MATSUI LEADS DELEGATION IN URGING CALIFORNIA TO APPLY FOR FEDERAL BEHAVIORAL HEALTH PROGRAMS

WASHINGTON, D.C.- Congresswoman Doris Matsui (CA-07) led 27 of her colleagues from the California Congressional delegation in a letter to California Health and Human Services Secretary Dr. Mark Ghaly, urging California to apply for the Substance Abuse and Mental Health Services Administration (SAMHSA)'s FY 2025 Cooperative Agreements for Certified Community Behavioral Health Clinic (CCBHC) Planning Grants.

The letter also urged the state to consider applying for the CCBHC Medicaid Demonstration opportunity when it becomes available.

CCBHCs are a specific type of behavioral health clinic required to provide a comprehensive set of services, with an emphasis on the provision of 24/7/365 crisis care; outpatient mental health and substance use disorder treatment services; immediate screenings, risk assessments, and diagnoses; and care coordination including partnerships with emergency rooms, law enforcement, and veterans' groups. They serve all individuals across the lifespan regardless of insurance status.

"We believe the federal support offered by the CCBHC demonstration will complement … efforts to establish a stronger continuum of care for Californians seeking behavioral health services," wrote the lawmakers.

"In California alone, there are already over 20 standalone CCBHCs enhancing access in their communities. Since becoming CCBHCs, many of these clinics have increased the number of children and youth they serve, the number of patients engaged in Medication-Assisted Treatment for Opioid Use Disorder (MOUD), their mobile crisis response and crisis stabilization capabilities, their engagement with the 9-8-8 Suicide and Crisis Lifeline, and more," the lawmakers continued. "However, the fullest potential of the CCBHC model is only accessible with additional state action to unlock the Medicaid demonstration. The Medicaid demonstration is an extension of the CCBHC model that allows clinics to receive a flexible prospective payment system (PPS) that supports clinics' costs of expanding services and increasing the number of clients they serve, while improving clinics' flexibility to deliver client-centered care."

A longtime champion for mental and behavioral health, Congresswoman Matsui introduced the Ensuring Excellence in Mental Health Actthis past May. This legislation would provide a permanent authorization of the CCBHC model. Congresswoman Matsui has led the effort to expand access to CCBHCs since introducing the bipartisan Excellence in Mental Health Act, legislation that established the CCBHC Medicaid demonstration and expansion grant program in 2014. In June 2022, Congresswoman Matsui's Excellence in Mental Health and Addiction Treatment Act of 2021, legislation that authorized the nationwide expansion of the CCBHC program, was signed into law as part of S. 2938, the Bipartisan Safer Communities Act.

A copy of the letter can be found below and HERE.

Dear Secretary Ghaly,

As members of the California Congressional delegation, we write to express our belief that California should apply for the Substance Abuse and Mental Health Services Administration's (SAMHSA) FY 2025 Cooperative Agreements for Certified Community Behavioral Health Clinic (CCBHC) Planning Grants. Further, we believe that California should strongly consider applying for the CCBHC Medicaid Demonstration opportunity when it becomes available. We are greatly appreciative of California's efforts to address behavioral health through initiatives such as Proposition 1, 9-8-8 implementation, crisis response, and Medicaid behavioral health reform. We believe the federal support offered by the CCBHC demonstration will complement these efforts to establish a stronger continuum of care for Californians seeking behavioral health services.

CCBHCs are a specific type of behavioral health clinic required to provide a comprehensive set of services, with an emphasis on the provision of 24/7/365 crisis care; outpatient mental health and substance use disorder treatment services; immediate screenings, risk assessments, and diagnoses; and care coordination including partnerships with emergency rooms, law enforcement, and veterans' groups. They serve all individuals across the lifespan regardless of insurance status.

Since their creation, CCBHCs nationwide have demonstrated extraordinary results in increasing access to care and improving patient outcomes. In California alone, there are already over 20 standalone CCBHCs enhancing access in their communities. Since becoming CCBHCs, many of these clinics have increased the number of children and youth they serve, the number of patients engaged in Medication-Assisted Treatment for Opioid Use Disorder (MOUD), their mobile crisis response and crisis stabilization capabilities, their engagement with the 9-8-8 Suicide and Crisis Lifeline, and more.

However, the fullest potential of the CCBHC model is only accessible with additional state action to unlock the Medicaid demonstration. The Medicaid demonstration is an extension of the CCBHC model that allows clinics to receive a flexible prospective payment system (PPS) that supports clinics' costs of expanding services and increasing the number of clients they serve, while improving clinics' flexibility to deliver client-centered care. In states that participate in the demonstration, CCBHCs have increased their capacity by an average of 33%, and increased their staff by a median of 22 positions. In addition, Medicaid status allows CCBHCs to expand their services - for example, 87% of Medicaid CCBHCs offer MOUD, compared to 64% of substance use disorder facilities nationwide.

We believe that California opting into the Medicaid demonstration would significantly benefit not only the existing CCBHCs, but the future of behavioral health access in California, and complement the current efforts of the Administration to enhance behavioral health care in the state.

CCBHCs can support the Proposition 1 goals to expand the behavioral health continuum, with a particular focus on people who are most seriously ill, vulnerable, or homeless. As a requirement, CCBHCs must serve everyone who walks in the door, regardless of their mental health diagnoses or ability to pay - and the PPS payment supports that cross-cutting care without siloing payment for different populations. This can complement the current Medi-Cal payment system for individuals with mental illness or substance use disorder. CCBHCs are also required to have formal agreements and partnerships with community-based organizations offering social services. Many CCBHCs specifically target outreach and supportive services to individuals experiencing or at risk of homelessness - 91% of CCBHCs proactively assist clients with finding or maintaining stable housing.

In addition, the CCBHC payment supports many of the activities California is pursing through CalAIM and other behavioral health reform initiatives. The PPS can adequately and flexibly cover care coordination; care management; transition of care; and Community Supports targeting social determinants of health including Housing Transition Navigation Services, Housing Tenancy and Sustaining Services, Respite Services, Day Habilitation Programs, Community Transition Services, Personal Care and Homemaker Services, Environmental Accessibility Adaptations, and Sobering Centers.

Finally, as California works to address the behavioral health workforce crisis, as mentioned, CCBHCs - especially those in the Medicaid demonstration - have increased workforce capacity. CCBHCs leverage the PPS to support a range of staffing positions, including nontraditional paraprofessionals and non-billable support staff. These staffing positions, not traditionally supported by Medicaid fee-for-service billing, can perform essential roles to support patients such as outreach and peer-to-peer counseling while freeing capacity for licensed clinicians.

Currently, the CCBHC Planning Grant opportunity is available to states to help them prepare an application to participate in a four-year CCBHC Demonstration program. While California is not required to receive a planning grant in this cycle to be eligible to apply for the demonstration, we believe that given the state's budgetary constraints, the infusion of targeted resources to support such a planning process may be beneficial. In addition, state associations representing CCBHCs such as the California Council of Community Behavioral Health Agencies (CBHA) and California Primary Care Association (CPCA) are ready and willing to support the state's efforts to plan the demonstration.

Even if California does not apply for the Planning Grant opportunity, we encourage the state to continue its evaluation of the Medicaid demonstration in advance of the next application opportunity.

We appreciate your attention to behavioral health in the state and continued efforts to innovate and improve care delivery for Californians. We look forward to working with you on this effort and invite you to reach out with any additional questions.

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