The Certified Community Behavioral Health Clinic (CCBHC) model represents one of the nation’s most ambitious and strategic investments in behavioral health care. By offering comprehensive services ranging from mental health crisis intervention and screenings to substance use disorder (SUD) treatment and psychiatric rehabilitation, CCBHCs aim to close gaps in care and improve outcomes for communities that need it most. Originally launched under the Protecting Access to Medicare Act of 2014, CCBHCs began as a pilot program in eight states in 2017. Today, with the recent passage of the Bipartisan Safer Communities Act, the model is on the verge of nationwide CCBHC expansion, offering new opportunities to strengthen behavioral health services across the U.S.
According to Kristan McIntosh, a principal at Health Management Associates (HMA), the Bipartisan Safer Communities Act not only extends the existing CCBHC Medicaid demonstration program for current participants but also allows new states to apply to join. “That’s very exciting,” McIntosh said during a recent webinar. The CCBHC landscape now consists of three primary types: original demonstration programs, state-run initiatives, and nonprofit-operated clinics supported through CCBHC expansion grants. Beginning this fall, states that were not part of the original eight-state demonstration can apply for planning grants. Those selected can later participate in a 10-state demonstration starting in July 2024. While current demonstration states aren’t eligible for the new planning grants, officials from SAMHSA and the Centers for Medicare & Medicaid Services (CMS) have indicated that these states can continue expanding their CCBHCs under the existing model, further supporting nationwide CCBHC expansion.
The Rapid Growth of CCBHCs Across the U.S.
The expansion of CCBHCs over the past several years has been remarkable, signaling widespread recognition of the model’s effectiveness. In 2017, the program started modestly with 66 certified clinics across the original demonstration states. By 2018, that number rose to 101, and by 2019, it reached 113.
The model truly began to scale in 2020, nearly doubling the number of clinics to 224. Growth continued in 2021, with 430 CCBHCs operational across the nation. Today, there are over 500 clinics, with North Dakota, South Dakota, South Carolina, and Virginia still lacking programs. Puerto Rico and Washington, D.C., also host CCBHCs, demonstrating the model’s reach beyond the 50 states.
Rebecca Farley-David, senior advisor at the National Council for Mental Wellbeing, emphasized that “nearly every state around the nation either has at least one CCBHC grantee or has implemented or is considering implementing the model as part of their state Medicaid program.” With the Bipartisan Safer Communities Act providing additional support and funding, the number of CCBHCs is expected to continue growing in 2023 and beyond. The ongoing CCBHC expansion is fueled by promising results from early demonstrations, broad policy support, and a growing national demand for integrated behavioral health services. The only major constraint limiting further growth is workforce shortages—a challenge impacting all sectors of health care. Amy Kanouse, a CCBHC expert, explained that recruiting and retaining qualified staff is a persistent barrier, limiting clinics’ capacity to serve patients fully and deliver the comprehensive services the model requires.
Michigan and New York: Lessons from the Ground
Examining the experiences of Michigan and New York provides insight into both the opportunities and challenges of implementing CCBHCs at the state level. Michigan, initially overlooked in the original eight-state pilot, officially joined the program in August 2020. The state has worked to expand access to care, integrate services, and prioritize patient-centered approaches, including peer-led programs and youth-and-family involvement. Lindsey Naeyaert, a behavioral health innovation specialist with Michigan’s Department of Health and Human Services, described how the CCBHC expansion has enhanced the state’s behavioral health system by layering new services onto existing initiatives and emphasizing patient-driven care.
New York, which launched its CCBHC demonstration in July 2017, has also experienced significant improvements. According to Bob Blaauw, program manager for New York’s CCBHC project team, and Nicole Haggerty of the state’s Office of Mental Health, the model has enhanced rapid access to care, integrated behavioral and physical health services, and improved outcomes for individuals with comorbid conditions. Haggerty noted, “CCBHC really aligns with our overall efforts to improve integrated care… improving rapid access to care so that individuals get what they need, when they need it—right away.”
Both states illustrate how the CCBHC expansion goes beyond merely adding clinics. It fosters a culture of patient-centered care, prioritizes peer-led initiatives, and strengthens collaboration across the health care system. Michigan’s experience also highlights how the CCBHC model can elevate previously successful strategies, ensuring broader access and more holistic support for individuals and families.
Overcoming Implementation Challenges
While the CCBHC model has proven successful, implementing it is not without obstacles. Workforce shortages remain a significant challenge, affecting the ability to recruit and retain clinicians, case managers, and peer support specialists. Staffing issues can directly impact a clinic’s ability to meet patient demand and provide the full spectrum of required services.
Other challenges involve integrating new clinics into state Medicaid systems and establishing operational procedures quickly. Blaauw noted that determining provider rates under a new model was a major undertaking in New York, requiring detailed calculations of service volumes, costs, and reimbursement structures. Similarly, Naeyaert emphasized the complexity of connecting all aspects of Medicaid contracting to ensure the model’s sustainability and success. Despite these hurdles, the CCBHC expansion continues to show measurable benefits, improving care quality, expanding access, and enhancing integrated service delivery.
The Future of CCBHCs
From a small eight-state pilot with 66 clinics to over 500 operational sites nationwide, the CCBHC model has become a cornerstone of behavioral health care in the United States. Its rapid expansion demonstrates the growing recognition of the importance of accessible, integrated, and patient-centered services. The Bipartisan Safer Communities Act and ongoing federal support will likely accelerate CCBHC expansion further, creating more opportunities for states, providers, and communities to benefit from this innovative model.
As CCBHCs continue to evolve, their focus on rapid access, integrated care, and patient-driven services will remain central to their mission. With continued investment, policy support, and workforce development, the CCBHC expansion is set to transform the behavioral health landscape, ensuring that individuals and families across the nation receive the care they need, when they need it.
