Innovative mental health centers in eight states will lose enhanced federal funding on Sunday for a Medicaid demonstration that enables them to offer a broad array of coordinated services for people with serious mental illness and substance use disorders.
The two-year, $1 billion certified community behavioral health clinic program (CCBHC), which enjoys bipartisan support, will end unless Congress quickly agrees to at least temporarily extend the funding.
Centers in Minnesota, Missouri, Nevada, New Jersey, New York, Oklahoma, Oregon and Pennsylvania have notified staff and patients about layoffs and service cuts.
Advocates hope Congress next week will pass a temporary bill to extend funding that was blocked by Sen. Mike Lee (R-Utah) based on concerns about how it would be paid for.
"Everyone is hopeful that Congress will extend it again," said Chuck Ingoglia, CEO of the National Council for Behavioral Health. "States and individual organizations are hanging in there. No one has shut down."
Sens. Roy Blunt (R-Mo.) and Debbie Stabenow (D-Mich.), the original sponsors of the CCBHC demonstration program, have pushed to renew the program and expand it to 11 additional states, including California and Texas.
On Thursday, Blunt said the CCBHC program in Missouri has helped in preventing patients from having to go to emergency departments to deal with mental health crises. He urged Congress to extend the program through the end of the current fiscal year because it's helping reduce overall healthcare costs.
But as of Friday, Blunt and Stabenow had not succeeded in winning an extension, as time ran out before lawmakers left for the weekend.
That means that nearly 3,000 staff at 67 CCBHCs around the country could lose their jobs and more than 9,000 patients receiving medication-assisted treatment for substance abuse could lose access to that treatment, the National Council for Behavioral Health has estimated.
The CCBHC demonstration, created by the Excellence in Mental Health Act of 2014, was the biggest federal investment in many years in improving community-based mental healthcare.
The demonstration tested a new, multidisciplinary model for delivering community-based mental health and addiction treatment. Participating clinics were required to provide nine types of evidence-based services, including 24-hour crisis care, substance abuse services such as medication-assisted treatment and detox, care coordination and integration with physical healthcare.
CCBHCs received enhanced, cost-based reimbursement from Medicaid through a global payment per patient model, while reporting 22 quality measures.
The enhanced funding enabled the clinics to cover the costs of support services such as outreach, case management, housing, legal and employment services. The Substance Abuse and Mental Health Services Administration projected that the current 67 CCBHCs would serve more than 380,000 people at 372 sites.
Experts say it's critical to expand and strengthen community-based behavioral and addiction services as a proactive alternative to the current patchwork of treating patients with advanced serious mental illness in emergency departments, jails or prisons. There's also a stark shortage of psychiatrists and other mental health professionals willing to serve Medicaid patients due to low payment rates.
A key benefit of the CCBHC model is offering a broad range of services in a single setting, so patients with disabling disorders don't have to navigate the system on their own.
Surveys of the clinics conducted last year by the National Council for Behavioral Health found that the program had enabled them to increase their patient caseload by an average of 25%. Two-thirds of the clinics had seen a decrease in patient wait times, and all had launched or expanded addiction treatment services, including hiring or training clinicians who can prescribe buprenorphine.
Brent McGinty, CEO of the Missouri Coalition for Community Behavioral Healthcare, said the CCBHC program is important in combatting the nation's opioid addiction crisis because it offers a sustainable model of funding that serves communities better than grant-based funding.
"It's a model that has increased access to medication-assisted treatment dramatically, and we'd like to pursue it as the standard of care across the state and the country," he said.