The bill (S-0813.1 / Senate Bill 5481, read 01/24/25 and referred to the Committee on Human Services) adds a new section to chapter 71.24 RCW requiring managed care organizations (MCOs) to reimburse for medically necessary behavioral health services that a licensed or certified behavioral health agency provides colocated within a school to a student enrolled in Medicaid. Reimbursement must be provided whether or not the behavioral health agency is in the MCO’s network, unless the MCO provides equivalent colocated services within the school that are available to the child using in‑network providers. The bill includes legislative findings about growing need for child and youth behavioral health services, barriers to access (time, distance, transportation), benefits of school‑based services (reduced stigma, better attendance), and challenges in rural and low‑income communities. This is a statutory coverage and procedural change: it creates a new statutory requirement for MCO reimbursement of school‑based behavioral health services and adds a new section to state law; it is not described as creating a new crime or changing criminal penalties. The extracted text does not define key terms used (for example, “medically necessary,” “equivalent services,” “colocated,” or which MCOs are covered), and it does not include an effective date, enforcement mechanism, reimbursement rates, implementation details, or dispute resolution procedures. These gaps mean additional statutory language or administrative rules would be needed to determine scope and operation.

If enacted, managed care organizations (MCOs that cover Medicaid children would be required to pay for medically necessary behavioral health care delivered in schools by licensed or certified agencies even when those agencies are not in the MCO’s provider network, unless the MCO already offers equivalent in-school services through its own in‑network providers. That will likely expand on-site behavioral health availability for Medicaid-enrolled students and provide new or increased revenue opportunities for community behavioral health agencies and schools hosting those services. MCOs will likely see higher out-of-network claims or feel pressure to create or contract for colocated, in-network school programs to avoid those payments, raising administrative and contracting work and potentially program costs. Important details are missing—such as who exactly is covered, how “medically necessary” and “equivalent” are defined, reimbursement rates, and when the rule takes effect—so the scale and timing of these cost and operational changes remain uncertain.