherwise be cut during budget crunches.
What families should know
Families who want their child's visits billed to insurance must provide consent and insurance information. On its CYBHI information page, San Diego Unified notes that the information is confidential and "protected under FERPA and HIPAA."
The district emphasizes that there is no cost to families. Services billed under the CYBHI fee schedule should not trigger copays or deductibles, and parents can opt out if they prefer. The district also says it is using a secure vendor to handle claims and that student services remain available whether or not families choose to participate.
Local leaders describe the new reimbursement pathway as a way to stabilize school wellness staffing and extend care to more students. "It's really a game changer," Nemour told NBC 7 San Diego, adding that the extra funding helps protect staff in behavioral-health positions and the students who depend on them.
