Access to Care: A Legislative Call to Action

Nationally, May is Mental Health Month; but in Florida it is when the legislature is in session deciding on policy and budget, largely determining the health and wellbeing of our mental health system. Right now, that system is at risk. While every news source reports a growing mental health crisis that exceeds what is available, Florida’s legislature continues to under-resource care and allow valuable resources to languish. Industry experts, providers, and the media document the need repeatedly with little change.

Across the state, there are community behavioral health centers that daily provide crisis, counseling, psychiatric, residential, and other supportive services to those with mental illnesses and substance use disorders. They are accredited healthcare organizations that meet state, federal, and professional guidelines for quality. They often provide services for which neither insurers nor the state pay, and struggle to cobble together local, state, federal, and philanthropic funds to stabilize families and save lives. The state legislature for years has failed to recognize, maintain, or upgrade these precious community assets. Most people do not even realize that these resources exist in their community, or the breadth of what is available through them.

Despite lofty language in statute, Florida’s legislatures – past and present – have failed provide the funding needed to create and maintain a minimum continuum of care in every community and to ensure access for all who need care. Even core services – like crisis stabilization beds – are too often funded as “special projects,” using non-recurring state funds. Innovative or new practices are funded only occasionally and then only temporarily. Initially, the state made a substantial investment in these centers (largely with federal funds), but like any asset, continued improvement and upkeep is required. The legislatures’ approach to funding has provided neither.  

Local communities must then decide what critical or innovative services to fund, which most small and/or fiscally constrained counties cannot afford. Some are fortunate to have elected officials whose leadership roles in the Legislature boost the odds that special projects for their area will be funded, for at least a year with no guarantee of future support, regardless of the project’s merit or performance. Legislators often recognize the need but not that existing community behavioral health centers, assets in which they already have a substantial investment, can be leveraged to address new and growing need if they are adequately supported.

While acknowledging the need, Florida’s leaders need to build upon and enhance the existing community behavioral healthcare infrastructure. Other states have done this successfully by moving their existing system to the evidence-based Certified Community Behavioral Health Clinic, or “CCBHC” model. The federal government created the model in 2017, in 10 demonstration states with 66 clinics, designing it to align funding with clinical outcomes and local community needs. The centers meet quality, access, scope of service, and data collection standards but are paid an enhanced rate, like that received by the federal Community Health Centers that exist across the country. Since 2017, the CCBHC model has been expanded using grants to 340 clinics in 40 states, including 11 in Florida. The CCBHC model reinforces the value of existing community assets, and uses additional funding to enhance their scope, quality, and sustainability.

CCBHCs emphasize greater outreach into the community, and speedier patient access. They increase the number of people seen and the range of services, based on unique community needs. Crisis response and diversion of people from the criminal justice system and homeless population improve. Intensive collaboration and communication with other community resources is required. These centers also have a more stable and enhanced workforce.

Although the CCBHC expansion grants are time limited, states can implement the program through Medicaid waivers or dedicated funding. Florida has not expanded Medicaid, which elsewhere has been shown to improve outcomes and reduce unnecessary healthcare expenditures. Instead, Florida continues to pay 100% of the cost of many behavioral health services for those who are low income but ineligible for Medicaid, leaving many without care at all. Expanding Medicaid would allow the state share for many of those costs to drop to 10%, freeing up current state funds to implement CCBHC’s and also provide needed housing, social, and vocational supports.

In the current healthcare crisis, at a time when need is growing, investing in the existing community behavioral health infrastructure is the wise and right thing to do. The legislature should act now to expand Medicaid and require state agencies to develop a plan for reinvesting the savings to implement the CCBHC model statewide, leveraging its most valuable behavioral healthcare asset, its existing community behavioral health centers.