2023 Behavioral Health Crisis Prevention Platform
Marylanders should have access to culturally competent behavioral health care that promotes recovery and resiliency, outcomes should drive care delivery and efficient use of resources, and care should be available to all regardless of age, race, gender or insurance status.
Unfortunately, this is not currently the case. Two-thirds of Maryland’s counties qualify as federally designated mental health professional shortage areas, commercial health insurance companies in Maryland reimburse behavioral health providers nearly 20% less than other doctors for similar procedures, Maryland ranked 7th worst in the nation last year for opioid death rates, and the state has seen a 46% increase in children accessing hospital emergency departments for suicide attempts.
There are solutions. Community-based reforms and workforce initiatives can improve behavioral health outcomes, save money, and keep people out of crisis.
Download our 2023 Behavioral Health Crisis Prevention Platform One-Pager.
With the passage of each Equal Treatment Maryland 2023 Behavioral Health Crisis Prevention Platform priority, we have made great strides forward as a community to ensure all Marylanders have access to mental health and substance use care when and where needed. As implementation begins, we look forward to continuing this important work with advocates, providers, and consumers alike.
Our Goal: Take immediate action to address the surge in demand for community mental health and substance use care.
How we get there: Require the Maryland Department of Health to develop and advance a plan to expand the state’s network of Certified Community Behavioral Health Clinics (CCBHCs).
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Certified Community Behavioral Health Clinics (CCBHCs) are specially-designated, sustainably-financed, 24/7 clinics that provide a comprehensive range of integrated, evidence-based mental health and substance use services, including 24/7 crisis response and medication-assisted treatment (MAT).
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An inability to access community-based mental health and substance use care on demand results in heavy reliance on emergency departments, law enforcement, and Maryland’s limited behavioral health crisis response system.
States that have implemented CCBHCs broadly have seen increased access to care, reductions in emergency department and inpatient utilization, mitigation of behavioral health workforce challenges, higher engagement post discharge from hospitals, improved utilization of medication assisted treatment (MAT) for opioid use disorders, and improved integration with physical care.
Maryland currently has five CCBHCs demonstrating strong outcomes, but they are time-limited and only available to a small number of individuals.
The federal government has made $40 million available for planning grants and technical assistance to states for CCBHC expansion, and is providing four years of enhanced Medicaid match for CCBHC services.
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Maryland currently has very limited CCBHC coverage, with just a few programs funded by federal grants they applied for directly. These programs, however, are seeing similarly positive results. Sheppard Pratt’s CCBHC program, for example, has reduced hospital stays by nearly 50% and reduced the average per client emergency room visit cost by 80%.
SB 362 (passed) will build on this momentum to expand Maryland’s network of CCBHCs. The bill requires the Maryland Department of Health (MDH) to apply for both a federal CCBHC planning grant in FY25 and for inclusion in the CCBHC demonstration program in FY26.
Our Goal: Ensure Medicaid recipients have equitable access to effective primary care services that are available to Marylanders with commercial insurance or Medicare.
How we get there: Require Medicaid reimbursement for the Collaborative Care Model (CoCM).
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The Collaborative Care Model integrates behavioral health into primary care. It is an evidence-based approach that improves health outcomes and saves $6 for every $1 invested.
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Most individuals receive mental health and substance use care from primary care physicians, and need has grown exponentially in the wake of COVID-19.
Collaborative care is a validated, evidence-based approach that efficiently integrates physical and behavioral health in primary care settings and has been shown to save $6 in health care spending for every $1 invested.
80+ randomized trials have demonstrated CoCM’s effectiveness, and it is a covered service in the Medicare program and among most commercial health insurers.
Maryland Medicaid recipients continue to be unfairly denied access to this effective service delivery model, despite clinically significant improvement in depression and anxiety symptoms among the small number of individuals served by Maryland’s very limited Medicaid pilot.
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SB 101/HB 48 (passed) will unleash the potential of this model in Maryland by expanding CoCM coverage to Medicaid recipients. Already covered by Medicare and commercial health insurers, this new service expansion will incentivize primary care practices to offer CoCM broadly across their patient populations, ensuring this best practice in care integration is equitably available to all citizens in need.
Our Goal: Ensure workforce exists to accomplish service access goals.
How we get there: Establish a Behavioral Health Workforce Investment Fund and require a comprehensive behavioral health workforce assessment to inform fund allocation.
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Maryland has 63 federally designated mental health professional shortage areas, including 16 entire counties, and less than 20% of individuals in these areas are getting their mental health needs met.
Staff vacancies exist in over 80% of Maryland’s child-serving community behavioral health programs.
Recent high profile clinic closures, including Eastern Shore Psychological Services, will impact thousands of Marylanders with behavioral health needs.
Several jurisdictions across the country have established dedicated funding for pipeline development and retention strategies to support and expand the behavioral health workforce.
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SB 283/HB 418 (passed) creates an infrastructure and a process to answer and act on these questions. The bill establishes a Behavioral Health Workforce Investment Fund to reimburse for costs associated with educating, training, certifying, recruiting, placing, and retaining behavioral health professionals and paraprofessionals. Funding is left discretionary initially to allow for a workforce needs assessment that will:
(1) determine the immediate, intermediate, and long-term unmet need and capacity of Maryland’s behavioral health workforce;
(2) calculate the total number of behavioral health professionals and paraprofessionals needed over the next 5 years, 10 years, and 20 years; and
(3) make specific findings and recommendations regarding the types of workforce assistance programs and funding necessary to meet the need across all sectors of the behavioral health workforce.