CYBHI- the Children and Youth Behavioral Health Initiative, is a transformative $4.6 billion initiative spearheaded by the state of California to revolutionize behavioral health support for children and youth. This initiative is part of a broader commitment to ensure that all children in California gain more integrated, equitable, and accessible support for their mental health and substance use needs.

CYBHI was created for young people and families, in collaboration with partners across sectors, to ensure providers meet California kids right where they are the most- in schools, college campuses, and other learning environments.

According to Governor Newsom’s Master Plan for Kids’ Mental Health, California is facing critical challenges in youth behavioral health. For example:

• Over 284,000 youth struggle with major depression.
• 66% of these young people do not receive any treatment.
• The suicide rate among kids ages 10-18 increased by 20% from 2019 to 2020.

These stark statistics highlight the urgent need for comprehensive reform in how mental health services are provided, prompting an overhaul of California’s mental health system to enhance accessibility, coverage options, and public awareness.

Goals of the CYBHI

The CYBHI is a significant new opportunity to increase funding for school-based behavioral health services in public schools, including K-12 settings, colleges, and universities. The main goal of the CYBHI is to introduce new and sustainable sources of funding which will allow districts to create an integrated, school-linked behavioral health system, ensuring timely access to mental health and substance use services for students.

The initiative focuses on being more responsive to the needs of children and youth by providing services through Medi-Cal Managed Care Plans (MCPs), Medi-Cal Fee-for-Services (FFS), commercial health plans, and disability insurers. This system allows schools to be reimbursed when providing covered services to students, making it easier for students to receive care when and where they need it most.

A crucial component of the CYBHI is improving access to school-based behavioral health services for students under the age of 26. This is why Local Education Agencies (LEAs) and County Offices of Education (COEs) play a pivotal role in the CYBHI framework, strengthening access to services for children and youth with emerging or existing behavioral health needs. Providing critical mental health support on campuses and within educational environments facilitates better student access to necessary care.

CYBHI Framework and Implementation Phases

The CYBHI is being rolled out in several phases, with Cohort 1 beginning on January 1, 2024, followed by subsequent cohorts in July of 2024 and January of 2025. This phased approach allows for gradual integration and scaling up of services, ensuring each stage is handled with the required responsiveness to feedback from participating organizations, and attention to detail.

Federal reimbursement regulations stipulate that Local Education Agencies (LEAs) must be registered as Medi-Cal providers from the start. Consequently, Cohort 1 consists primarily of LEAs already registered with Medi-Cal, most likely through the LEA Billing Option Program (BOP). The Department of Health Care Services (DHCS) also strongly advised that LEAs in the first cohort should be involved in the Student Behavioral Health Incentive Program (SBHIP) in collaboration with a Medi-Cal MCP.

As this cohort is intended to be a learning group, existing connections with Medi-Cal MCPs are advantageous for fine-tuning the overarching policies that will later be implemented across all LEAs by the third cohort's rollout in January of 2025.

How CYBHI Funding Works for School-Based Services

A new CYBHI funding mechanism will be introduced in the form of a sustainable fee schedule that requires multiple payers, including Medi-Cal MCPs, FFS models, commercial health plans, and disability insurers, to reimburse schools providing covered services.

The CYBHI funding model simplifies the cost structure involved in delivering school-linked behavioral health services, enhances reimbursement processes, eases administrative challenges, and increases the scope of funding to include more service providers. When uncertainty around student coverage is reduced, barriers to care can be eliminated, and more students can access available services.

CYBHI Service Delivery: Establishing a Provider Network

Under the CYBHI, schools can bill for services provided by a range of qualified professionals who are employed, contracted, or affiliated with LEAs. Schools will obtain reimbursement from Medi-Cal MCPs, Medi-Cal FFS, commercial health plans, and disability insurers obligated under state law to reimburse school-linked providers. Pupil Personnel Services credentialed providers and Certified Wellness Coaches employed by LEAs are included as service providers under the CYBHI. 

By expanding the types of practitioners eligible for reimbursement for school-based behavioral health services and shifting to a more approachable fee-for-service model, the CYBHI eases burdens for educational entities around rate negotiation, delivery systems, and contracting. The CYBHI is establishing a statewide multi-payer school-linked fee schedule that defines the scope of inclusive services, applicable billing codes and rates, and eligible providers who can bill for services.

LEAs must identify and designate providers and practitioners, including those employed, contracted, or affiliated with the LEA. LEAs will be reimbursed for services provided to students by any, or all, of the following: 

• PPS credentialed practitioners such as PPS school psychologists, PPS social workers, PPS counselors, and registered credentialed school nurses employed by the LEA 
• Mental health specialists employed by, contracted, or affiliated with the LEA 
• Community-based organizations or behavioral health providers designated by the LEA as eligible to deliver services to students.

Establishing Operational Readiness Through the CYBHI Grant Program

For schools to participate in the CYBHI, they must demonstrate operational readiness, which includes adequate infrastructure, billing capabilities, and compliance with Medi-Cal enrollment requirements. Schools interested in joining the initiative must submit a statement of interest and provide documentation proving they meet these standards.

LEAs have the opportunity to build the necessary capacity, infrastructure, and partnerships needed to achieve a long-term and sustainable funding model through one-time School-Linked Partnership and Capacity Grants. This CYBHI grant program will provide a $550 million investment to support California’s educational system. 

The minimum operational readiness requirements for CYBHI include all of the following:

Medi-Cal Enrollment

• LEAs and their affiliated providers, such as community-based organizations and school-based health centers, must be Medi-Cal enrolled and comply with all federal and state requirements. 
• LEAs that are not currently enrolled in Medi-Cal should note that they may opt to become Medi-Cal enrolled and eligible to join the fee schedule starting in July 2024 for the second cohort, or January 2025 for the third cohort.

Service Delivery Infrastructure

• LEAs must demonstrate a sufficient existing service delivery infrastructure or capabilities to expand service offerings to meet needs, such as space, staffing, and resources.

Data Collection and Documentation

• LEAs must have defined policies and protocols for collecting, storing, and transmitting information such as:
  • Student data and healthcare coverage
  • LEA eligible practitioners and affiliated or contracted school-linked providers
  • Service-level data

Billing Infrastructure

• LEAs must demonstrate the ability to transmit information for claims and receive payments.

CYBHI Support and Technical Assistance

The state is committed to supporting schools through the CYBHI implementation process and providing technical assistance to help schools navigate the new system effectively.

• DHCS, in collaboration with the Sacramento County Office of Education and the Santa Clara County Office of Education, will assist with grant administration and co-lead statewide technical assistance efforts across COEs and LEAs in every county. The state will also provide ongoing technical assistance to LEAs as they build operational readiness requirements and utilize the fee schedule.
• DHCS is also contracted with Carelon Health, a third-party administrator, or TPA, that will serve as a mandatory statewide clearinghouse for claims management and payment remittance and provide support to LEAs to ensure that claims meet federal and state requirements. Carelon will centralize LEA network oversight, including certain functions necessary to maintain the program’s integrity, such as quality oversight. 

The Future of School-Based Behavioral Health Services in California

The Children and Youth Behavioral Health Initiative represents a significant investment in the future of California’s youth. By participating in the CYBHI, schools have a unique opportunity to directly impact the well-being of their students, fostering environments where children and youth can thrive.

Exym is here to support California school districts as they prepare for the Children and Youth Behavioral Health Initiative. We have over 20 years of mental health billing experience in California, and we’ve developed a custom billing solution designed for the CYBHI Cohort 1. This advanced billing solution is now available to all CA districts participating in the CYBHI.

By partnering with Exym, districts can save valuable time and reduce frustration. We're ready to assist with Medi-Cal eligibility checks, formatting documents for billing, creating detailed reports, and managing data efficiently. Our easy-to-use software also has an flat affordable monthly fee, so you keep more of your funding regardless of billing volume.

To learn more about the California districts Exym currently serves and how we can help your district with CYBHI regulations, click on the button below and connect with us.