Children's advocates are pressing California lawmakers to pass a bill that would increase oversight on health plans when they deny mental health services for children. Right now, parents have to ask their health plan for a review when a child's mental health condition isn't covered by their insurance - and if service is still denied, they can ask the state for an independent medical review.

Lishaun Francis, senior director of behavioral health with the nonprofit Children Now, a sponsor of the bill, said this is a critical issue.

"This bill says if plans deny care for a Youth Mental Health Service, they have to automatically review that denial, as opposed to a parent calling and asking them to take a second look. If it is an emergency service, that review goes to the state automatically," she explained.

The California Association of Health Plans opposes the bill, arguing that the extra reviews could delay care and build more unnecessary costs into the health care system. Case stories posted on the state's Department of Managed Health Care website suggest the types of services most commonly denied by health plans include residential mental health treatment, and medication or surgery for gender dysmorphia.

Francis said when parents escalate their fight to an independent medical review, they often win.

"Almost 70% of all claims that make it to the state get overturned by the independent medical review process, which tells us a big chunk of this is something that health plans should actually be covering," she said.

Senate Bill 294 would also require the state to make public the number of independent medical review claims they receive each year, and how they were resolved. The bill has already passed the state Senate, and is now before the Assembly Committee on Health.

Colorado has made significant improvements in connecting young people with the mental health care they need, according to the mental health advocacy organization Inseparable's latest School Mental Health Report Card.

Many of those gains could be erased if the Trump administration signs off on cuts to Medicaid.

Sen. Dafna Michaelson Jenet, D-Commerce City, said Colorado relies on Medicaid dollars to reach students where they spend most of their time - in school.

"We use Medicaid to cover a lot of school-based health center care," Michaelson Jenet pointed out. "We could lose that completely, and then how do we fund our school based health centers?"

Since the last report card in 2022, Colorado has improved the ratio of mental health professionals to students by adding 43% more psychologists and 70% more social workers. Colorado also got good marks for creating school environments embracing mental health, for example by allowing excused mental health absences and not disciplining students through exclusion.

The state also instituted annual mental health screenings but the future of the program is in question after Colorado's Joint Budget Committee, facing a $2 billion budget deficit, recently cut its funding.

Caitlin Hochul, vice president of public policy for Inseparable, said when you catch a condition early on, students are more likely to be more engaged in school, have academic success and perform better in the workforce later on.

"We really emphasize providing annual screenings to students so you can catch some of those symptoms or flags early on," Hochul explained. "Then connecting them with some of the care that they need."

Under Colorado's Taxpayer Bill of Rights, voters would have to approve any new revenues to pay for screenings and other initiatives not making the cut. Michaelson Jenet emphasized she is working to keep effective programs to protect children in place.

"One of the things that I'm grateful that the budget protected this year is the I Matter program, offering free therapy for any school-age youth who wants it," Michaelson Jenet noted. "From the beginning of I Matter, we have seen our suicide rate go down."

Nebraska lawmakers are considering a bill to ensure managed health care companies cannot limit the state reimbursement rate for mental health service providers.

Advocates for the bill want to make sure in the future, the companies could not negotiate a lower rate. Right now, there's no requirement they use the posted rates, it has just been the practice. Legislative Bill 380 would keep "guardrails" in place.

Annette Dubas, executive director of the Nebraska Association of Behavioral Health Organizations, said providers have worked for 20 years just to get the reimbursement rates to meet the minimum state standards.

"Nebraska's rates were, two decades ago, towards the bottom," Dubas pointed out. "We've worked hard over those last two decades to get rates built up. It comes down to the ability to build capacity, so that people who are in need of mental health care can access that mental health care."

Dubas noted the bill was introduced after Nebraska autism care providers had to fight an effort to reduce their reimbursement rates last year. It awaits action in committee. Dubas emphasized her group opposes an amendment to remove the minimum pay "guardrails."

Dubas explained low wages and often challenging working conditions already make it difficult to find mental health care professionals, and lower reimbursement rates mean even lower wages and less stable employment. She added protecting the rates already in place is critical to ensuring the ability to recruit and retain workers.

"If rates do not stay up where they need to be, it just puts that much more pressure on these providers to be able not only bring in new workforce, but to retain the workforce that they have," Dubas explained. "Burnout is a huge issue."

Dubas added any rate adjustment legislation could also complicate a reimbursement process she described as already confusing and complex in Nebraska.

A national report card finds that even with a $150 million budget threat last year, Michigan still made solid progress in staffing up its school mental health system.

The report released by Inseparable - a mental health policy organization, as part of the Hopeful Futures Campaign - shows the state reached 36% of recommended psychologists, nearly 60% of counselors, and just over 40% of social workers.

However, Inseparable's Vice President of Public Policy Caitlin Hochul said some gaps remain, including in staff training and essential early mental health screenings.

"When you catch a condition early," said Hochul, "and you get treatment that you need early, you have better outcomes. You're more likely to be more engaged in school and have academic success and perform better in the workforce later on."

The report also finds that while Michigan is making progress, it has failed to enact other key policies, including excused mental health absences and school-linked mental health services program.

According to Inseparable, there's been significant improvement in Michigan's social worker-to-student ration - going from one per 2,300 students to one per 600.

Lynn Maye, a licensed social worker with over 20 years in Detroit schools, credited proper training as key to the state's success.

"There is an organization called the Michigan Association of School Social Workers," said Maye, "who make sure that those types of trainings and educational classes are made available for professional growth and development, for our mental health professionals in the schools."

Polls reveal that mental health is a priority for Americans, regardless of party, with 90% of voters saying expanding mental health care should be a priority for elected officials.