Statewide CCBHC model would facilitate whole-person care in Washington, advocates say


Shane Ersland


Washington certified community behavioral health clinic (CCBHC) representatives believe the model can provide stability for a US mental health system that has faced numerous challenges over the past several decades. They discussed the benefits CCBHCs offer at the 2024 Washington State of Reform Health Policy Conference.

Washington Council for Behavioral Health CEO Joan Miller said the state’s mental health providers face three primary challenges, regardless of their location or size. They include decades of underfunding for care, a workforce shortage combined with an unprecedented demand for services, and Medicaid reimbursement rates that don’t adequately cover the cost of care. 

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The 1981 federal Omnibus Budget Reconciliation Act reduced the capacity of the Mental Health Systems Act to provide services to those in need. This decimated the community behavioral health side of the public safety net system, Miller said. The act established Social Services Block Grants (SSBGs), allowing the federal government to allocate funds for states to support social services for those in need. But states have broad discretion in the services they support with SSBG funding.

“Funding was block-granted from the state, and we lost our federally-qualified status and our federal definition, which resulted in a dramatic reduction in funding,” Miller said. “We also lost the stream of federal funding for the uninsured and underinsured populations. But we were still required by Medicaid to serve anyone who walked in the door. So after 1981, we had the mandate but not the funding, and the community behavioral health system has been playing catchup ever since.”

The CCBHC model is designed to ensure everyone has access to quality behavioral healthcare, regardless of their ability to pay, their age, or their diagnosis, Miller said. 

“Providers can tailor services to what their community needs are. The CCBHC model is also paired with a prospective payment system (PPS) financing methodology, which is very similar to the (one federally qualified health systems) are reimbursed (for). PPS enables clinics to anticipate their future costs to deliver services required by the CCBHC model, and therefore get paid for the true cost of care. That PPS methodology gives providers the financial flexibility to think innovatively and creatively, and increase access to care for people they serve.”

— Miller

Compass Health CEO Tom Sebastian—a member of Fourfront Contributor—said the CCBHC model gives Washington an opportunity for a needed behavioral health system change. A statewide CCBHC model would help improve access to care, Sebastian said.

“We need a complete system transformation in Washington in order to truly advance that,” Sebastian said. “We are making progress. But the truth is that we still do not have our doors open to the community in the way we need to.”

A statewide CCBHC model would also address the fragmentation of the behavioral health system, Sebastian said. 

“We need to transform the system so that any door any community member comes through is able to respond to what all their needs are,” he said. “That doesn’t mean we, as providers, do all those things ourselves. It means we have solid, clear protocols in place with partners to provide ready access to whatever those needs might be of those that come to us for care. That’s whole-person care.”

The current community behavioral health system, as it is constructed, does not facilitate that type of care, Sebastian said. 

“We do not have the same standards. We do not have the quality outcomes we’re working towards. We don’t have any of those pieces in place. Fundamentally, what we’re doing now is providing a lot of services we can’t get reimbursed for. So we’ve got to move money over from other things we do in order to support care coordination and some of the other things that are critical for those we’re serving.”

— Sebastian

Sound Health CEO Katrina Egner—another Fourfront Contributor member—said the CCBHC model reduces barriers to care for people who need it. 

“We’ve invested a lot of grant money in infrastructure, increasing staff at the front door, increasing peers who can do engagement work with the clients as soon as they walk in, (and) nurse care managers,” Egner said. “All of those things that, when people walk in, they get engaged and connected right away. [We’ve been] using our community needs assessment, which you have to do for the [CCBHC] application, to figure out where the gaps in services are. 

When we did our community needs assessment on the east side, we found a large need in the LGBTQ, BIPOC, and veterans populations. The whole idea of CCBHCs is it’s less about warm handoffs, and really about letting people walk in and, even if they go to a different provider, they wouldn’t really know there was a seam in that care.”

Approximately 2.1 million people are currently being served through some sort of CCBHC grant or agency, Egner said. 

“And they’re finding that once you start this and see it through, on average, clinics have about 900 more people throughout the process,” she said. “So they’re gaining clients. They’re also recruiting and retaining staff in a more sustainable way. They’re [health] outcomes are better, access is better. But what I find amazing is that they found a 72 percent reduction in hospitalization, a 40 percent decrease in homelessness, and 60 percent less jail time. The data speaks for itself. There’s agencies that have been doing this since 2016 in Kansas, Missouri, and some of those states in that first bucket. From the first year of having a grant, and being new, to those who have been doing it a long time, the model has proven to work and it’s getting a lot of momentum across the country.”

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