The NCSL Blog

04

By Colleen Becker

Access to quality behavioral health care has long been a priority for many legislators. Using quality health research and data helps legislators create evidence-informed policies.

Research from the National Alliance on Mental Illness suggests one in five U.S. adults experience a mental illness, and Mental Health America reports substance use disorders affect nearly 8% of adults and youth.

Results from a Kaiser Family Foundation poll show that, since the start of the pandemic 41% of people surveyed said they experienced depression or anxiety, whereas only 11% reported the same concern in 2019. The physical, emotional and economic toll the emergency situation placed on both Americans and state agencies only heightened lawmakers’ concerns.

While public health and behavioral health departments administer a range of programs, the types and quality of mental health and substance use services can vary across and within state agencies. Policymakers are addressing these gaps by establishing Certified Community Behavioral Health Clinic programs.

First established in 2014 as a Medicaid pilot program, Certified Community Behavioral Health Clinics, or CCBHCs, are non-profit organizations or local government behavioral health agencies offering a wide range of mental health and substance use disorder services for people with complex needs. In exchange, CCBHCs formed under the pilot receive an enhanced Medicaid reimbursement rate to provide these services.

According to the National Council of Mental Wellbeing,  340 CCHBCs operate in 40 states, Washington D.C. and Guam. Ten states are part of a current Medicaid demonstration project: Kentucky, Michigan, Minnesota, Missouri, Nevada, New Jersey, New York, Oklahoma and Pennsylvania. To participate, these states applied for a Medicaid 1115 waiver or state plan amendment (SPA). States may also implement a CCBHC program outside of the demonstration, by applying for a 1115 waiver or SPA on their own or applying for a grant through the Substance Abuse and Mental Health Services Administration (SAMSHA).

The CCBHC model integrates behavioral with physical health care by including local primary care and hospital partners, and building coalitions with criminal justice entities, health advocates and others. Qualified CCBHCs directly provide, or contract with partner organizations to provide nine types of services including outpatient mental health and substance use treatment, primary care screening and monitoring and crisis behavioral health resources.

CCBHC certification standards are primarily determined by states and include measures for staffing, care coordination, availability and accessibility of services and quality. For example, 2021 laws in Illinois (SB 2294) and Kansas (SB 138) allow the state to implement a certification process and funding mechanism for CCBHCs.

To help states and the federal government assess the impact of the CCBHC program, state agencies and CCBHCs involved in the demonstration must annually report to the U.S. Department of Health and Human Services on 21 separate quality measures. However, an analysis conducted by the Government Accountability Office cited several limitations to this data, including a lack of baseline information, making the evaluation of the CCBHC program difficult.

Although performance metrics might vary, some states report that by coordinating services across entities, CCBHCs have saved their states money while simultaneously helping patients achieve better outcomes. For example, research has shown that people living with mental health or substance use disorders typically have higher rates of emergency department usage and hospitalizations, which was reduced by using the CCBHC model.

In a National Council impact report, one CCBHC in Missouri indicated a 66% decrease in requests for crisis intervention services, while 85% of those referred for inpatient hospitalization were diverted to community care options. In a CCBHC partnership with a local jail, Oregon estimated $2.5 million in reduced prison costs.

No policy is “one size fits all” and legislators might consider a range of possible options to meet the unique needs of their district. Lawmakers looking to implement a CCBHC program may want to start by engaging local public and behavioral health officials to find out more about the status in their state. They can also visit the National Council for Mental Wellbeing’s CCBHC Success Center for more detailed information.

Additional Resources

Behavioral Health Overview, NCSL

State Actions on Coronavirus Relief Funds, NCSL

Mental Health Overview, Centers for Disease Control & Prevention

Substance Abuse and Mental Health Block Grants, SAMHSA

This project is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $250,000 with 100% funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.

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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.