In a May 10 informational bulletin, the Centers for Medicare and Medicaid Services (CMS) reviews Medicaid demonstration projects and additional ways to leverage Medicaid and the Children’s Health Insurance Program to improve mental health and substance use disorder (SUD) treatment services for individuals experiencing homelessness.
Certified Community Behavioral Health Clinic (CCBHC) Demonstration
The CCBHC demonstration promotes expansion of comprehensive services and supports in ambulatory clinic settings for Medicaid beneficiaries with mental health conditions or SUDs. CCBHCs must provide coordinated services, such as care coordination, and physical health care in addition to social services. CCBHCs can provide services in homes, public housing, and shelters, as well as through supportive housing programs. The program requires clinics to provide certain services for people with a mental health condition or SUD experiencing homelessness, such as outreach, targeted case management, and psychiatric rehabilitation services.
The 2022 Bipartisan Safer Communities Act extended and expanded the CCBHC demonstration. Currently, eight states participate in the demonstration, and 10 more will join in July 2024. States can receive an enhanced federal Medicaid match for services provided by community-based clinics to certain beneficiaries.
Section 1115 Demonstration for Improving Community Reentry following Incarceration
States can improve access to mental health and SUD treatment among individuals experiencing or at risk of homelessness through a Section 1115 demonstration to improve transitions out of incarceration, outlined in a 2023 state Medicaid director (SMD) letter.
Through this waiver, states can provide coverage of case management services, medications for all SUDs with counseling, and a 30-day supply of prescription medications upon release for individuals who soon will be formerly incarcerated. CMS has approved proposals for this demonstration in two states and is considering 16 additional state applications.
Addressing Health-Related Social Needs (HRSN)
CMS has released guidance on HRSN and a HRSN framework that review opportunities in Medicaid and CHIP to cover HRSN services linked to improved health outcomes for individuals with mental health conditions or SUDs experiencing homelessness. These include housing services and supports, such as housing transition services and case management.
States can also provide housing-related support services through managed care “in lieu of” services and settings (ILOS). Most recently, the departments of Health and Human Services and Housing and Urban Development announced the Housing and Services Partnership Accelerator, providing housing-related support and services, and care coordination under Medicaid authorities to individuals experiencing homelessness.
Section 1115 Demonstrations Focusing on Improving Treatment for SUDs
States can leverage Section 1115 demonstrations to improve access to the full continuum of care for SUD treatment, including short-term residential treatment and inpatient settings, as discussed in a 2017 SMD letter. States have added or expanded coverage of services focused on enrollees experiencing homelessness through supportive housing programs.
Section 1115 Demonstration Focusing on Improving Care for Individuals with Serious Mental Illness
States also can improve access to mental health outpatient services, intensive outpatient programs, and short-term services in specialized inpatient and residential treatment settings, as discussed in a 2018 SMD letter. Participating psychiatric hospitals and residential treatment settings are required to assess housing situations of individuals being discharged and connect them with community providers to coordinate housing services. States are updating programs to integrate supportive housing into treatment. Other states are updating their Medicaid provider manual or changing hospital licensing rules to ensure psychiatric hospitals assess housing needs during discharge planning.
Contact Director of Policy Rob Nelb, MPH, at rnelb@essentialhospitals.org or 202.585.0127 with questions.
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