In April of 2021, The Center for Law and Social Policy (CLASP) reported findings on the effectiveness of mobile responses – “an alternative to using law enforcement to respond to mental health and social crisis.” In December CLASP generated a letter (that CWLA joined onto) to CMS to support these efforts.
On December 28, 2021 HHS issued guidance and announced some planning grants ($15 million) to 20 State Medicaid Agencies for the purpose of developing a state plan amendment (SPA), section 1115 demonstration application, or section 1915(b) or 1915(c) waiver request to provide qualifying community-based mobile crisis intervention services.
Grants went to: Alabama, California, Colorado, Delaware, Kentucky, Massachusetts, Maryland, Maine, Missouri, Montana, North Carolina, New Mexico, Nevada, Oklahoma, Oregon, Pennsylvania, Utah, Vermont, Wisconsin and West Virginia.
Last March’s 2021 COVID-19 relief package gave CMS new authority to provide states with additional resources and tools to enhance these programs. According to HHS this new Medicaid option also offers flexibility for states to design programs “that work for their communities, allowing states to apply for this new option under several Medicaid authorities.”
Community-based mobile crisis intervention services include professional and paraprofessional staff who can respond quickly to crisis situations and provide individual assessment and crisis resolution. The Medicaid option is intended to expand access to behavioral health professionals as the initial contact for someone in crisis.
The CLASP report dissects successful mobile response systems in Connecticut, Oklahoma, and Oregon, and shares principles for implementation, funding opportunities, and recommendations for the federal government to get involved.
CLASP reports indicates that individuals with untreated mental illnesses are 16 times more likely to be
shot and killed by the police while one in four of all individuals who are incarcerated. Black people with a mental health diagnosis are more likely to be incarcerated than any other race. Currently many states mobile response systems are funded using multiple sources, including Medicaid 1915 (b) and (c) waivers.
Oklahoma’s Mobile Crisis Response and Stabilization service is funded with a combination of state and Medicaid dollars. This allows staff to be adequately compensated for their time and provides free services for clients. Oklahoma’s service is based on a continuum of care, so it offers follow-ups for non-hospitalized clients, services for individuals up to age 25, de-escalation, restoration to pre-crisis level of stabilization, and prevention services for homelessness, detention, and hospitalization.
Oregon enacted a similar program, CAHOOTS. Oregon has struggled to reach a state-wide level because of the lack of funding. Currently, Medicaid and city grants pay for funding in Springfield and Eugene, which provides de-escalation and homelessness services. From the services, both cities were able to save $15 million from ER diversion and visit high schools for prevention services. CAHOOTS struggles with outreach and funding, so it is at a standstill of services.
To access the Medicaid Guidance on Coverage and Reimbursement for Qualifying Community-Based Mobile Crisis Intervention Services, visit https://www.medicaid.gov/federal-policy-guidance/downloads/sho21008.pdf – PDF.