Funding Strategies for County Behavioral Health Crisis Care
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America’s 3,069 counties are a cornerstone of the nation’s health systems, investing over $80 billion annually in community health, which includes crisis care services. County-based behavioral health programs operate in 23 states, serving 75 percent of the U.S. population. Counties also deliver Medicaid-eligible services and assist with bridging funding gaps in administering the program. By providing wrap-around human services supports such as housing assistance, employment services, and food security programs, counties strengthen crisis care and ensure timely community-based support for individuals facing mental health and substance use challenges.
County-based behavioral health programs operate in 23 states
America’s 3,069 counties are a cornerstone of the nation’s health systems, investing over $80 billion annually in community health, which includes crisis care services. County-based behavioral health programs operate in 23 states, serving 75 percent of the U.S. population. Counties also deliver Medicaid-eligible services and assist with bridging funding gaps in administering the program. By providing wrap-around human services supports such as housing assistance, employment services, and food security programs, counties strengthen crisis care and ensure timely community-based support for individuals facing mental health and substance use challenges.
Counties can leverage diverse funding streams and intergovernmental and cross-sector partners to improve coordination of care for individuals with mental illness and substance use disorders.
Primary Behavioral Health Funding Streams
Creative Funding Strategies
Counties across the country are developing innovative strategies to fund behavioral health care.
Blending occurs when financial resources from various funding streams are combined into a unified pool of commingled funds to support an initiative or acquire specific services.
Braiding combines multiple funding streams to provide specific services simultaneously, requiring interagency coordination and collaboration.
Sequencing organizes different sources of funding to separate and sequentially provide specific services.
Reducing Barriers
Counties are applying a variety of creative solutions to overcome barriers to behavioral health care funding.
Strategy
Counties can blend, braid and sequence various funding sources from federal, state and local governments, as well as private grants and donations.
County in Action
Missoula County, Mont. leverages funding from Montana's HB 872, which includes a historic $300 million investment in behavioral health and developmental disabilities service systems. This bill supports the Behavioral Health Systems for Future Generations initiative aimed at enhancing infrastructure, improving access to care, and ensuring long-term sustainability.
Strategy
Leverage state and federal funding sources, such as Medicaid, IMD waivers and opioid settlement funds to cover the cost of care while working to establish comprehensive insurance reimbursements through state, federal and private collaboration.
County in Action
Middlesex County, Mass., leverages the MassHealth Behavioral Health Initiative to fund Community Behavioral Health Centers (CBHCs) through a Medicaid 1115 demonstration waiver, which enhanced reimbursements for outpatient and crisis care. With this state tool, the county is further supporting expanded mobile crisis and preventive services, thereby reducing dependence on costly emergency and inpatient care.
Strategy
Encourage community involvement to increase awareness and support for behavioral health initiatives, which can result in additional funding through local fundraising efforts, non-profit or community organization resources and philanthropic donations.
County in Action
In 2022, The Leona M. and Harry B. Helmsley Charitable Trust awarded a $4 million grant to Pivot Point, the Pennington County (S.D.) Crisis Stabilization Unit to fund the first 36 months of operations in the new facility.
U.S. Department of Health and Human Services announces major restructuring
On March 27, the U.S. Department of Health and Human Services (HHS) announced a sweeping reorganization that will consolidate agencies, shift key programs under a new framework and eliminate thousands of positions. This change brings HHS in line with President Trump's Executive Order, “Implementing the President’s ‘Department of Government Efficiency’ Workforce Optimization Initiative.”
U.S. Department of Health and Human Services moves to reduce public comment in rulemaking
On February 28, the U.S. Department of Health and Human Services (HHS) announced a policy change limiting public comment opportunities to only those required by law. Published in the Federal Register on March 3, the decision rescinds the “Richardson Waiver,” a 1971 directive from then-HHS Secretary Elliot Richardson that encouraged broader public input on regulations related to public benefits, grants and healthcare policies.
U.S. Department of Health and Human Services renews Public Health Emergency Declaration to address national opioid crisis
On March 18, the U.S. Department of Health and Human Services (HHS), under the direction of Secretary Robert F. Kennedy, Jr. renewed the public health emergency (PHE) declaration to address the ongoing opioid crisis, extending critical federal support for coordination, treatment expansion and research efforts. While overdose deaths have declined by 25.5 percent over the past year, synthetic opioids like fentanyl continue to drive fatalities, with approximately 150 Americans dying daily from overdoses.
CMS announces extended funding application period to improve the continuity of care for justice-involved individuals
On September 27, the Centers for Medicare & Medicaid Services announced $106.5 million in state planning grants aimed at improving healthcare continuity for individuals transitioning from incarceration.
Panel: People in crisis need support, not handcuffs
Counties can better serve people experiencing a behavioral health crisis by engaging behavioral health specialists instead of law enforcement, experts told county officials at a recent meeting held at NACo headquarters.
HRSA Releases Final Reentry Care Guidelines Following NACo Input
On November 29, the Health Resources and Services Administration (HRSA) released their final Policy Information Notice (PIN) with policy guidance for health centers who support transitions in care for justice-involved individuals reentering their communities.
Supported Mothers, Thriving Children: Connecting Maternal Health and Child Wellbeing
Counties can significantly improve children's health and wellbeing by supporting maternal mental health through a variety of key strategies. In this webinar, speakers will explore examples of local policies and programs that bolster county efforts to holistically address child wellbeing through focusing on maternal mental health and substance use. Participants will gain insights into local options for addressing maternal mental health needs and substance misuse, learn about the challenges and triumphs experienced by county programs, and discover new opportunities to strengthen their local children’s health services.