The Certified Community Behavioral Health Clinic (CCBHC) model has helped thousands of Michiganders achieve successful whole-person healthcare outcomes. Professionals who work with CCBHCs discussed their impact on the state during the 2023 Michigan State of Reform Health Policy Conference.
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The Michigan Department of Health and Human Services’ (MDHHS) request to become a CCBHC demonstration state was approved by CMS in 2020. The demonstration provides whole-person care by integrating patients’ physical health with behavioral health and substance use disorder services to residents regardless of their income or insurance coverage.
Lindsey Naeyaert, state administrative manager at MDHHS, said the demonstration served over 53,000 unique individuals between Oct. 1st, 2021—when the demonstration began—through September 2022. Of those people, 77% were adults on Medicaid, while 24% were children under 18.
“The portion of children that did not have Medicaid was higher than the percentage of children that did have Medicaid,” Naeyaert said. “So we are seeing that children without Medicaid are really coming in to get services at CCBHCs, which is telling in terms of improving access.”
Naeyaert said 7.7% of the individuals without Medicaid coverage seen by CCBHCs came from a different county than where the CCBHC was located.
“And that’s compared to only 1% of folks who saw a CCBHC that lived in the county with a CCBHC,” she said. “So we’re seeing that non-Medicaid folks are traveling to CCBHC locations to get services.”
There are 13 behavioral health service providers participating in the demonstration program, serving 16 Michigan counties.
“Our next steps are continuing to improve and monitoring our oversight at our current sites to implement the new CCBHC criteria that CMS just released,” she said. “And we’re really focused on our demonstration expansion, which we announced in April, to expand CCBHC to more sites starting in October.”
Panelists also discussed Michigan’s Integrated Health Homes for Medicaid beneficiaries. The program allows the state to develop innovative, integrative, and sustainable care management/coordination programs for high-need, high-cost Medicaid beneficiaries with chronic health conditions. Michigan has two integrated health homes for the specialty behavioral health population—Behavioral Health Homes for serious mental illness, and Opioid Health Homes for opioid use disorders.
“We’ve seen enrollment picking up in the last year because providers are able to shift their priorities from COVID to other things,” Naeyaert said. “We’re still looking at our outcomes for Behavioral Health Homes, but we are seeing some promising things.”
Tracy Andrews, director of managed and integrated care services at Northern Lakes Community Mental Health Authority, said Northern Lakes was one of the pilot programs for the Health Homes initiative in 2014. Following the program’s expansion in 2020, Northern Lakes now serves six counties, she said.
“The intent of Health Homes was to meet people with a specific eligibility criteria to assist them in achieving better health outcomes,” Andrews said. “It’s a little bit of a wraparound because we’re not providing a direct service. But we’re assisting them with their physical health needs, their natural healthcare needs, and social determinants of health (SDOH).”
Northern Lakes also helps patients with transitional care, Andrews said.
“If someone is coming out of the hospital, we’ll do a follow-up with them within a few days of them being discharged from the hospital, whether it be for acute care or inpatient mental health services,” she said. “If they’re coming out of the hospital, and have increased physical needs, we’ll make sure the location or home they’re returning to is a safe environment. And provide that extra level of care and support, and make sure they have transportation to their follow-up appointments.”
Four of the six counties Northern Lakes serves are in rural areas, Andrews said.
“So many of our challenges include just identifying providers,” she said. “Part of our focus had to be on identifying people who had serious SDOH needs so we could help their health by helping them improve their life situation. Just identifying those folks was a bit tricky. In year two, we were fortunate to be able to take advantage of some of the COVID grant funds that were available. We were able to build up our staffing, and hire staff who were dedicated to this program.”
Washtenaw County Community Mental Health Executive Director Trish Cortes said the county’s program utilizes peer support services to help patients.
“Those peers really focus on physical health issues,” Cortes said. “They do walking groups and go to grocery stores [for patients]. In our Health Homes program, we use peers in that function.”