Expansion of Certified Community Behavioral Health Clinics Increases Access to Mental Health

These federally funded clinics, which provide comprehensive care regardless of ability to pay, have expanded rapidly since their inception in 2016.

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The expansion of Certified Community Behavioral Health Clinics (CCBHCs) is significantly improving access to mental health and substance use disorder care across the United States, with more than half of the US population now living within a CCBHC service area.¹ These federally funded clinics, which provide comprehensive care regardless of ability to pay, have expanded rapidly since their inception in 2016, with geographic reach growing from just 1.53% of counties to nearly 40% by June 2024.

There are 2 types of CCBHCs: Medicaid CCBHCs, which receive bundled payments through Medicaid, and expansion CCBHCs, which rely on federal grants from the Substance Abuse and Mental Health Services Administration (SAMHSA). Both types aim to expand care access, although they are funded through different mechanisms. In addition to these funding streams, non-Medicaid CCBHCs may receive Medicaid reimbursements through alternative payment models.

The federal government has made significant investments to expand the CCBHC model, with over $1.7 billion allocated for expansion grants and an estimated $8.5 billion earmarked for CCBHC Medicaid payments between 2022 and 2032. These investments are part of a larger strategy to increase the number of CCBHCs nationwide and improve behavioral health service availability across a diverse range of geographic regions.

Despite this progress, disparities in access remain, particularly in rural and underserved areas, highlighting the need for continued efforts to ensure equitable availability of these critical services.

Earlier research analyzing the geographic distribution of CCBHCs found that population density is a stronger predictor of CCBHC presence than poverty rates or mental illness prevalence.² Counties with higher population density were 28 percentage points more likely to have a CCBHC than the most rural counties. Expanding CCBHC services to rural areas may require changes to current funding and certification processes, such as increasing infrastructure support or streamlining certification requirements to enhance access in underserved regions.

However, the extent to which this expansion reaches different parts of the country remained unclear until this recent study.¹ Investigators conducted a longitudinal study to analyze the distribution and growth of CCBHC service areas across the US, tracking the availability of CCBHCs from when the first clinics opened in October 2016 through June 2024. This study aimed to measure the proportion of US counties and populations within the service areas of both Medicaid and expansion CCBHCs to better understand the geographic reach and impact of these clinics.

Using county-level service area data from various government sources, including the National Council for Mental Wellbeing (NCMW) and the SAMHSA Grants Dashboard, researchers compiled an exhaustive data set of CCBHC service areas. Medicaid CCBHCs were identified in the 12 states where CMS had approved Medicaid bundled payments during the study period. Expansion CCBHCs, funded through SAMHSA grants, were tracked through both primary and secondary sources to determine their service areas over time.

The data set captured the presence of CCBHCs at the county level, offering insight into how CCBHCs are distributed geographically and how their reach has expanded since the program’s inception.

By June 2024, 55.66% of the US population lived within a CCBHC service area, a significant increase from the program's early years. In contrast, only 1.99% of the US population was within a Medicaid CCBHC service area when the first clinics opened in October 2016. By June 2024, that figure had grown to 26.63%, reflecting the expansion of Medicaid CCBHCs over time. Meanwhile, expansion CCBHCs served 53.93% of the US population by June 2024, a notable increase from the 13.36% recorded when the first expansion grants were awarded in September 2018.

Geographically, 39.43% of counties were covered by CCBHCs in some capacity by June 2024. This marked a considerable improvement over the initial 1.53% of counties served in 2016. However, the study found significant geographic variation in CCBHC availability. While some states, such as New York, Missouri, and Oregon, saw widespread implementation, other areas remained underserved.

The study stated that the rapid growth of CCBHCs highlights the success of federal investments in expanding behavioral health services. The increase in both Medicaid and the expansion of CCBHCs has enhanced access to critical mental health and substance use disorder care for millions of Americans. However, the study also underscores the continued need for targeted efforts to reduce geographic disparities in CCBHC availability.

While this study did not directly measure the number of patients served by CCBHCs, it used county-level service areas as a proxy for geographic reach, a limitation acknowledged by the authors.

As the federal government continues to invest in the expansion of CCBHCs, particularly through Medicaid, ongoing research will be essential to monitor the impact of these clinics on health outcomes and to ensure that underserved populations are reached effectively.

References

1. Mauri AI, Xiang N, Adams DR, Purtle J. Proportion of US counties and population served by Certified Community Behavioral Health Clinics. JAMA Health Forum. 2024;5(10):e243001. doi:10.1001/jamahealthforum.2024.3001

2. Frank RG, Paris J. Investing in Certified Community Behavioral Health Centers to fulfill their promise. Psychiatric Services. 2024;75(3):268-274. doi:10.1176/appi.ps.20230037