HHS Drastically Expands Mental Health/Substance Use Pilot Program

A total of 10 states are being added to the demonstration program.

A groundbreaking pilot program meant to combat the nation’s mental health and substance use crisis was expanded dramatically last week, when 10 states were added to the Certified Community Behavioral Health Clinic (CCBHC) Medicaid Demonstration Program.

CCBHC, a joint project by the U.S. Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), and Substance Abuse and Mental Health Services Administration (SAMHSA), will now involve services in Alabama, Illinois, Indiana, Iowa, Kansas, Maine, New Hampshire, New Mexico, Rhode Island, and Vermont, after each successfully developed necessary state-level infrastructure and worked with providers to develop programs that meet CCBHC standards.

A CMS press release issued last week notes that the pilot “provides states with sustainable funding that helps them expand access to mental health and substance use services,” supporting a broader effort to overhaul the nation’s behavioral health system – an effort that also includes the transition to the national 988 Suicide & Crisis Lifeline, as well as the additions of a new mobile crisis benefit to Medicaid and new crisis codes to the Medicare program.

“Certified Community Behavioral Health Clinics have significantly improved behavioral health treatment in our country, and today’s announcement will dramatically expand and improve access to equitable, quality care for Americans with serious mental health and substance use treatment needs,” HHS Secretary Xavier Becerra said in a statement. “Thanks to the Bipartisan Safer Communities Act, we are adding 10 new states to this groundbreaking demonstration across the country, ensuring our CCBHCs can serve more Americans who need our help.”

“Certified Community Behavioral Health Clinics serve anyone who requests care for mental health or substance use conditions. With sustainable funding, CCBHCs in participating states will now be able to connect more people to the care they need,” HHS Deputy Secretary Andrea Palm added. “This is another example of our commitment at HHS to transforming behavioral health and ensuring all Americans have access to behavioral health resources.”

To be part of the program, CCBHCs must ensure access to a comprehensive range of services, providing care coordination when needed and incorporating evidence-based practices and other services, based on a community needs assessment – including crisis services available 24-7. CCBHCs are also required to provide routine outpatient care within 10 business days of a hospitalization.

The Bipartisan Safer Communities Act (BSCA), signed into law by President Biden, gave HHS the authority to add 10 new states to the CCBHC Medicaid Demonstration program every two years, starting with the 10 announced last week. All of the participating states had previously received planning grants, and they join 8 states already enrolled in the program: Michigan, Missouri, Kentucky, Nevada, New Jersey, New York, Oklahoma, and Oregon.

While involved in the planning stages, all participating states got to work certifying clinics as CCBHCs, establishing prospective payment systems for Medicaid reimbursable services, and preparing applications to participate in what amounts to a four-year trial run. A notice of funding opportunity to award 15 additional states with planning grants is expected to be posted this summer, and 10 more states will have the opportunity to join the CCBHC Demonstration Program by the 2026 fiscal year (FY).

“For our communities to thrive, behavioral health, including mental health, needs to be prioritized,” CMS Administrator Chiquita Brooks-LaSure said. “That requires an all-hands-on-deck approach, which is why it’s so encouraging to see more states support person- and community-centered solutions like CCBHCs. Aligned with the Biden-Harris Administration’s commitment to mental health, CCBHCs equip communities with the tools they need to tackle many of society’s most entrenched challenges – from substance use disorders and mental health crises to housing insecurity, public safety, and the more efficient use of our health care resources.”

“We’re pleased to welcome these 10 states in the CCBHC Medicaid Demonstration Program and look forward to adding more in the years to come. CCBHCs provide a model of care that supports wellness for the entire community and connects people to care. They guarantee access to services to individuals and families, regardless of ability to pay,” added Miriam Delphin-Rittmon, Ph.D., HHS Assistant Secretary for Mental Health and Substance Use and the head of SAMHSA. “Equity is a significant and overarching priority in all that we do, and expanding and improving the CCBHC model across America helps us to continue our path forward to make quality behavioral health care for everyone even more widely available.”

It’s an important point – statistics maintained by the National Institute of Mental Health paint something of a bleak picture. More than one in five U.S. adults – an estimated 57.8 million – live with a mental illness, and the incidence varies by demographic, according to the agency. Women (27.2 percent) tend to have higher rates than men (18.1 percent), and while only 15 percent of individuals 50 or older are so afflicted, more than a third (33.7 percent) of people ages 18 to 25 are.

Incidence of mental health illness among white, Black, and Hispanic populations is rather similar, but here the disparity lies in treatment: 52.4 percent of white individuals with mental illness received mental health services in 2021, but the figure was 39.4 percent for Black individuals and just 36.1 percent for Hispanics.

Federal officials said the expanding prevalence of CCBHCs will address such issues, increasing access to crisis and behavioral healthcare in underserved populations. Such facilities have been reportedly shown to reduce homelessness and substance use among the people they serve, and decrease use of emergency rooms and hospitalization.

The CCBHC Demonstration Program provides reimbursement through Medicaid for the full cost of services that such clinics provide, at higher, more competitive rates than community mental health centers previously received for Medicaid-eligible individuals.

“This sustainable funding also ensures CCBHCs can provide a more comprehensive range of services, rather than fragmented services driven by separate billing codes,” CMS’s press release read. “CCBHCs were created to transform mental health and substance use treatment across the country and provide sustainable funding for robust community outpatient mental health treatment. They are required to meet federal standards for the range of services that they provide. CCBHCs offer a no-wrong-door approach, because they must serve anyone who requests care for mental health or substance use conditions, regardless of their ability to pay, place of residence, or age.”

The first CCBHCs were funded under Medicaid in 2017, with 67 clinics operating across 8 states. Today, there are more than 500 CCBHCs across 46 states, the District of Columbia, and Puerto Rico, most of which are supported through SAMHSA’s CCBHC Expansion Grant program.

Officials added that if you or someone you know is struggling or in crisis, help is available: call or text 988, or chat at 988lifeline.org. To learn how to get support for mental health, drug, or alcohol issues, visit FindSupport.gov.

If you are ready to locate a treatment facility or provider, go directly to FindTreatment.gov or call 800-662-HELP (4357).