State to Change School Medi-Cal Billing Program

We have very exciting news to share about the “free care rule” reversal that reopens a critical avenue of reimbursement for Local Education Agency (LEA) school health providers.

Learn More About the Free Care Rule

The Department of Health Care Services (DHCS) announced on August 29 that changes to the provider manual for the LEA Billing Option Program will reflect the most recent policy direction from the Centers for Medicare & Medicaid Services (CMS) regarding “free care.” The draft changes to the manual are available for review and should be officially published later in September.

This exciting anticipated change to the LEA Billing Option program ensures that Medi-Cal may reimburse LEA providers for services provided to Medi-Cal eligible students, even if they are not in special education.

We hope that everyone providing health services in schools will learn about this opportunity to draw down more revenue to create robust school health systems that include both school districts and community providers.

You can learn more about the “free care” policy, the LEA Billing Option program, and CMS’s policy change on our Free Care Rule page. We have been working closely with DHCS, LEAs, the California School Nurses Organization, and other advocates to make sure that our state makes changes to the LEA program to strengthen school-based health care.

Judy Appel Named Executive Director

Judy AppelThe California School-Based Health Alliance Board of Directors has named Judy Appel as the new executive director to lead our organization.

Judy starts on September 19 and is excited to join us at a moment of incredible opportunity to build more support for school-based health care. Our Board of Directors chose Judy after a comprehensive search process because of her strong experience leading a regional nonprofit to statewide and national prominence.

Judy has served since 2005 as the executive director of Our Family Coalition, which is based in the Bay Area and advances equity for lesbian, gay, bisexual, transgender, and queer (LGBTQ) families with children through support, education, and advocacy.

She has led policy victories for Our Family Coalition, including the Welcoming and Inclusive Schools Program that guides schools to create more welcoming environments for LGBTQ families, and LGBTQ inclusion in the new history-social science curriculum framework recently adopted by the State Board of Education. She is also involved in statewide policy efforts on ending the school-to-prison pipeline.

Judy serves on the Board of Education for the Berkeley Unified School District, where she oversees a complex budget of $135 million; guides policy direction for instruction and programs; supports physical and mental health services for students; and leads Board efforts to implement restorative justice, social emotional learning, and trauma-informed practices at school sites.

In addition, she is involved with numerous initiatives aimed at improving education and health equity for all students, including the Restorative Practices Advisory Committee, the Berkeley Unified 2020 Vision Leadership Team, and the Fix School Discipline Policy Coalition.

We are pleased to welcome Judy as we begin a new phase of growth for the California School-Based Health Alliance and school-based health care in California!

Health Access Grows for Students in CA

Hiram Johnson SBHC Opening

Students and faculty join CA Rep. Doris Matsui in celebrating the opening of the Hiram Johnson SBHC in Sacramento in March 2015.

School-based health care is growing in California and providing more services and health care access for students.  There are now 243 school-based health centers (SBHCs) providing high-quality health care to students. Across California, more than 257,000 students attend a school that has a health center, and many more have access to other types of school health services.

This is more than double the number a decade ago. Of the 243 SBHCs, 150 offer mental health care, 66 offer dental treatment, and 124 offer youth engagement programs that keep kids engaged in school and thinking about their future.

SBHCs are so popular because they offer convenient health care for kids in a setting families already know and trust.

Students who utilize SBHCs are less likely to go to the emergency room or be hospitalized, keeping costs down. SBHCs also improve attendance, reduce dropout rates, improve school climate, and support students’ academic achievement. Schools and school districts partner with health service providers to finance SBHCs.

More Information on California’s SBHCs

There are 243 SBHCs serving 257,000 students across California. SBHCs are usually located directly on a school campus and provide primary care like any health clinic. Staff vary in size, and typically includes nurse practitioners, nurses, mental health providers, as well as part-time physicians and medical students. Services are provided at no or low cost. No one is refused service for inability to pay.

Services Offered

Service Number Percentage
Medical 209
Health Education 172 71%
Mental Health
150 62%
Reproductive Health – Screening & Education
146 60%
Reproductive Health – Clinical Care 136 56%
Youth Engagement 124
Dental Prevention 118
Dental Treatment


Sponsoring Org Types

Type of Sponsoring Organization Number Percentage
Community Clinic 131 54% 
School District 69 28% 
Local Health Department 11 5%
Hospital 10
Nonprofit Organization 8
Mental Health Agency 8
University,  Including Medical Center 1
Tribal Government 1 .4%
Other 4 2%


Onsite SBHC Location Level 

School Level Number Percentage
High School 115 47%
Elementary School 62 26%
Middle School 26 11%
Other (school-linked/mobile/combined levels) 40 16%



AG’s Report Raises Alarm on Poor Elementary School Attendance

Attorney General Kamala Harris raises awareness about poor elementary school attendance in California and calls for action.

Attorney General Truancy Report #EveryKidCountsWhen students are chronically absent from elementary school, they fall behind academically, they are less likely to graduate from high school, and they are more likely to be unemployed and on public assistance. Putting kids on a path to success requires attention to student attendance, particularly in the early years. Research shows that early school attendance is a critical building block to a child’s success.

Read more about the causes of chronic absence.

Attorney General Kamala D. Harris has made reducing elementary school truancy and chronic absence a priority. As part of this effort, the Attorney General released an annual report, In School + On Track, to disseminate effective practices for reducing student absences, to track changes in statewide attendance rates, to raise awareness about the critical importance of elementary school attendance, and to call others to action.

The 2015 report includes new and updated data on the still alarming rates of elementary school truancy and chronic absence across the state.

  • More than 1 in 5 elementary school students in California are truant based on data from the California Department of Education.
  • An estimate of 8% of elementary school students in California are chronically absent. That means over 230,000 of our youngest students are already at risk of falling behind in school.
  • Data also shows that there are disproportionately high rates of absenteeism and suspensions for students of color, low-income, homeless, foster youth and special education students.

There is also a positive trend across California: increased attention and more concerted efforts to improve elementary school attendance. The 2015 report highlights some of the districts and counties engaged in this important work.

The California School-Based Health Alliance applauds the Attorney General for continuing to draw attention to the issue of chronic absence in California. We know SBHCs make a huge difference at the schools they serve in addressing the underlying health issues that may impact attendance. Check out some of the ways that SBHCs are making a difference.

“School-based health providers across the state have firsthand experience with both the causes and consequences of chronic absence. Economic inequities prevent many children from getting the health, mental health, and dental care they need, which leads to untreated health problems that keep kids out of class. School-based health centers are an important part of a comprehensive solution to improving attendance, advancing equity, and closing the achievement gap.” 
– Serena Clayton, Ph.D., Executive Director, the California School-Based Health Alliance

$2 Million Grant to Help Address Trauma in Oakland


Serena Clayton, Executive Director of CSHA, and Fred Blackwell, CEO of The San Francisco Foundation, at the grant announcement in Oakland.

The California School-Based Health Alliance (CSHA) received a $2 million grant July 14 from The San Francisco Foundation to support trauma-informed care in 15 school-based health centers in Oakland Public Schools.

CSHA is one of 17 Oakland-based nonprofit community-based organizations receiving funding as part of a $34 million gift made to The San Francisco Foundation from an anonymous donor in 2015. Read more about the anonymous gift.

“For young people who grow up in communities where violence and instability are a way of life, trauma can have a profound impact on motivation, school performance, and life options. Trauma results from, and contributes to, the glaring social inequities that face our communities,” said Dr. Serena Clayton, Executive Director of CSHA.

“We are grateful to the San Francisco Foundation and its donor for their confidence in us and in the potential of school-based health centers to achieve transformational change in the lives of young people,” said Clayton.

The grant will enable CSHA to build supportive environments and services to help students cope with high levels of trauma. CSHA will be engaging school-based health centers in implementing schoolwide screenings, support groups, trauma-informed care, and support for teachers.

Click to expand map

Click to expand a map of the impact this grant will have on Oakland Schools.

School-based health centers bring medical and mental health professionals directly on to school campuses where they are in close proximity to both students and school staff. This proximity leads to unique opportunities for teachers, students, families, and medical and mental health providers to work together.

CSHA will share lessons learned throughout California and nationally.

CSHA’s partners include the following:

Seven Supporting Agencies

East Bay Agency for Children
East Bay Asian Youth Center
Fred Finch Youth Center
La Clinica de la Raza
LifeLong Medical Care
Native American Health Center
UCSF Benioff Children’s Hospital of Oakland

Fifteen School-Based Health Centers

Frick Middle School-Based Health Center
Shop 55 Wellness Center-Oakland High School
Rising Harte Wellness Center-Bret Harte Middle School
Fremont High School Tiger Clinic
Havenscourt Health Center-Coliseum College Preparatory Academy
Hawthorne Health Center-Urban Promise Academy
Roosevelt Middle School Health Center
TechniClinic-Oakland Technical High School
Elmhurst/Alliance Middle School Wellness Center
West Oakland Middle School Health Center
Madison Park Business and Art Academy Health Center
Seven Generations School-Based Health Center-Skyline High School
Seven Generations School-Based Health Center-United for Success/Life Academy
Chappell Hayes Health Center-McClymonds High School
Youth Uprising/Castlemont Health Center-Castlemont High School

Rural SBHCs Increasing in Central Valley

This article appeared in California Healthline on April 13, 2015.

By Alice Daniel, California Healthline Regional Correspondent

LIVINGSTON — Salina Mendoza grew up in a tiny unincorporated community called Oro Loma on the west side of the Central Valley. Her parents were farm workers and resources were scarce, especially when it came to medical care. It wasn’t just that the doctor was a 30-minute drive away in Firebaugh; going there meant losing a day’s work.

“For me, it was growing up in a place where access was always an issue,” Mendoza said. “My dad had the only vehicle so that meant if we ever had to go to the doctor, he couldn’t go to work that day.”

And if he didn’t go to work, he wouldn’t get paid. “You grow up and you really don’t go to the doctor,” said Mendoza, who is now the Central Valley program manager for the California School-Based Health Alliance.

Merced County’s First On-Site School Clinic

It’s a situation Ralph Calderon sees every day. He’s the principal of Livingston High School in this Central Valley town of 14,000 in Merced County. He said more than 90% of his students come from low-income families, typically from homes where both parents work, yet the median family income is below $40,000. Employment is usually in the fields, the packing houses or at the Foster Farms chicken processing plant.

“You either go to work and get paid, or you don’t earn that money,” he said. “Yes, our parents absolutely love their kids and want to take care of them. But if it’s a choice of food and clothing and a roof over their heads, the health problem is always going to come in fourth.”

It’s one reason that Livingston High School will soon be the first site in Merced County to have a school-based health center with its own primary care physician and behavioral health clinician.

“We have a lot of mental health issues, stressors from poverty,” said Calderon. “There are an inordinate amount of students with anxiety disorders that sometimes turn into full-blown panic attacks. These are the things we want to try to get addressed.”

In fact, Livingston High School makes three times the number of ambulance calls as the other high schools in the Merced Union High School District, and it’s the smallest school, with about 1,100 students.

Stakeholders Say Students’ Mental Health is a Concern

The idea for the center evolved last year when the district was working on its Local Control Accountability Plan. Part of the process is to engage a stakeholder group of parents, students, teachers, administrators and staff to determine the needs of the district.

“The largest area of concern was mental health and the overall wellness of students in our district,” said Tammie Calzadillas, assistant superintendent of educational services.

A local clinic that had an active relationship with the high school proposed a partnership. Livingston Community Health, a federally qualified health center, suggested a school-based community health clinic.

Calzadillas said she became convinced this was the direction the district should take after looking at several studies. “Overall attendance rates improve, the health of the family improves,” she said.

According to the California School-Based Health Alliance in Oakland, there are 231 school-based health centers in California. The schools usually provide in-kind contributions. The centers get reimbursed through private health plans, the Child Health and Disability Prevention Program, Family PACT and Medi-Cal, California’s Medicaid program.

Livingston High School will provide the facility, phone lines and parking spaces. Livingston Community Health will provide the services. “This is really about the overall health and wellness of students and taking the services to where the students and parents are,” said Leslie McGowan, chief executive officer of Livingston Community Health.

The on-site center is expected to be open part-time by late summer and running full-time within a few months if approval is granted by the Office of Statewide Health Planning and Development.

“What this will do is provide another point of access to care,” McGowan said. “The needs of our community are definitely ones we feel equipped to address. We’re a 45-year-old organization here.”

Read the full article at California Healthline

New SBHC OK’d for Merced’s Livingston High

Merced Union High School District is set to open a new school-based health center in summer 2015 and it will be the first such facility in Merced County. You can read more about this planned SBHC from this story in the Merced Sun Star.

By Doane Yawger – Originally published in the Merced Sun Star on December 24, 2014.

By next summer, a school-based health center will be located on the Livingston High School campus, a move heralded by educators and medical officials as the wave of the future. This will be the first such center in Merced County.

Among those most excited about the school-based health center’s prospects is Tammie Calzadillas, the Merced Union High School District’s assistant superintendent for educational services. Another major advocate is Livingston High principal Ralph Calderon.

“It’s exciting,” Calzadillas said. “In the high school district we have an opportunity to educate the whole child. We want to make sure we do things right. We will have care coordination teams on the school sites who will put protocols in place.”

Calzadillas said there is no formal time line yet for the health center opening other than getting it running in the next school year.

Calderon said 90 percent of the students at Livingston High are classified as living in poverty. He said people don’t realize how hard it is for children to get the medical care that others take for granted.

A memorandum of understanding between MUHSD trustees and Livingston Community Health Services was ratified Dec. 10; it’s the culmination of a five-year relationship between the school and the health clinic.

Leslie McGowan, Livingston Community Health Services chief executive officer, said she is hoping a clinic will be open on a part-time basis at Livingston High next summer. It could become a full-time operation about three months later if approval is granted by the Office of Statewide Health Planning and Development.

“We’re very excited about the program,” McGowan said. “ It’s definitely a way to get health care where the kids and their families are. It’s a great day in the health care industry.”

Community Health Services sent an architect to the high school to lay out a floor plan using two classrooms for the clinic. The school will be able to make room for the clinic in classrooms not yet used when the campus was recently remodeled and expanded.

McGowan said the clinic could include a physician who is a primary-care provider, possibly a licensed community social worker to address mental health issues and a dentist.

Livingston High School has about 1,200 students.

Scott Scambray, high school district superintendent, said he is very excited about the health center concept and how important it will be in keeping students in school.

“It allows us to be proactive and not reactive,” Scambray said. “Keeping students in the classroom is the No. 1 goal. We are proud of our attendance figures but would like to improve attendance even more.”

The health center was identified as a top need when the school’s Local Control Accountability Plan was developed.

A group of MUHSD administrators recently toured Kerman-Floyd Elementary School in Kerman, part of the school district run by Robert Frausto, a former assistant superintendent with the Merced City School District.

Frausto said the school-based health center there is in its second year of operation and has worked out well, beyond his expectations.

“It’s been real positive,” Frausto said. “Attendance went up as a result. It is open for staff as well. The goal is we want to get kids back in class as soon as possible rather than utilizing doctors in Kerman or Fresno.”

Read more here.

CSHA Part of $600,000 EPA Asthma Prevention Grant

A mother gives her son his asthma inhaler at school before she leaves him for the day. (Deborah Svoboda/KQED)

A mother gives her son his asthma inhaler at school. (Deborah Svoboda/KQED)

The U.S. Environmental Protection Agency awarded a $600,000 grant to the Public Health Institute’s Regional Asthma Management & Prevention (RAMP) on December 17, 2014, to help school-based health centers across the country prevent and manage environmental asthma triggers for children. Asthma, a chronic respiratory disease that causes the lung’s airways to swell and narrow, leading to wheezing, coughing, and shortness of breath, is the most common chronic disease among school-aged children.

Read a report from KQEDRead a report in the Oakland TribuneListen to a KCBS report

“Asthma affects over 7 million children in America and over 900,000 children in California,” said Jared Blumenfeld, EPA’s Regional Administrator for the Pacific Southwest. “EPA’s support for RAMP and its partners advances our commitment to help communities improve indoor air quality to prevent environmental asthma triggers such as dust, mold, smoke and poor ventilation.”

Under EPA’s grant, RAMP and its partner the California School-Based Health Alliance (CSHA), will: develop an Asthma Environmental Intervention Guide for school-based health centers nationwide that identifies actions to prevent and manage environmental asthma triggers at school and at home; conduct trainings at state conferences of school-based health centers in California, Michigan, New York, and Connecticut – all states with high asthma prevalence; and convene a national learning collaborative among school-based health centers in California and nationwide.

“Children spend a significant amount of time at school, making schools a very important place to address asthma,” said Anne Kelsey Lamb, RAMP Director. “We look forward to partnering with the EPA, the CSHA, and school-based health centers across the country to collectively improve indoor air quality and reduce the burden of asthma.”

“Reducing exposure to environmental asthma triggers and improving indoor air quality can play a significant role in improving health for students with asthma,” said Kristin Andersen, CSHA Associate Director “We’re so pleased that EPA is giving us an opportunity to partner with RAMP and school-based health centers to do just that.”

RAMP is among eight organizations in the U.S. receiving grants from EPA to reduce risks to public health from indoor air pollution, for a total investment of $4.5 million. EPA announced the grant award today with RAMP and its partners at the West Oakland Middle School LifeLong Health Center, one of over 230 school-based health centers in California and 2,000 nationwide that will benefit from the grant project. School-based health centers are clinics typically located on a school campus to provide primary health care for students and families at no or low-cost.

While there is no cure for asthma, with access to medical care, appropriate medications, proper self-management, and prevention of environmental asthma triggers, people can control their symptoms.

Read more about children and asthma and see our asthma resources for school-based health centers. 


With Youth Depression, Young People Often the ‘First Responders’

By Zachary Forster and Peter Schurmann, New American Media

With Youth Depression, Young People Often the ‘First Responders’High school sophomore Kelly Morimoto says when her friend first came to her to talk about his depression she was “shocked.” No one, after all, had ever spoken to her about how to respond in these kinds of situations.

“I didn’t believe him [at first] because he seemed so normal all the time … like any other kid,” recalls Morimoto, 16, of the encounter in her freshman year. Not knowing what to say, she urged her friend to seek counseling, but he was “non-responsive. He didn’t want to seek help because he saw it as giving up.”

Morimoto – who attends Bentley Upper School, a private high school in Lafayette, an East Bay suburb outside San Francisco – is one of a number of young people in California who act as de-facto “first responders” for peers coping with mental health issues, despite having little to no training.

Some 30 percent of adolescents in California report experiencing depression or related feelings, such as anger, anxiety or guilt, according to As with Morimoto’s friend, many of these young people turn to their peers first for help.

“He talked to me about it a lot. There would be phone calls where he’d be sitting there with a knife in his hands. It was intense,” says Morimoto. “I remember being really worried that I was going to miss his call, [and] a chance to save his life. It was a lot of responsibility.”

Mental health advocates say making courses on depression or related issues more a part of the curriculum in schools could go a long way in preparing youth like Morimoto to both detect signs of distress and how best to respond when they do.

Teaching mental health in the classroom

In January, California enacted a new law that looks to expand mental health education in classrooms. Prior education policy drafted more than a decade earlier did not include mental health as part of a school’s overall health curriculum.

Some of the topics covered under the new law include warning signs, symptoms, and definitions of common disorders, as well as how to obtain mental health services and overcome stigma. Revisions to the state’s Health Framework curriculum aren’t likely, however, until the 2015-16 school year.

Alicia Rozum is a project director with the California School Based Health Alliance, which works to expand health resources in California’s public schools. She says most of the teaching for students around mental health still happens outside the classroom.

She points to recent initiatives, like one in San Francisco that have led to the creation of school-based wellness centers that train young people in a variety of health education topics.

As of last year there were 226 such centers in public elementary, middle and high schools across the state, up from 200 in 2012. A majority of these centers provide basic health services at no cost, while just over half offer mental health services.

A recent study published in the Journal of Adolescent Health showed that a majority of students accessing these centers are “high risk,” and that most reported improvements in things like “student expectations” and “caring relationships” with others on campus, factors positively correlated to improved academic outcomes.

“These centers hire and work with young people,” explains Rozum, “who then go out and do presentations to their peers on topics like suicide prevention, social media and mental health.”

Rozum says the message is “so much more effective” in getting through to young people when it comes from peers, but she notes this kind of student engagement remains a “big but unfunded component” of her work.

Social media

Sarah Wilson is the lone counselor at Bentley, a school of some 320 students. While that ratio may seem high for a private school, even a small one like Bentley, in public schools the statewide average is closer to 1,016 students per counselor.

But even if a counselor is available on campus, Wilson says students often turn to social media instead to open up about their struggles.

Read the full story at New American Media.

LAUSD Earmarks $50 Million for SBHCs

By Thomas Himes, Los Angeles Daily News

Los Angeles Unified is poised to expand its efforts to make access to health care easier for schoolchildren with an allocation of $50 million for wellness centers on campuses.

Above, health pamphlets are available to students in the Wellness Center at Hollywood High School. At left is the lobby area of the Wellness Center. The Los Angeles Unified School District has 12 of 14 clinics up and running that were funded three years ago.

The scale of the plan to open facilities that will serve kids and community members alike is unprecedented for the district, noted Los Angeles Trust for Children’s Health Executive Director Maryjane Puffer. “The concept for this process is that it’s full comprehensive oral-health, physical-health and mental-health delivery,” she said.

Over the next six months, school administrators and The Los Angeles Trust for Children’s Health will create plans to spend the dollars on building new clinics and remodeling existing spaces at schools across LAUSD.

The idea is to reach as many in-need students as possible by placing clinics where there’s little access to medical care, Puffer said.

Three years ago, Los Angeles Unified allocated $36 million for 14 clinics. Twelve of those have been up and running for more than a year, with more than 20,000 patients treated.

LAUSD board member Monica Garcia said the wellness centers are effective because they’re conveniently located at schools, so they can get medical care to kids who wouldn’t otherwise see a doctor. Even kids who have health insurance, she added, have trouble making it to the doctor, as their parents can’t always provide transportation to the office or take time off from work.

“We need to put the wellness centers up in front, because there’s so much conversation right now about how to deal with people who the state has trouble reaching, the county has trouble reaching and sometimes LAUSD has trouble reaching — except for the children come to our schools,” Garcia said.

To determine prospective sites for the clinics, Puffer said, officials will review health data for areas where illness is common and doctors are rare, then home in on campuses that can spare the space, whether it’s through building a new facility or converting an old area.

The center at Monroe High School in North Hills, with a $10.8 million construction budget — including $10 million provided by L.A. County — is scheduled to open in November.

While board member Tamar Galatzan joined the unanimous vote last week to allocate the additional $50 million, she had concerns about putting a dollar amount on the project before planning its specifics.

Community partners would have been more helpful in opening Monroe’s clinic before releasing an actual budget, she said, noting the district’s predetermined funding level became a “stumbling point” because potential partners knew how much money the district had to spend.

“I think if we can get the partners and the plan lined up first, then we know how to maximize our dollars,” Galatzan said.

The district has been able to forgo costly operating expenses by handing the running of the wellness centers over to community clinics and other partners, who bill health insurance companies, said LAUSD spokeswoman Shannon Haber.

A pediatrician from Kaiser Permanente Community Fellowship stepped in to operate the health clinic at Hollywood High School two days a week, after a proposed provider backed out at the last minute. A school-district doctor, Rosina Franco, sees students on a third day, until a new partner takes over operations, Franco said

Hollywood High’s center features a waiting room, five exam rooms, a space designated for taking lab samples and two mental-health rooms. While the clinic requests students schedule visits in advance, a referral from the school nurse gets them an immediate appointment, Franco said.

The new funds could also be used to expand Hollywood High’s or other existing campus clinics, Puffer said. She recommended the district look to increase its dental offerings, as a dental pilot program at five wellness centers has seen more than 2,000 students, 117 of them suffering from broken teeth or abscesses.

“That’s a significant level of dental disease,” Puffer said. “How do you concentrate in class?”

Before voting to allocate the $50 million, school board member Bennett Kayser warned the district needs to make good on its promises to restore the health curriculum that was cut amid the budget crunches of the past several years. The classes teach healthy eating habits, hygiene and other preventative measures.

“Otherwise we’re just going to have recidivism with the wellness centers,” Kayser said.

Read the full story at the Los Angeles Daily News.