How Certified Community Behavioral Health Clinics Expand Mental Health Care Access
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“We hope that one day every individual in this country will have access to high quality, timely services that are fully integrated with other health and social service providers, making mental wellbeing—including recovery from substance use—a reality for everyone.”
Rebecca Farley-David, Senior Advisor, Public Policy and Special Initiatives at the National Council for Mental Wellbeing
The Community Mental Health Act of 1963 established a system of community-based care, rather than institutional-based care, for treating Americans with mental illness. Nearly 50 years later, that system is as important as ever.
America is facing a mental health crisis. The good news is that it’s facing it: even before the pandemic, in 2021, an estimated 82 percent of Americans perceived mental health as important as physical health. The bad news is that the need still vastly outstrips the demand: approximately 22.8 percent of US adults experienced mental illness in 2021, while serious barriers in accessing quality mental health care remain.
The Certified Community Behavioral Health Clinic (CCBHC) model is part of the answer. These are facilities that meet federal standards and offer comprehensive mental health services regardless of any individual’s ability to pay. They may employ various behavioral health professionals: psychiatrists, licensed clinical social workers (LCSWs), mental health counselors, substance use counselors, and many others.
From the initial 67 CCBHCs operating across eight states in 2017, there are now more than 500 CCBHCs, operating through various funding streams across 47 states, DC, Guam, and Puerto Rico. The continued growth of the CCBHC model will be critical to supplying comprehensive, community-based care to all who need it.
Read on to learn how CCBHCs are shaping the future of mental health in America.
The History of the CCBHC Model
When President Kennedy signed the Community Mental Health Act of 1963, it funded the construction of community mental health centers (CMHCs) across the country. Those centers were intended to form the backbone of a nationwide community mental health system. But fragmented funding streams and differences in state policies and systems led to a patchwork system, with many areas not having access to needed mental health and substance use services.
“Historically, community provider organizations have struggled under a siloed, underfunded financing system that fails to fully support access to timely, comprehensive services, care coordination, and population health management,” says Rebecca Farley-David, senior advisor, public policy and special initiatives at the National Council for Mental Wellbeing. “Pockets of excellence have existed, but scope and quality of services vary across communities, services are often limited to specific populations or interventions, and individuals face long wait times for care. As a result, far too many people cannot access services when and where they need them–meaning they often end up in hospitals, emergency departments, or jails for needs that could have been better addressed in a community setting.”
In 2014, the Protecting Access to Medicare Act (PAMA) directed the Department of Health and Human Services to develop criteria for Certified Community Behavioral Health Centers (CCBHCs). Those criteria would come to include a requirement from PAMA for CCBHCs to serve patients regardless of where they lived or their ability to pay, providing a one-stop shop for all behavioral health needs in an easy, accessible, and expedited way. Eight states were chosen to participate, with operations formally beginning in 2017.
“What CCBHCs add onto community mental health centers (CMHCs) is a set of standards, and those standards cover a variety of different areas,” says David de Voursney, division director at the Substance Abuse and Mental Health Services Administration (SAMHSA). “Those standards include staffing standards, standards around access, standards around care coordination, standards around the range of services that CCBHCs have to provide, standards around data collection and quality improvement programs, and standards around governance. It’s those comprehensive standards that set the stage for the CCBHC providing everything a person would need on an outpatient basis for mental health or substance use.”
As part of their certification, CCBHCs are required to proactively engage with unserved and underserved populations. For CCBHCs in the Medicaid demonstration program, a prospective payment system (PPS) has been designed to cover CCBHCs’ costs of expanding services and reaching new populations. It also allows clinics to provide more of the services their communities need, and in a more streamlined manner, without providers worrying about what billing codes correspond to which payment rates. Providers can simply provide.
“The payment model supports historically non-billable activities known to be critical for improving client outcomes, such as care coordination, outreach and engagement, and data-driven population health management,” Farley-David says. “Taken together, the certification criteria and payment enable clinics to transform the way they serve individuals in needs and improve their wellbeing and health outcomes.”
Challenges Facing CCBHCs Today
The CCBHC model’s biggest strengths also represent some of its greatest challenges. Take funding for CCBHCs, which is a complicated but critical component. Currently, CCBHCs are only funded through Medicaid in 12 states. Further complexities exist in the distinctions between Medicaid demonstration funding and Medicaid funding more broadly, and, as de Voursney notes, it gets weedy quickly.
A parallel federal grant program supports hundreds of clinics in taking on the services and activities of a CCBHC, but this does add another funding stream to an already somewhat fragmented funding landscape, and it cannot fully replace the steady and sustainable funding needed to achieve the full promise of the CCBHC model.
“We need the model to become available through Medicaid in more states,” Farley-David says. “Efforts are underway to do just that through a federal demonstration program, but demonstrations are also time-limited. We were thrilled to see Senators Debbie Stabenow and John Cornyn introduce the Ensuring Excellence in Mental Health Act, which establishes CCBHCs as a provider type in both Medicaid and Medicare. The bill also increases funding for CCBHC grants and makes other important investments in the program.”
The CCBHC model is young. It began with slots for eight states in 2017 from a candidate pool of 24 states. Starting in 2024, the CCBHC model has the authority to expand to ten more states every two years. SAMHSA currently has 15 states that have funded planning grants and are competing for those ten expansion slots coming up next year.
“It is a competitive process,” de Voursney says. “There are a lot of states that are interested in investing in the CCBHC model, but Congress has made their decisions about where there’s funding available. It’s a question of the allocation of resources.”
The other challenge is the certification process itself, which can be rigorous. Future CCBHCs often require a lot of implementation support. Advocacy groups like the National Council are working to help them through the change process.
“It’s a really heavy lift to take on all the services and activities, data reporting, partnerships, etc.—which signals how the model is such a big advancement for our field,” Farley-David says.
The Future of CCBHCs and Mental Health in America
New and aspiring behavioral health professionals can join advocacy efforts by organizations like the National Council to help sustain and support CCBHCs. The National Council’s virtual Hill Day took place on October 18, 2023. More will follow. These events are open to all attendees who want to advance CCBHCs and other behavioral health priorities. It’s also possible to sign up for action alerts regarding opportunities to advocate for federal CCBHC legislation.
“We hope that one day every individual in this country will have access to high quality, timely services that are fully integrated with other health and social service providers, making mental wellbeing—including recovery from substance use—a reality for everyone,” Farley-David says.
For new and aspiring behavioral health professionals, one of the most important ways they can advocate for a better future is to get involved at the practitioner level; that may be with CCBHCs themselves, as employees or volunteers, or even in the field of community mental health more broadly.
“We are facing a historic workforce shortage,” de Voursney says. “If you’re thinking about going to get a master’s degree or trying to explore a career in behavioral health, please do it. We need your help, and CCBHCs need your help. It’s great that there’s this broad recognition of the importance of mental health and substance use, but we need people on the ground, too.”
In September of 2023, nearing the anniversary of the Mental Health Act of 1963, the Biden-Harris Administration awarded nearly $130 million to expand CCBHCs across the country. Nearly 50 years after the passage of the Mental Health Act of 1963, it renewed the promise of community-based care, providing 128 grants to health clinics in 40 states and Puerto Rico. Each grantee will receive $1 million per year for four years.
Today, there are approximately 500 CCBHCs nationally. That’s a lot, but not enough. There are 3,143 counties in America, and while not every county will require its own CCBHC, it’s a relevant unit of scale, de Voursney says. It also indicates how much more room for growth remains under the CCBHC model.
“I don’t think there’s a community in this country that doesn’t need a strong safety net system to help people who have mental health or substance use needs,” de Voursney says. “These services are needed everywhere.”
Matt Zbrog
WriterMatt Zbrog is a writer and researcher from Southern California. Since 2020, he’s written extensively about how counselors and other behavioral health professionals are working to address the nation’s mental health and substance use crises, with a particular focus on community-driven and interdisciplinary approaches. His articles have included detailed interviews with leaders and subject matter experts from the American Counseling Association (ACA), the American Mental Health Counselor Association (AMHCA), the American School Counselor Association (ASCA), and the Substance Abuse and Mental Health Services Administration (SAMHSA).