CalOptima says managed care plan and school district partnerships will increase behavioral health care access for children and youth


Soraya Marashi


Last month, CalOptima Health announced its intent to partner with school districts across Orange County to improve access to preventive and early intervention behavioral health care in K-12 public schools as part of the Student Behavioral Health Incentive Program (SBHIP)


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The SBHIP is part of the statewide Children and Youth Behavioral Health Initiative (CYBHI), which will invest $4.4 billion over 5 years to redesign the behavioral health care system for children and youth in the state.

CalOptima says it will administer up to $25 million in incentives for school districts that make improvements to their behavioral health systems and allow Medi-Cal reimbursement of behavioral health care services delivered at school. These incentive dollars will fund increased resources at schools including more counselors, wellness programs, telehealth services, crisis screenings, and other programs.

CalOptima currently provides health coverage to over 317,000 students in Orange County schools. According to Carmen Katsarov, Executive Director of Behavioral Health Integration at CalOptima, the SBHIP will bring different systems together to better serve children in Orange County. 

“As a managed care plan, we don’t ordinarily work with schools, even though we know that a lot of our members that have our Medi-Cal CalOptima health insurance go to school,” Katsarov told State of Reform. “They’re accessing behavioral health services during the day, and they also have the need for the services. 

[This is] going to bring all the different systems together that are serving our children in Orange County so that we can streamline those services and have better access for these children. [We’re really just trying to work on the whole delivery system] that’s very complicated and more siloed.”

Katsarov emphasized the adverse effects of the pandemic on the behavioral health of Californians, especially children and youth. She said CalOptima had serviced 22,000 members for outpatient therapy in 2021, and already over 17,000 so far in 2022.  

“The consequences of unaddressed mental health conditions in children often extend into adulthood,” said Michael Hunn, CEO of CalOptima Health, in a news release. “Due to the pandemic, there has been a staggering increase in mental health distress among our members and their families. It is imperative that we reach students where they are and provide help to prevent and treat behavioral health issues. Building school-based health care services is a solution that addresses disparities many children face in Orange County.”

Katsarov said the ultimate goal is for the school programs created and expanded through the SBHIP to be sustainable in the long term.

“I think the biggest thing we’re hoping is going to come out of this one is more efficiency [and] quality, and just getting more students to access behavioral health care that’s defined by them,” Katsarov said. “[It’s] not just the schools and [managed care plans] dictating what’s going to happen, this is also coming from all of the different research that they’ve done polling students and parents and looking at the data of how students want to access things. This needs to meet the students where they’re at, and how they want to get behavioral health care.”

Implementation of SBHIP initiatives will begin in 2023 with approval from DHCS. CalOptima said 17 school districts have expressed interest in collaborating so far, and that they are open to participating from all school districts in the county.