Certified Community Behavioral Health Clinics in Michigan: Expanding Access to Behavioral Health Services
The Michigan Certified Community Behavioral Health Clinic (CCBHC) Demonstration is an initiative designed to expand access to community behavioral health services and improve Medicaid reimbursement. Michigan joined the federal Demonstration on October 1, 2021, with 13 initial sites, following authorization by the CARES Act of 2020. The program was later extended to a six-year demonstration, set to end in September 2027, with an additional 17 sites added in October 2023.
CCBHCs are non-profit organizations or units of local government behavioral health authorities that provide comprehensive, integrated mental health and substance use disorder (SUD) services to anyone who seeks care, regardless of their diagnosis, insurance status, ability to pay, or residence.
The Michigan Department of Health and Human Services (MDHHS) contracted the Center for Health and Research Transformation (CHRT) to evaluate the Demonstration, with funding from the Michigan Health Endowment Fund (MHEF).
The evaluation’s primary goals are to understand implementation, measure the impact on expanding access for underserved populations, and inform the design for future statewide expansion and sustainability. The evaluation uses a mixed-methods approach that includes qualitative interviews, Medicaid administrative data (FY2018-FY2024), and patient experience surveys.
Key Findings
Key findings indicate a significant improvement in access to behavioral health care in Michigan, particularly for veterans and individuals with mild to moderate behavioral health needs.
-Screening, Assessment, and Diagnosis was the most utilized core service, while Outpatient Substance Use Services and Crisis Services also saw significant increases.
-CCBHCs demonstrated substantial growth across all core services, with a sixfold increase in unique individuals and an eightfold increase in services provided for Outpatient Substance Use Services.
-The removal of barriers related to insurance type and severity, along with a “no wrong door” approach, improved access and quality of care. The percentage of CCBHC-eligible individuals receiving core services increased from 78% in FY2021 to 85% in FY2024, with the largest growth observed during the initial demonstration rollout.
-The demonstration had a small but significant impact on all-cause Emergency Department (ED) utilization, with an overall decline of 2.4% after individuals received CCBHC services, though other impacts were mixed and warrant further monitoring.
Successful implementation factors included continuous quality improvement, effective data integration (Electronic Health Records and dashboards), and the importance of advocacy and flexible mindsets. However, challenges identified by CCBHCs and Pre-Paid Inpatient Health Plans (PIHPs) included staffing shortages, payment methodologies, a perceived lack of coordination among different behavioral health sectors, and the requirement for CCBHCs to provide 51% of services internally, which sometimes forced the discontinuation of established external partnerships. Concerns were also raised about the funding model’s ability to adequately reimburse services for the growing non-Medicaid population.
Read the full report for more detail on the findings, recommendations, and challenges.