© 2026 First 5 Center for Children’s Policy. All rights reserved.
Key Points:
The Children and Youth Behavioral Health Initiative (CYBHI) set out to design a system that meets the behavioral health needs of children and youth where they are. While the intention of CYBHI was to support the birth to 25 age range, many of the state’s investments have focused on children older than five, leaving out the earliest years when the brain is rapidly developing. When mental health needs are addressed early, children receive care at a time when the brain is most sensitive and responsive to relationships and experiences, leading to stronger social‑emotional skills, communication, learning, and lifelong well‑being.
Many of the CYBHI components are wrapping up as the five-year initiative enters its final year, but there remains much to be explored with the Statewide Multi-Payer Fee Schedule for School-Linked Behavioral Health Services (Fee Schedule) program which officially launched in January 2024. Unlike other CYBHI components that are time-limited, such as the CYBHI Evidence-Based and Community-Defined Evidence Practices grants, the Fee Schedule program establishes an ongoing funding mechanism for local educational agencies (LEAs) and public institutions of higher education (IHEs) to support the delivery of behavioral health services in schools and school-linked settings for children and youth from birth to 25. As a multi-payer program, Medi-Cal and commercial health plans must reimburse eligible school-linked behavioral health providers at set rates, regardless of whether those providers are in-network.
The reimbursement rates for Fee Schedule covered services are standardized across plans, reducing the burden for LEAs and IHEs to negotiate contracts and rates. Covered services fall into the categories of psychoeducation, screening and assessment, therapy, and care coordination. Certain dyadic services, which focus on the child-caregiver relationship, are also reimbursable when they are provided to the caregiver of a child between birth to 20 years old. In addition, the Fee Schedule includes Certified Wellness Coaches as a practitioner type eligible for reimbursement. This presents an opportunity to support children and youth using a range of non-clinical preventive and wellness promotion services.
One of the biggest untapped opportunities with the Fee Schedule program is its ability to support children ages 0 to 5. While LEAs and IHEs are at the center of this program, they can contract with or designate community-based school-linked providers and practitioners as “affiliated providers or practitioners” to provide behavioral health services in school settings as well as off-campus clinics or community-based organizations. This enables LEAs and IHEs to leverage the experience of community-based behavioral health providers in their community to deliver developmentally appropriate services across the birth to 25 population. First 5s could serve as a key implementation and thought partner for LEAs and IHEs exploring the birth to age five space due to their longstanding relationships and contracts with early childhood community organizations in the county.
The Placer County Office of Education (PCOE) is leveraging this opportunity, approaching the Fee Schedule not only as a school-based reimbursement mechanism, but as a tool to strengthen a broader behavioral health continuum that reaches families before children are formally connected to a school system. Early implementation of the Fee Schedule program illustrates how, with parental consent and family partnership at every step, the program can expand access to services for young children by intentionally coordinating interventions and practitioners across an interconnected early childhood system.
PCOE was uniquely positioned for this early success because the county already had a cross-agency infrastructure for coordination and service delivery in place. Using the Interconnected Systems Framework (ISF)—an evidence-based blueprint merging mental health and behavioral supports across school and community settings—early childhood educators, behavioral specialists, clinicians, and special education partners were already working as a cohesive team in partnership with families. While much of the information about the new Fee Schedule program catered to TK-12 public schools and IHEs, PCOE was able to overlay the Fee Schedule onto their existing ISF workflow. This established structure allowed them to bill for services provided to young children in non-school settings like preschool classrooms, child care homes, or in the community. It also allowed for a broader range of practitioners and service types to be reimbursed, such as Certified Wellness Coaches, encouraging collaboration across disciplines and settings.
Early lessons from PCOE point to both promise and system hurdles. On the positive side, the Fee Schedule has helped normalize early behavioral health support as part of a child’s overall development and has created a more sustainable funding pathway than time-limited grants. It also reinforces the importance of cross-system coordination by creating incentives for education and behavioral health partners to jointly plan, refer, and deliver services. At the same time, key challenges remain. Reimbursement rates do not fully cover the cost of services nor do they account for the time-intensive, relationship-based nature of early childhood services, particularly family-centered interventions. In addition, navigating the billing process requires expertise and capacity that many schools and child care providers do not currently have.
On the horizon, PCOE is building toward stronger participation from community-based providers. Efforts are underway to support these partners in navigating billing processes. The county is preparing a convening to build community provider capacity, reflecting a broader recognition that successful implementation depends on equipping all parts of the early childhood system to participate effectively.
Local efforts like in Placer County are unfolding against a broader statewide picture. With the help of DHCS, LEAs and IHEs have made significant progress in implementing the Fee Schedule. However, as of May 2026, only around 25% of the 700 participating entities have submitted claims, with most of these claims coming from larger and better-resourced entities who have the staff, expertise, and economies of scale required to implement medical billing infrastructure. Of the nearly 200,000 claims that have been reimbursed, almost none have been submitted for services provided to children ages 0 to 5.
The state has an opportunity to clarify the utility and feasibility of billing for young children who are eligible for Fee Schedule services but may not yet be formally connected to the school system. This could include strategies for LEAs and IHEs to utilize the First 5 infrastructure and connections to reach families with young children. PCOE offers insights that can inform guidance about how community-based organizations can participate in the Fee Schedule program and how the state can support educational systems to leverage this funding source to make behavioral health services accessible to children both in and out of schools.
© 2026 First 5 Center for Children’s Policy. All rights reserved.