Module 3: Access and Eligibility

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• SchooLink: County-Funded School-Based Behavioral Health Services

  Overview

  • Services are provided at no or low cost to the family as authorized by the behavioral health provider’s contract with the County of San Diego.
  • No one is turned away due to inability to pay.
  • Services can be provided during or outside of school hours, on-campus or in a community setting, based on the student’s and family’s needs.
  • Located at schools with a significant number of Medi-Cal and uninsured students.
  • Some programs focus on treating substance use disorders as the primary need, while others require that the student has a primary mental health disorder.

  Eligibility Criteria

  Meets medical necessity criteria for specialty mental health services or Drug Medi-Cal. For more information, go to:

  • Title 9 Medical Necessity Criteria
  • Title 22 Diagnosis Medical Necessity DSM
  • Behavioral Health Information Notice No: 21-073

  In a Nutshell

  • Student has a mental health or substance use condition, or is at high risk for a mental health condition due to experience of trauma
  • The behavioral health disorder is or will impair an important area of life functioning
  • There is a reasonable expectation that intervention will help
  • Medi-Cal enrolled or low income and uninsured or underinsured youth up to 21 years old

  How to Access

  Submit SchooLink referral form to designated contact on campus. 

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• County-Funded Community-Based Mental Health Providers

  Overview

  • Services are provided at no or low cost to the family as authorized by the behavioral health provider’s contract with the County of San Diego.
  • Services can be provided by an organizational (clinic) or fee for service (private clinician) provider.
  • No one is turned away due to inability to pay.
  • Services are provided in a community setting.
  • Some programs focus on treating substance use disorders as the primary need, while others require that the student has a primary mental health disorder.

  Eligibility Criteria

  Meets medical necessity criteria for specialty mental health services or Drug Medi-Cal. For more information, go to:

  • Title 9 Medical Necessity Criteria
  • Title 22 Diagnosis Medical Necessity DSM
  • Behavioral Health Information Notice No: 21-073

  In a Nutshell

  • Student has a mental health or substance use condition, or is at high risk for a mental health condition due to experience of trauma
  • The behavioral health disorder is or will impair an important area of life functioning
  • There is a reasonable expectation that intervention will help
  • Medi-Cal enrolled or low income and uninsured or underinsured youth up to 21 years old

  How to Access

  Call the San Diego County Access & Crisis Line at 888-724-7240 or 988 to ask for the closest providers by zip code, or utilize the Behavioral Health Services Directories for Children, Youth, and Families

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• Medi-Cal Health Plans

  Overview

  Medi-Cal health plans can help their members identify a behavioral health provider in their network. Find the Medi-Cal Managed Care Plans (MCP) Contact Card by searching for “Health Plan Contact Card” under Resources on Optum’s Healthy San Diego page.  

  Eligibility Criteria

  Eligible services, participating providers, and related co-pays will depend on the Medi-Cal health plan.

  How to Access

  Encourage or help the parent call their child’s Medi-Cal health plan. Most Medi-Cal insurance cards list a separate phone number for behavioral health services.

  • Blue Shield of California Promise Health Plan: 855-321-2211
  • Community Health Group Partnership Plan: 800-404-3332
  • Kaiser Permanente: 877-496-0450 (English) |  800-788-0616 (Spanish)
  • Molina Healthcare: 888-665-4621

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• Private Insurance

  Overview

  Private insurance plans, often provided through a parent’s employer, can help their members identify a behavioral health provider in their network.

  Eligibility Criteria

  Eligible services, participating providers, and related co-pays will depend on the plan.

  How to Access

  Encourage or help the parent call their child’s insurance plan. Most insurance cards list a separate phone number for behavioral health services.

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• Federally Qualified Health Centers

  Overview

  Many federally qualified health centers (FQHCs), also known as community health centers, provide no or low-cost behavioral health services.

  Eligibility Criteria

  • For Medi-Cal enrolled or eligible youth, services are provided at no cost to the family as authorized by the Medi-Cal managed care plan.
  • For uninsured youth, community health centers offer behavioral health services on a discounted sliding fee scale based on the family’s income and size.

  How to Access

  • Search online at: https://findahealthcenter.hrsa.gov/ or FQHC List Public
  • Call 211 San Diego to ask for the closest federally qualified health center with behavioral health services.

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• Primary Care Providers

  Overview

  Primary care providers can provide behavioral health services and/or refer their patients for care.

  Eligibility Criteria

  Eligible services and related co-pays will depend on the provider and the student’s insurance.

  How to Access

  Encourage or help the parent call their child’s insurance plan. Most insurance cards list a separate phone number for behavioral health services.

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• Special Education-Related Services

  See Module 14: Special Education for eligibility and referral information for special education-related behavioral health services.

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• Children and Youth Behavioral Health Initiative (CYBHI) Fee Schedule Program

  Overview

  • Outpatient mental health and substance use disorder support.
  • Services rendered at a school or school-linked site.
  • Children, youth, and families will not pay out-of-pocket expenses and there will not be any impact to their existing insurance plan nor deductibles.

  Eligibility Criteria

  • Children, youth, or Transitional Aged Youth (TAY) under the age of 26
  • Enrolled in public TK-12 schools or institutions of higher education, AND
  • Covered by Medi-Cal managed care plans, Medi-Cal Fee-for-Service, health care service plans, and disability insurers
  • Children, youth, and families will not pay out-of-pocket expenses and there will not be any impact to their existing insurance plan nor deductibles. 

  How to Access

  Available at participating schools. Information is also available on the CYBHI Fee Schedule program website: Fee-Schedule