California health plan and nonprofit leaders talk progress and pitfalls of improving access to behavioral health


Hannah Saunders


At the 2023 Southern California State of Reform Health Policy Conference, health plan and nonprofit leaders discussed barriers to behavioral healthcare access, as well as factors that have led to positive changes, with a specific focus on children and youth in the state.

Lucy Marrero, director of behavioral health and social programs at Gold Coast Health Plan, said she finds it striking how over one-third of individuals—including children and adults— who needed care for depression received it last year. 

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“We have a huge unmet need right now,” Marrero said. “We’re living in this completely different society than we were two to three to four years ago, and we also have this fractured system.”

She brought up how suicide rates for children have increased, and how the shortage of behavioral healthcare providers combined with the increased demand for assistance and interventions creates challenges. Although the state is amplifying mental health services through mandates and programs, Marrero feels like a “Frankenstein stitch” is happening because the mandates and programs are flooding in and aren’t perfect. 

Marrero also discussed productivity and pandemic-related measures. She said the ability for federally qualified health centers and community health centers to get reimbursed for behavioral health and medical visits at a regular fee-for-service rate is important, but now providers are experiencing additional pressures. 

“In reality, asking pediatricians, asking primary care doctors, or providers to do one more thing is a little bit of a challenge right now. Providers are tired.”

— Marrero 

A newer state initiative is the Children and Youth Behavioral Health Initiative (CYBHI). Through CYBHI, Medi-Cal providers and commercial health plans will be responsible for reimbursing for school-linked behavioral health services for those up to 25 years of age, beginning in 2024. 

“This will establish a fee schedule, so this is the rate at which we’re required to pay for these services. This is fantastic. If you think about access to important services, like family planning, the state took a similar approach where you have to do out-of-plan reimbursements for those services, whether or not that provider is in your network.”

— Marrero

Marrero explained how schools provide covered services via covered provider types, which health plans reimburse for. As a result, patients won’t have to face copayments or coinsurance costs. 

“It also expands the behavioral health services that are covered for families and for children, so, screening and assessment, psychoeducation, peer counseling, and care coordination. It also expands provider types as well,” Marrero said. 

The expansion of provider types includes wellness coaches, which provide services designed to support children and youth. California received federal approval for these Medi-Cal reimbursements at a rate of 87.5% for 2024. 

Debbie Manners, president and CEO of Sycamores—a nonprofit organization whose programs support underserved communities—noted that CalAIM is a major area of focus in California, but that it has its own issues. Manners said the positives of CalAIM include a higher volume of individuals accessing healthcare appointments. She attributed this to a reduction in mental health stigma due to CalAIM’s emphasis on behavioral healthcare—in addition to politicians and athletes speaking out about their experiences with depression or anxiety. On the other hand, she believes a population of focus is being left out of discussions regarding behavioral healthcare.

“Oftentimes, what you’re not hearing about is health for the seriously mentally ill,” Manners said. 

Manners also discussed the homelessness crisis and said the state must address the root cause. She said providers are committed to solving the issue and funding is available, but that civil liberties issues like systemic racism and stigma surrounding those with serious mental illnesses are barriers to care. She praised the mayor of Los Angeles, who worked to increase housing and support services under the Behavioral Health Continuum Infrastructure Program (BHCIP)

“We’re very excited about BHCIP. That infrastructure money is going to have huge impacts across the state.”

— Manners

Manners also focused on effective policies with workforce recruitment, particularly for those who are underrepresented in the workforce. She said that for years, additional compensation has been provided to Sycamores employees if they speak a language in addition to English. 

“One of the biggest changes that has helped with recruitment—which I was not really happy about when it happened—[is that] as of January 1st, when you post a [job] opening, you have to post what the salary range was. That allowed everybody to see what your peers were paying, and so it was a very transparent system.” 

— Manners 

Following this law’s implementation, Manners saw companies alter their salaries, which she said creates a level playing field for applicants. She also said it allows applicants to work at places that have a fitting workforce culture for them, instead of chasing salaries.