Last week, the U.S. Department of Health and Human Services announced it will be awarding up to $15 million in new planning grants to states as part of its national expansion of the Medicaid-funded Certified Community Behavioral Health Clinic (CCBHC) demonstration program under the Bipartisan Safer Communities Act. The announcement comes on the heels of nearly $300 million in separate grant funding awarded by SAMHSA directly to CCBHCs in September to support new and existing CCBHCs.
As we’ve previously written about on Say Ahhh!, the Bipartisan Safer Communities Act included a number of provisions related to Medicaid and mental health including a provision to expand the Medicaid-funded CCBHC demonstration nationally. But before we get into the national expansion, below is a bit of background on the original Medicaid demonstration program for those less familiar–
The CCBHC Medicaid demonstration was created in 2014 under the Protecting Access to Medicare Act. Under the original demonstration, the Secretary of HHS was authorized to award demonstration planning grants to states and provide states selected to participate in the demonstration with enhanced federal matching funds (equal to the CHIP matching rate) for services provided to individuals covered by Medicaid at CCBHCs – clinics required to meet federal standards for a range of services like 24/hour crisis services and routine outpatient care and required to serve anyone who requests care for mental health or substance use, regardless of their ability to pay or age. According to a 2021 report by HHS on the existing demonstration, about 23 percent of CCBHC clients were children or adolescents (ranging from 8% to 27% depending on the demonstration state). The CCBHC demonstration was initially limited to 8 states for a duration of two years. Congress subsequently extended and slowly expanded the Medicaid-funded demonstration and also authorized separate funding directly to CCBHCs outside of the Medicaid demo. However, the CCBHC Medicaid demonstration was still limited to 10 states . . . that is, until the Bipartisan Safer Communities Act, passed in June, included language expanding the demonstration program nationally.
Building on this effort, the Bipartisan Safer Communities Act national expansion opens the demonstration up to all interested states under a phased-in approach to include 10 new states every two years, starting in 2024, and provides $40 million to the Secretary for purposes of carrying out the demonstration including awarding new planning grants and providing technical assistance to states. Under the demonstration, each new state would establish a prospective payment system for Medicaid reimbursable CCBHC services and receive enhanced Medicaid funding for such services under their demonstration period lasting four years. According to the Congressional Budget Office, the national expansion is expected to provide an estimated $8.5 billion in new federal Medicaid support over the next 10 years.
But first, interested states must apply for a planning grant. The new planning grants are intended to support states in developing and certifying their CCBHC programs and preparing an application to participate in the four-year CCBHC Medicaid demonstration. At the end of the planning grant period, planning grant states must be prepared to submit applications to participate in the demonstration by March 2024, including a description of the populations served through CCBHCs and the extent of service needs. However, we encourage HHS to require applicants’ project narrative descriptions to not only identify the populations being served by CCBHCs in the state’s demonstration program but to also specifically state how the needs of children and youth will be addressed, especially in light of ongoing youth mental health crisis. After applications are submitted, up to 10 selected states will be eligible to join the demonstration as soon as July 1, 2024, as part of the first phase of the national expansion.
Planning grant applications are due Monday, December 19th and may be submitted by State Mental Health Authorities, Single State Agencies, or State Medicaid Agencies. The Notice of Funding Opportunity and additional information can be found here.
To find out if there are currently CCBHCs in your state and whether or not your state is currently participating in CCBHC Medicaid demonstration, take a look at the map here. (Pro-tip: use your cursor to hover over your state to see whether or not it is a “CCBHC Medicaid Demonstration State.” Note, not all states that have state-certified CCBHC sites or CCBHCs that have received separate expansion grants are participating in the CCBHC Medicaid demonstration.)