In response, new federal funds through the American Rescue Plan Act (ARPA) are available to states to help expand and modernize the full continuum of crisis services so that individuals can be assessed, triaged, and diverted away from higher levels of care — including hospitalization, incarceration, and involuntary commitment. These resources include:

• Section 9813 of the ARPA, which provides an enhanced federal medical assistance percentage (FMAP) rate of 85% for a new state Medicaid plan option to deliver team-based, mobile crisis intervention services.
• ARPA planning grants through the Centers for Medicare and Medicaid Services (CMS) for state Medicaid agencies to consider how to develop mobile crisis intervention service-specific state plan amendments, section 1115 demonstration applications, or 1915(b) or (c) waiver requests. The recipient states of these planning grants now have additional capacity to do this work.
• Section 9817 of the ARPA provides states with a temporary 10 percent increase to the federal medical assistance percentage (FMAP) for qualifying home and community-based services (HCBS). States may choose to use this FMAP increase to enhance their crisis service systems, including implementing 988 hotlines, increasing mobile crisis response capacity, and standing up crisis stabilization units. Most states have also been awarded 988 state planning grants by the Substance Abuse and Mental Health Services Administration (SAMHSA) to assist with the planning and rollout of the national hotline in July 2022.
• Section 2713 of the ARPA, which allocates an additional $420 million in expansion grants for the certified community behavioral health clinic (CCBHC) model of care, which seeks to increase access to integrated, community-based substance use and mental health services and sustainably reimburse for these services.

In considering how to leverage these funds, the majority of which are time-limited, the challenge for states is in aligning these opportunities to build crisis capacity into existing systems and policy landscapes. Key considerations for state policy makers include:

• Maximizing and aligning Medicaid and other funding sources: Georgia is maximizing its Medicaid dollars by using Medicaid Administrative Funding, along with state funds, to cover the cost of its behavioral health crisis line, mobile crisis response, and peer-run respite services.
• Sustaining new crisis capacity: Given the time-limited nature of these funds, states will need to find sustainable funding sources to maintain newly developed infrastructure. States can look to the Model Bill for Core State Behavioral Health Crisis Services Systems when considering how to efficiently implement the federally mandated 988 crisis hotline system.
• Providing crisis services in rural areas: Delivering crisis services in rural areas can prove particularly challenging, as it is challenging to attract and retain providers, and transportation over long distances presents a significant access barrier. Co-responder models that utilize telehealth to connect the person in crisis with a mental health professional, like Missouri’s Virtual-Mobile Crisis Intervention program, can help states extend their behavioral health workforce to hard-to-reach clients.
• Addressing endemic workforce challenges: Leveraging non-licensed workforce, such as peers and community health workers, is one strategy to help to alleviate acute workforce shortages. Staffers working New Mexico’s statewide Peer-to-Peer Warmline offer callers both peer and clinician services and triage accordingly. Further, states can continue investing in telehealth infrastructure and payment policy to help alleviate pressures on existing clinical staff. Enhanced federal HCBS funds also offer an opportunity for states to provide reimbursement increases and other supports to recruit and retain workforce.
• Sharing data: Arizona’s Crisis Response Network (CRN), one of several organizations in the state that works with community-based providers to offer 24/7 mobile teams-based crisis services, supports a public-facing data dashboard. The dashboard shares call volume and mobile team dispatch, top geographic regions served, and how the call was resolved.
• Investing strategically: Alabama established three Crisis Centers at community mental health centers in 2021 and has funded a fourth and fifth center in FY 2022 and 2023, respectively. The state will transition all Crisis Centers to the CCBHC model to ensure the sustainability of these services over time.

Conclusion

As part of its State Policy Academy on Rural Mental Health Crisis Services, NASHP is currently working with five state teams to support their work to improve rural crisis response systems. Stay tuned for more NASHP resources as we continue to work with these states over the course of the next nine months.