Key Takeaways
- A four-year Massachusetts pilot placed free, on-site mental health services in 23 public schools and reduced emergency calls, suspensions, and behavioral incidents across participating campuses.
- The $5 million in philanthropic grant funding sustaining the program expires in June 2026, with no guaranteed replacement from state or federal sources.
- Federal behavioral health funding has become increasingly volatile: SAMHSA canceled as many as 2,800 grants in January 2026 before reversing course within days, and Bipartisan Safer Communities Act school mental health grants faced termination before a federal court intervened.
- Proposed Medicaid cuts under the One Big Beautiful Bill Act could reduce coverage for up to 350,000 Massachusetts residents over the next decade, compounding the loss of grant funding for students who depend on school-based services.
- Shifting the program to insurance billing would reintroduce the access barriers the model was designed to eliminate: prior authorization, out-of-network issues, and the requirement to travel to an outside provider.
- The sustainability challenge is national: school districts that expanded mental health services during and after the pandemic are confronting grant cliffs that their operating budgets were never designed to absorb.
Before the grant funding arrived, Keith Asher, the principal of Washington Elementary School in Springfield, Massachusetts, was calling 911 and requesting an ambulance as often as once a week. Students who had lost control of their emotions would throw chairs or other objects, and the school’s existing staff did not have the capacity to de-escalate the situations safely. With the additional clinicians funded by the state’s pilot program, the ambulance calls dropped to two or three for the entire school year. At Somerville High School, where Cambridge Health Alliance was already running an in-school clinic, the grant paid for an extra clinician and a bilingual specialist. Suspensions dropped significantly.
The numbers are modest in scale and enormous in implication. A four-year pilot program, launched in 2022 and run by the Massachusetts Association for Mental Health, placed free urgent mental health services in 23 public schools across the state (the first program of its kind in Massachusetts). The results, by nearly every available metric, suggest it worked. And now the $5 million in philanthropic grant funding that sustained it (provided by three private foundations to get the program started) is expiring, with no guaranteed replacement in sight.
How Massachusetts School-Based Mental Health Services Worked
The program was born at a particularly fraught moment. The COVID-19 pandemic had disrupted the social and emotional development of an entire generation of students. Social media pressures were intensifying. And Massachusetts schools, like schools across the country, did not have enough mental health professionals to meet the need. The state had one psychologist for every 686 students (well short of the one-to-500 ratio recommended by the National Association of School Psychologists), and the behavioral health workforce shortage showed no signs of easing.
By supplementing existing school mental health teams with additional staff (therapists who could offer free sessions and develop long-term treatment plans, social workers, bilingual specialists), the program aimed to provide a level of care that most schools could not sustain on their own. The model was simple in concept: place the services where the children are. Joan Mikula, former Massachusetts commissioner for mental health, described school-based delivery as the most effective way to reach kids and families, because schools are where the majority of children spend their time.
The results bore that out. Beyond the reductions in suspensions and emergency calls, school administrators reported improvements in attendance, classroom behavior, and the ability to identify students in crisis before their situations escalated. The program demonstrated, in a controlled and measurable way, that embedding mental health services in schools is not merely a nice-to-have but a direct contributor to safety, stability, and educational outcomes.
The School Mental Health Funding Cliff: What Happens in June 2026
The grant expires in June 2026. Danna Mauch, president of the Massachusetts Association for Mental Health, has been working to assemble a patchwork of replacement funding: third-party insurance billing, private grants, and state appropriations. School clinics could, in theory, bill services to student insurance coverage, but that approach would not cover all of the resources the grants funded (social workers, bilingual specialists, and the kind of flexible, walk-in availability that made the program effective in the first place).
The state has some resources available. At least five funding streams through the Massachusetts Department of Education account for $11 million designated for mental health support in schools. At the federal level, Massachusetts received nearly $20 million in relevant grant funding in the current year. But the reliability of those federal dollars is increasingly uncertain.
Federal Behavioral Health Funding Cuts: Uncertainty at the National Level
The precariousness of federal behavioral health funding has become a defining theme of the current moment. In January 2026, the Substance Abuse and Mental Health Services Administration sent hundreds of grant termination notices to health providers across the country, canceling as many as 2,800 grants affecting up to $1.9 billion in funding (more than a quarter of SAMHSA’s total budget, according to reporting by STAT News). The cancellations hit Massachusetts particularly hard: the state received at least $195 million in SAMHSA grant funding in the prior year, and Governor Maura Healey estimated the cuts would cost state programs tens of millions of dollars.
The administration reversed the cuts within days, amid public outcry and legal challenges. But the episode left providers deeply unsettled. At Casa Esperanza, a Roxbury-based nonprofit providing supportive housing and addiction treatment, two termination notices arrived on Tuesday evening, followed by four more by the next morning (six in total, representing 14 percent of the organization’s budget). Days after the reversal, staff still had not received official confirmation that the grants had been restored.
A separate federal funding battle played out over the Bipartisan Safer Communities Act, the landmark 2022 legislation that invested $1 billion in school-based mental health services in the aftermath of the school shooting in Uvalde, Texas. In April 2025, the Department of Education abruptly notified grantees that it would not renew their multi-year awards. Sixteen state attorneys general sued. In October, U.S. District Court Judge Kymberly Evanson called the cuts arbitrary and capricious and issued a preliminary injunction blocking the terminations. In December, she granted full summary judgment, ordering the department to resume lawful continuation decisions. But the legal victory, while significant, did not eliminate the underlying policy risk: in future budget cycles, the administration could decline to fund the programs through different means.
Medicaid Cuts and School Mental Health Access
Beneath the immediate funding questions sits a longer-term structural challenge. Up to 350,000 people in Massachusetts are at risk of losing their Medicaid coverage over the next decade, according to a study published by the Center on Budget and Policy Priorities. The One Big Beautiful Bill Act, signed on July 4, 2025, included approximately $1 trillion in Medicaid and CHIP spending cuts over ten years, the introduction of work requirements, and a shift to six-month redetermination cycles. For children who rely on Medicaid for access to behavioral health services (including many of the students served by Massachusetts’s school-based clinics), the erosion of Medicaid coverage could compound the loss of grant funding, creating a bind in which neither the school-based model nor the traditional clinic-based model has sufficient resources to meet demand. States facing similar pressures have already begun responding: Indiana rewrote its Medicaid ABA reimbursement rules in ways that gave a preview of what broad eligibility changes can do to behavioral health access at the provider level.
The irony is difficult to miss. The pilot program succeeded precisely because it lowered the barriers to access: services were free, on-site, and available without prior authorization or a trip to an outside provider. Replacing that model with one that depends on insurance billing reintroduces the very barriers the program was designed to remove.
School-Based Mental Health Services: A Proven Model Without Permanent Funding
Pam Sager, executive director of the Parent Professional Advocacy League, a nonprofit mental health advocacy group, has argued that the stakeholders in school-based mental health (educators, clinicians, parents, insurers, state agencies) can work through the financial and logistical challenges if they are willing to sit at the table. The model, she and others contend, has been proved. What it lacks is a sustainable funding mechanism. Value-based care arrangements, which tie reimbursement to outcomes rather than services delivered, represent one potential path: recent investment activity in the space suggests payers and providers are beginning to take that model seriously, though it requires outcomes infrastructure that most school-based programs have not yet built.
That gap is not unique to Massachusetts. Across the country, school districts that expanded mental health services during and after the pandemic are confronting the expiration of the federal grants and emergency funds that made those expansions possible. The Bipartisan Safer Communities Act was designed to address the shortage of school-based mental health professionals (the National Association of School Psychologists estimated the legislation could support the hiring of 14,000 additional professionals nationwide). Participating schools reported a 50 percent reduction in suicide risk, improved attendance, and stronger engagement between students and staff. But the funding was always time-limited, and the political will to renew it at scale is far from guaranteed.
Parent training is another model gaining traction as a supplement to clinic-based sessions, with some research suggesting it can extend the benefits of clinical contact without adding therapist hours. Like school-based services, it requires its own reimbursement structure to be sustainable, and it works best when it complements rather than replaces direct clinical access.
For the 23 Massachusetts schools that participated in the pilot, and for the students whose crises were averted by the clinicians it funded, the question is not whether the program worked. The question is whether anyone is willing to pay for it.
Frequently Asked Questions:
How is school-based mental health funded?
School-based mental health services are typically funded through a combination of federal grants (including those authorized under the Bipartisan Safer Communities Act and SAMHSA), state education and Medicaid appropriations, third-party insurance billing, and private philanthropy. Most programs rely on multiple funding streams simultaneously, which creates vulnerability when any one source is reduced or eliminated.
What happened to Bipartisan Safer Communities Act school mental health grants?
In April 2025, the Department of Education notified grantees that it would not renew multi-year awards under the Bipartisan Safer Communities Act. Sixteen state attorneys general sued, and a federal district court issued a preliminary injunction in October 2025 blocking the terminations. In December 2025, the court granted full summary judgment ordering the department to resume lawful continuation decisions. Future funding remains subject to the administration’s budget decisions.
Does Medicaid cover school-based mental health services?
Medicaid can cover certain school-based mental health services for eligible children, but coverage terms vary significantly by state. Billing Medicaid for school-based services typically requires prior authorization and does not cover all staff roles (such as social workers or bilingual specialists) that grant-funded programs include. Proposed federal Medicaid cuts under the One Big Beautiful Bill Act, including six-month redetermination cycles, could reduce the number of children eligible for coverage, further limiting this funding pathway.
What is the recommended student-to-school-psychologist ratio?
The National Association of School Psychologists recommends one psychologist for every 500 students. Massachusetts had one psychologist for every 686 students prior to the pilot program, a gap that the program’s additional clinical staff were designed in part to address. The behavioral health workforce shortage affecting ABA and adjacent fields makes closing that gap more difficult over time.
Why is the grant cliff a national problem, not just a Massachusetts issue?
School districts across the country expanded mental health services during and after the COVID-19 pandemic using temporary federal funding, including pandemic relief dollars and Bipartisan Safer Communities Act grants. As those time-limited funds expire, districts face operating budget shortfalls they were never designed to absorb. The Massachusetts pilot is one of many programs confronting the same structural question: how to sustain services that were built on grants rather than permanent appropriations.
