One of the comprehensive funding bills for the federal government enacted in recent weeks, the Consolidated Appropriations Act 2024 (Pub. L. No. 118-122), contains a provision that creates a permanent State plan option for Medicaid agencies to implement the certified community behavioral health clinic (CCBHC) program.

The Medicaid CCBHC program provides support for safety-net outpatient behavioral health clinics that provide a wide variety of mental health and substance use disorder services and serve all individuals who need services, regardless of ability to pay. Currently, the program exists in two forms: a Medicaid demonstration program, and individual grants that Congress has authorized for the Substance Use and Mental Health Services Administration (SAMHSA) to award to individual entities to carry out the CCBHC project.

The CCBHC Medicaid demonstration, originally authorized in the Protecting Access to Medicare Act (PAMA) of 2014, is limited both in the number of states that may participate, and in duration. Only eight states currently operate a CCBHC demonstration. Congressional enactments subsequent to PAMA—most recently, the Bipartisan Safer Communities Act (BSCA) of 2022—have both expanded the number of states that the Department of Health and Human Services (HHS) may select to participate, and extended the duration of the demonstration. As a result of the BSCA, HHS is currently in the process of selecting 10 additional states to launch a CCBHC demonstration this year. Nonetheless, the fact that the CCBHC demonstration is a time-limited opportunity, and is not uniform across the US, has created uncertainty as to the long-term role of CCBHCs in Medicaid.

The new legislation, contained in Division G, Section 209 of CAA 2024, would add CCBHC services to the scope of services included in “medical assistance” under the Social Security Act (Section 1905(a)), as an optional service. This means that States could carry out the program without the concern of it being time-limited. Under the legislation, State plan CCBHC services will be comprised of the same nine services that CCBHCs offer under the Medicaid demonstration, and the CCBHCs would be selected by the same mechanism currently used: States “certifying” individual clinics, by applying program criteria developed by HHS.

It is worth noting that while the CCBHC Medicaid demonstration qualifies for enhanced federal match (a federal medical assistance percentage (FMAP) equal to about 85 percent), the new state plan CCBHC services will be eligible for only the standard federal participation.

More than any of the prior CCBHC-related legislation, which merely extended and expanded the original demonstration concept, the CAA 2024 provision reflects a permanent role for CCBHCs in the Medicaid program.

If you have any questions regarding the CCBHC Medicaid program, please contact Susannah Vance Gopalan at 202.466.8960 or sgopalan@feldesman.com.