School-Based Health Programs and Billing
A student's health and well-being are closely connected to their ability to learn, grow, and succeed both inside and outside the classroom. The Lancaster School District wants to strengthen school-based health programs by administering the Children and Youth Behavioral Health Initiative (CYBHI) Fee Schedule program, the LEA Billing Option Program (LEA BOP), and School-Based Medi-Cal Administrative Activities (SMAA). These programs were designed to make it easier for children and youth to receive behavioral health and other eligible health services where they already spend much of their time, in schools and other familiar settings.
Lancaster School District, in cooperation with the California Department of Health Care Services, participates in this School-Based Medi-Cal Services Program. The District can be reimbursed with Federal Medicaid dollars for specific health services (assessments and direct services, including hearing and vision testing, speech/language, and mental health) provided to eligible students at schools. These funds are separate from individual benefits and are set aside specifically for allocation to school districts, and DO NOT affect students' or families' individual Medi-Cal status, benefits, or claims.
In accordance with FERPA, Local Education Agency, and California Department of Health Care Services privacy guidelines, eligible students' related records may be forwarded to the District's contracted billing agency under specific HIPAA-compliant confidentiality measures to ensure information is not disclosed inappropriately.
This program will not change or affect school health services currently provided to all students; students will not be denied services they need to attend school, and the school district will not bill parents.
The goal is to enhance integrated health and social services for Lancaster School District students and their families by reinvesting funds obtained through participation in these programs.
CHILDREN AND YOUTH BEHAVIORAL HEALTH INITIATIVE (CYBHI Fee Schedule)
The CYBHI Fee Schedule Program helps schools provide behavioral health services to students by allowing schools to receive reimbursement for eligible services. If your child received eligible behavioral services at school or through a school-linked program, the school may bill your health insurance to help cover the cost. You and your family will not be charged. Your child can continue to receive services regardless of your ability to pay.
To be eligible, students must:
- Be under 26 years of age;
- Be enrolled in a public TK-12 school or participating public college; and
- Have Medi-Cal or another participating health insurance plan.
Billing through the CYBHI Fee Schedule Program does not increase your out-of-pocket costs, affect your insurance benefits, or change your deductibles. Its purpose is to help schools sustain and expand access to behavioral health services so more students can receive the care they need.
Resource: CYBHI Fee Schedule Program
LOCAL EDUCATIONAL AGENCY MEDI-CAL BILLING OPTION PROGRAM (LEA BOP)
The LEA BOP program allows schools to receive reimbursement for eligible health services already provided to students enrolled in Medi-Cal.
These services may include nursing, speech-language services, occupational therapy, physical therapy, mental health services, and other eligible health services identified in a student’s Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP).
If your child is eligible for Medi-Cal and receives covered services at school, the school may receive reimbursement through the LEA BOP program. There is no cost to families, and participation in the program does not reduce your child’s available Medi-Cal benefits.
SCHOOL-BASED MEDI-CAL ADMINISTRATIVE ACTIVITIES (SMAA)
The SMAA program helps schools receive federal reimbursement for administrative activities that support students’ access to Medi-Cal-covered services.
Examples of these activities include:
- Sharing information about the Medi-Cal program.
- Assisting families with the Medi-Cal application process.
- Coordinating with Medi-Cal service providers.
- Planning and administering programs that support access to Medi-Cal services.
- Training staff on program requirements.
