A Hybrid Funding and Coverage Model to Ensure Universal Access to Mobile Crisis Services
Patricia Boozang, Sabrina Corlette, Ashley Traube, and JoAnn Volk, Manatt Health and Georgetown University’s Center on Health Insurance Reforms
COVID-19, the resulting behavioral health crisis (including those related to mental health and substance use disorders), and calls for law enforcement reform related to behavioral health crisis response have heightened the urgency among federal, state, and local policymakers to expand access to behavioral health crisis services. Recently, the federal government has provided new funding opportunities to states to improve access to behavioral health crisis services, including mobile crisis services. The American Rescue Plan Act of 2021 (ARP) gives states the option of covering community mobile crisis intervention services in Medicaid for five years beginning in April 2022 (see here for additional information on the ARP mobile crisis option).
As states review the opportunities available to begin, enhance, or expand mobile crisis intervention services under ARP, policymakers may further consider a hybrid funding model that provides mobile crisis providers with a consistent and steady stream of funding to ensure they are able to maintain 24/7 availability and respond in a timely manner to all individuals in crisis, regardless of insurance status. Such a new model for funding mobile crisis services could also be designed to hold payers accountable for covering mobile crisis services when their enrolled members use this essential resource. This issue brief presents a sustainable, hybrid coverage and funding approach for mobile crisis services where mobile crisis providers would obtain:
A set amount or base funding that allows them to maintain continuous coverage; and
Third-party insurance reimbursement for services rendered to commercially covered individuals and Medicaid
enrollees.
As states are working diligently to operationalize the unwinding of the Medicaid continuous coverage requirement, State Health and Value Strategies has been tracking the creative strategies states are implementing to minimize coverage losses. This expert perspective highlights all the hard work states are engaged in and spotlights innovative strategies other states may want to consider adopting. SHVS will continue to track and share state efforts to support coverage through the unwinding period. If your state is implementing a new effort to reach enrollees, or if you have questions about how you can implement an example included in this EP, please be in touch.
The unwinding of the Medicaid continuous coverage requirement represents the largest nationwide coverage transition since the Affordable Care Act, with significant health equity implications. Given the intense focus on coverage transitions during the unwinding, some states are publishing their data to monitor progress. To date, 44 states (including the District of Columbia) have released unwinding data in either an interactive dashboard or static pdf format, or are making public their required CMS Monthly Unwinding Data reports. This expert perspective includes an interactive map with links to state dashboards and reports to CMS. SHVS will continue to update this EP as more states publish their unwinding data.
States are traditionally laboratories for policy innovation and the 2023 legislative session was no exception. The expansion of health coverage was a major priority for states, particularly for low-income populations, children, postpartum individuals and individuals of undocumented status. As the high cost of care continued to be a major barrier for consumers, states bolstered their efforts to enhance healthcare affordability. States also used the 2023 legislative session as an opportunity to study system innovations to expand health coverage and affordability. This expert perspective explores these trends in state healthcare policy reflected in innovative legislation enacted this year.
