The wait has a workaround: 5 funded programs most pediatricians have never heard of

This country already built a way to put behavioral health next to a well-child visit and pay the office for it. The billing codes are live. The phone line is live. One state even set aside $5 million so practices could hire the staff to do it. And a parent can still live three miles from one of those offices and wait 18 months for help.

This is not a story about a program that does not exist. It is the opposite. There are five separate, funded systems for this, and most pediatricians could not name two of them. Here is each one, what it pays for, and why so few families are ever offered it.

If you are waiting on services and want help figuring out what you can ask your pediatrician for in the meantime, a 45-minute family care mapping call can help you lay out the options. Book a 45-minute family care mapping call

I am a BCBA, but I am not your BCBA. This is general education, not treatment, and not a treatment recommendation for your child or your state. Build the real plan with the people who actually treat your child.

1. The free child psychiatry access line

It is called Pediatric Mental Health Care Access, and you may hear it called a child psychiatry access program. The idea is simple. A pediatrician who has a child in front of them who might need a psychiatric opinion calls a dedicated line, and a child psychiatrist calls back, often the same day. The family is not billed. No copay, no claim.

It traces back to Massachusetts, where MCPAP launched in 2004 after concerns about rising psychiatric prescribing in children without easy access to a specialist. It became the model other states copied. North Carolina's is NC PAL, run with Duke and UNC Chapel Hill since 2017. California's CalMAP launched in December 2024. Maryland has BHIPP, New Jersey has NJPPC, and Texas built CPAN by state law in 2019.

The catch is the federal money. HRSA funded 54 of these programs in 2024 and 2025. The new 2026 cycle funds up to 22, with a pool of about $9.79 million and a 20% non-federal match. States that miss an award either keep the line going with state, Medicaid, or foundation money, or scale it back. HRSA reports the program can reach as many as 3.5 million children, and in fiscal year 2024 primary care providers who used their regional teams served more than 30,000 children and teens. A phone call is the easiest, least intrusive door on this list, and its federal funding is shrinking.

2. Collaborative care (CoCM) and the billing codes

Most care is fragmented. One referral leads to another, with multiple appointments and nobody checking that you made it to the last one. Collaborative care is built differently. It uses three people: the pediatrician, who stays the treating clinician; a behavioral health care manager, who runs a registry, does brief check-ins, and tracks scores; and a consulting psychiatrist, who reviews the whole caseload once a week without needing to see every child.

All three are paid through monthly codes billed under the pediatrician's own NPI, the clinician's identification number. 99492 covers the first month (the first 70 minutes). 99493 covers each month after that (the first 60 minutes). 99494 is an add-on for each extra 30 minutes. G2214 covers a shorter month (the first 30 minutes). On the public Medicare schedule, that works out to roughly $80 to $90 per hour of care manager time.

That is not a therapist's salary, and that is the point. The model is designed so one care manager can carry 50 to 80 children on a registry. There are also hard rules: you cannot bill general behavioral health integration (99484) in the same month, you cannot count the same minute twice, and you cannot count ABA's codes (97151 through 97158) as collaborative care time.

Here is why this matters for an autism show even though the codes never mention autism. Collaborative care is built for conditions you can score every month and adjust, like anxiety, depression, and ADHD. Autism is not a mood score. A pediatrician can use CoCM for a co-occurring condition, like the anxiety that came along with the diagnosis, but not as the autism treatment.

What is built for autism coordination: tailored care management

In North Carolina there is a real answer. Under tailored care management, autism and intellectual or developmental disabilities are named eligible conditions with the state's tailored plans (Alliance, Trillium, Vaya, and the fourth plan in the state). The state pays a monthly rate when there is a qualifying contact that month, built for a caseload of about 25 to 30 engaged members. The job is the whole child: medical, behavioral health, developmental disability services, pharmacy, school, rides, and food. It is supposed to talk to the ABA team, not be the ABA team.

North Carolina also requires conflict-free care management. The agency delivering the therapy is usually not allowed to also be the official manager of that therapy. That rule keeps autism clinics from simply becoming care managers, and it is one reason most autism providers have never been part of that network.

Why practices don't do it

If the codes exist, why is your pediatrician still handing you a pamphlet and an 18-month wait? Here is the honest case for why a rational practice stays where it is.

• The hire. Collaborative care does not pay for itself on 10 children. It pays on a panel of 50 to 80. Most pediatric practices do not have a spare office, a spare supervisor, or a psychiatrist on speed dial.
• The wage. The math only works if the care manager is paid like a coordinator, not a licensed clinician. A practice that prices it at a clinician's salary will look at the fee schedule and walk away. That is not a moral failure. It is arithmetic.
• Autism is the wrong target. Families come in for language, behavior, and school. The code is built around a depression screening score. A practice that lives on autism referrals does not see itself in the billing manual.
• ABA already uses the coordination hour. Parent training and treatment planning are written into ABA codes. Stacking a care management code on top is how a practice ends up explaining itself to a program integrity reviewer.
• No coach. In some states the codes are turned on, but nobody walks the practice through the first six months.

And the pros: when it runs, the medical home actually handles the co-occurring piece. Tailored care management, used correctly, gives a North Carolina family one official coordinator instead of seven separate plans. The solution is not fake. It was built for a different room, a different wage, and a different score.

Startup grants and the practices that made it work

North Carolina's General Assembly appropriated $5 million for a CoCM Capacity Building Fund so Medicaid-enrolled primary care practices could stand up collaborative care. NCDHHS oversees it, Community Care of North Carolina (CCNC) screens applicants and makes the awards, and NC AHEC does the coaching. Awards are per clinic site, high-need counties get priority, and there are tiers for practices starting from scratch, practices expanding, and practices that want to contract the work to an outside team instead of hiring. A decision takes about 30 to 45 business days, and applying does not guarantee funding. North Carolina Medicaid has covered CoCM since 2018, with the copay waived for Medicaid.

It works in real waiting rooms. Twin City Pediatrics in Winston-Salem, now part of Novant Health, hired an in-house care manager with coaching from Northwest AHEC. Its published case study reports billing above the care manager's cost, a monthly surplus, and a $50,000 CCNC grant underneath it. One Health, a group of practices around Charlotte, tried for years to do it alone, then contracted a vendor for a virtual care manager, consulting psychiatrist, and registry. As of June 2023, it was running in 5 of 29 practices. One practice figuring it out is not a system, but it is proof the two missing people can be found.

Not sure which of these your state offers? We can look at it together. Book a 45-minute call

Georgia and Florida

Georgia and Florida have the same CPT codes, and collaborative care is billable in both. A January 2026 Meadows Institute and Concert Health tracker summarizes it: North Carolina covers it above Medicare with written guidelines, Georgia at Medicare rates without written guidelines, and Florida below Medicare without written guidelines, often as an extra a Medicaid plan chose to offer. There is no $5 million fund and no AHEC-style coach. Same three roles, same codes, and no one standing next to the practice while it figures it out.

3. HealthySteps

HealthySteps puts a child development specialist in the room with the pediatrician for children up to age three. The specialist does a developmental screen and screens the family for food insecurity, housing instability, and maternal depression, things a 15-minute visit does not ask about. If something comes up, they offer one to three focused sessions right there and stay with the referral instead of handing off the file.

As of the end of 2025 there were 369 sites across 25 states plus DC, and 67% get some form of reimbursement. Maryland and Arkansas both pay small add-ons for children under four at sites that meet fidelity standards. Those add-ons are not built to cover a salary, so HealthySteps relies on braided funding: Medicaid plus grants, health system support, and other sources. And the door closes on a child's third birthday, right when preschool and daycare start asking their own questions.

4. Integrated Care for Kids (InCK)

This was the most ambitious idea of all: a CMS Innovation Center model, with six awardees nationally, aimed at coordinating health, school, and child welfare for the whole child. North Carolina's version covers Alamance, Durham, Granville, Orange, and Vance counties, run by NCDHHS, Duke, and UNC Chapel Hill.

In those counties, children under 21 on Medicaid or NC Health Choice are enrolled automatically. You do not fill out a form. What is not automatic is the extra person. CMS's evaluation of the first two years put North Carolina's attributed population at about 112,000 children, with 1.6% (about 1,792 children) engaged in model activities. A county can say every Medicaid child is in the program while a stressed parent is still the coordinator.

Here is the debate, and I think both sides argue in good faith. Some in health policy say a program like this should start as a time-limited test and only get permanent money once it proves itself. Many family advocates say building something families come to depend on and designing it to expire on a fixed date is itself the failure. The model ends December 31, 2026. If you are in one of these counties, I would love to hear what you have been told about January 1.

5. School Medicaid and school-based health centers

The last option is not a clinic at all. It is the school. Twenty-eight states have taken steps to expand school Medicaid billing beyond students with IEPs, but only eight (Illinois, Maryland, New Mexico, Ohio, Oregon, Utah, Virginia, and Wisconsin) have a CMS-approved state plan amendment in hand. California's school billing mechanism generated $11.3 million in new revenue from more than 230,000 claims. And just before this episode was recorded, North Carolina announced $1.25 million to expand rural school-based health centers, including behavioral health. The catch: school counselors carry caseloads in the hundreds, and consent forms and billing rules slow everything down before a child gets help.

What to do with this

One fair question: if a vendor supplies the missing care manager and psychiatrist, is that still a medical home, or just another referral? People who build outsourced models say the pediatrician's NPI, oversight, and billing relationship are what keep it a medical home. Critics say the point was to keep the team inside the practice. North Carolina's fund built the contracted option on purpose.

So here are the five: a free phone line losing federal funding, a monthly code most practices cannot staff, a specialist who leaves at age three, a coordinated care model that expires this December, and schools slowly getting room to bill for what they already do. None of these fixes the ABA waitlist. They can help the rest of the child while you wait.

• Parents: ask your pediatrician whether they use your state's child psychiatry access line, and whether the office offers collaborative care for anxiety, ADHD, or depression.
• If your child is under three: ask whether the practice is a HealthySteps site.
• In North Carolina: ask whether your child qualifies for tailored care management.
• Pediatricians and practice managers: the state-by-state resources linked in the episode description are a place to start.

If your child's doctor has never heard of the phone line in their own state, that is not you failing to coordinate. That is the system failing to tell the one person whose job it was to know.

Tell me in the comments: has your pediatrician ever offered behavioral health help in the office, or said the words collaborative care to you?

Sources

• CMS, Integrated Care for Kids (InCK) Model
• NC PAL (North Carolina Psychiatry Access Line)
• MCPAP (Massachusetts Child Psychiatry Access Program)
• HRSA, Pediatric Mental Health Care Access Program
• HealthySteps
• State-by-state CoCM and child psychiatry access resources (from the episode description)

Sources for the NC CoCM Capacity Building Fund, the Twin City Pediatrics and One Health case studies, the Meadows/Concert Health tracker, and the school Medicaid figures are pending verification and will be added.

Ashleigh Dominguez, MS, BCBA, is a Board Certified Behavior Analyst licensed in North Carolina, Georgia, and Iowa. This article is general education based on the episode. It is not clinical advice, not treatment, not legal advice, and not a treatment recommendation for your child or your state. Ashleigh is not your BCBA and has not met your family. Please build your real plan with the providers who know your child.