"California’s groundbreaking initiative to integrate mental health services into schools, designed to reach millions of students, is faltering due to bureaucratic complexities and systemic delays, leaving many schools struggling to access promised funding and provide critical care."
California launched an ambitious, first-in-the-nation plan to address the escalating youth mental health crisis by requiring health insurance companies to reimburse schools for providing on-campus behavioral healthcare. This initiative, a cornerstone of Governor Gavin Newsom’s "Master Plan for Kids’ Mental Health," aimed to make mental health services more accessible by embedding them where young people spend most of their time. However, five years after its inception, the program is plagued by inadequate state guidance, an incomplete billing infrastructure, a lack of standardized forms, and significant payment delays, hindering its effectiveness and leaving many educational institutions, particularly those in rural areas, in a precarious financial and operational state.
The program’s stated goal was to revolutionize access to mental health support for students, particularly those whose families faced long waiting lists and financial barriers to private therapy. By enabling schools to bill insurers, the state intended to create a sustainable funding stream for counselors, therapists, and wellness coaches, many of whom were initially hired using a surge of federal COVID-19 relief funds. However, the reality on the ground has been a stark contrast to the initial promise. Plumas Charter School in Quincy, California, exemplifies the struggles faced by many educational institutions. Taletha Washburn, the school’s executive director, described two years of "spinning our wheels" navigating state webinars, complex forms, and researching electronic health record systems. Despite their efforts, the school only received its first reimbursement check in April, a mere $8,000, with at least $12,000 in outstanding claims. This experience, Washburn noted, has been a "disappointing bust" for a program she believed could be a "game changer" in their rural community.
The challenges extend far beyond Plumas Charter School. Roughly 1,000 public schools, community colleges, and universities participate in the initiative, but a significant majority – over half of California’s school systems and colleges – have not enrolled in the billing program. Among those that have, fewer than one-fifth had filed any claims as of June 1, according to the latest state data. This low participation rate directly impacts the program’s ability to generate the promised half-billion dollars in annual revenue, which was intended to cover the salaries of thousands of mental health professionals. The shortfall has contributed to widespread layoffs across California school districts, with thousands of pink slips issued amid local budget cuts.
State lawmaker Dawn Addis, a former special education teacher, has been a vocal critic of the program’s slow implementation, stating, "One of the things that makes people hate government is when we make a promise and then we struggle to keep that promise because we can’t get the administrative part of it up and running." Governor Newsom’s office declined an interview but, at a press conference, highlighted the initiative as "unprecedented" and asserted that "no other state in the nation has done more." He acknowledged the ongoing need for investment in youth mental health but did not definitively label the program a success.
Tom Insel, former head of the National Institute of Mental Health and an advisor to Governor Newsom, offered a nuanced perspective. He recognized the groundbreaking nature of California’s efforts but expressed disappointment in the lack of tangible outcomes, given the substantial investment. "What we struggle with in California is: We spend the money, but we don’t always see the outcomes," Insel remarked. "It’s sobering to realize, especially as an advocate, that you could actually get the programs, get the money, get everything that you want from the policy side, but the execution just isn’t there."
The initiative emerged from a dire national mental health landscape. In 2021, one in ten high school students nationwide reported attempting suicide, making it the second-leading cause of death for young people aged 10 to 24. In response, Governor Newsom announced a $4.4 billion "Master Plan for Kids’ Mental Health," intended to be a transformative overhaul of the state’s behavioral health system. Experts lauded it as the most ambitious state-level attempt to combat the youth mental health crisis, exacerbated by the COVID-19 pandemic.
The state allocated significant funding across various components of the plan. $730 million was earmarked for workforce development, including recruitment campaigns and student loan repayment programs. An additional $220 million facilitated partnerships between local governments and school officials, while $381 million was distributed as grants for facilities and services. The state also invested approximately $532 million in digital platforms designed to connect families with counseling and support primary care physicians in managing behavioral health issues. Furthermore, $232 million was dedicated to state operations and program evaluations. Despite these investments, the pledge to add 10,000 school counselors by the end of 2024 has fallen short, with only 1,855 added since 2021, according to the American School Counselor Association.
The "flagship" component of the Children and Youth Behavioral Health Initiative (CYBHI) focused on enhancing on-campus behavioral health services at no cost to families, by enabling schools to bill health insurers. This required an investment of approximately $1.3 billion, nearly a third of the total budget, towards establishing wellness centers, building new billing infrastructure, and bolstering school-based mental health support. However, the transition to medical billing proved to be an "administrative nightmare" for schools unfamiliar with its complexities.
The Fresno County Office of Education, for instance, described its February 2025 medical billing launch as "like building the plane while flying it." Delays were so severe that lawmakers authorized $20 million in grants to Fresno and 170 other school systems to prevent layoffs of newly hired mental health staff. Anaheim Elementary School District, lauded as a "champion" of the program, has recouped over $1.1 million since February 2025, but this represents less than 30% of the behavioral health services provided. Challenges in Anaheim, a largely Latino district, also stemmed from parental reluctance to share insurance information due to fears rooted in past immigration enforcement actions.
To manage claims statewide, California contracted with Carelon Behavioral Health, operated by Elevance Health, for $65 million. Despite this, schools have struggled to get claims approved and many have incurred substantial costs, sometimes hundreds of thousands of dollars, hiring external vendors to resolve billing issues. As of June 1, Carelon had approved approximately 232,100 claims totaling over $11.3 million for 186 school districts and educational agencies, a fraction of the anticipated participation and far from the $500 million per year projected.
Amy Blackshaw, behavioral health project director for the California School-Based Health Alliance, observed, "We probably were given the impression that this was going to happen more quickly and now there’s this reality of a kind of slow growth." Christina Kim, Carelon contract manager, declined to comment, referring inquiries to the state. Autumn Boylan, deputy director of the Office of Strategic Partnerships at the Department of Health Care Services (DHCS), stated that the state has incorporated feedback, extended deadlines, and eased onboarding requirements, but emphasized that systemic changes take time. "We’re trying to help the school districts increase their scale," Boylan told lawmakers. "It’s not a problem of claims being submitted and not paid. It’s a problem of claims not yet being submitted for payment." She noted a significant increase in reimbursements since the first claims were filed in November 2024.
Meanwhile, the youth mental health crisis persists. In 2024, nearly 14% of individuals aged 12-17 reported delaying or skipping mental healthcare due to inability to get an appointment, and one in four teens cited cost as a reason, a notable increase from the previous year, according to the California Health Interview Survey. While the rate of young adults aged 18-24 considering suicide has stabilized, it remains higher than pre-pandemic levels. Suicide rates among Californians aged 12-25 have seen a decrease from their 2021 peak, mirroring national trends, yet rates for female and Black youths increased between 2023 and 2024. Assembly member David Alvarez expressed concern, stating, "We have to have high expectations that when we invest in the magnitude of billions as this program did, we would have results to show."
Other states are observing California’s implementation challenges and adopting more focused strategies. Sharon Hoover, formerly co-director of the National Center for School Mental Health at the University of Maryland, noted that some states are implementing fewer components than California’s comprehensive rollout. Illinois, for example, focuses on universal mental health screenings, while Colorado has expanded coverage for behavioral health services for youth without formal diagnoses. Hoover acknowledged the difficulty of being a first mover, stating, "It’s always hard to be first, and someone has to be brave enough and hopeful enough to take that leap." She added that launching the reimbursement program before the billing infrastructure was fully established created momentum but also presented significant obstacles.
Alex Briscoe, a principal at the nonprofit Public Works Alliance, views Newsom’s emphasis on prevention and early intervention as a significant national policy shift. "We’re going to look back on this thinking it was one of the most progressive actions in the history of public systems," Briscoe stated. "We spent a significant amount of money preparing for it. I just don’t think we did that very well or strategically."
For rural schools like Plumas Charter, the challenges are amplified. By fall 2021, students had experienced a confluence of traumas, including wildfires, COVID-19 shutdowns, and the death of a classmate. Teachers observed heightened levels of depression, anxiety, and behavioral issues, with nine students reporting suicidal ideation that year. The school responded by hiring a full-time therapist and wellness coach using temporary federal funds. Senior Will Coelho, who arrived at the school later, found solace and crucial support from the on-campus therapist, who helped him process grief from a friend’s death and navigate a difficult family situation. "It has had a large impact on the way I process emotions and my outlook on life," Coelho shared.
However, sustaining these services has become a major concern. Plumas Charter’s applications for the state’s reimbursement program were twice rejected due to unmet requirements, such as lacking robust systems for billing private insurers and collecting student insurance information. When school staff encountered issues with online claims, state officials suggested paper submissions. Washburn expressed disillusionment, arguing the program is ill-suited for small rural districts where staff often juggle multiple responsibilities. While DHCS spokesperson Tony Cava stated that many charter schools are small and not expected to participate, lawmakers representing rural districts contend that all children should benefit. Addis’s proposed legislation to provide intensive technical assistance to school officials is intended to address these disparities, though it may arrive too late for Plumas Charter, leaving Washburn uncertain about their ability to fund their therapist without further delays.
