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In many communities, behavioral health crisis response consists of a fragmentary array of services rather than a cohesive system. People experiencing acute crisis may touch several separate and often inappropriate systems — 911, first responders, hospital emergency departments, and even jails — without ever receiving adequate behavioral health treatment. Without a comprehensive crisis system, law enforcement personnel and first responders become the default primary responders even though they are frequently ill-equipped to stabilize the situation. Police interaction with people experiencing a behavioral health crisis — one related to mental illness or substance use disorder — increases the likelihood of traumatic and adverse outcomes, such as the person being arrested, handcuffed, imprisoned, involuntarily hospitalized, injured, or even killed.

Recent national legislation and federal investments provide opportunities for states to examine their current crisis services and create in their place a robust system of support for people in crisis. These new developments include:

• The National Suicide Hotline Designation Act of 2020 mandated a nationwide and easy-to-remember telephone number, 988, that will route calls through National Suicide Prevention Lifeline call centers across the country beginning in July 2022. The 988 line has the potential to create both a centralized access point and — with careful planning and expansion of services — a comprehensive crisis system.
• The American Rescue Plan Act of 2021 (ARPA) provides a state Medicaid option, through state plan amendment or waiver, for community mobile crisis intervention services for five years. ARPA incentivizes state participation with an 85% enhanced Federal Medical Assistance Percentage (FMAP) for the first three years of qualifying services, starting in April 2022. This legislation represents the first time federal law has recognized mobile crisis response as a specific and separate optional Medicaid benefit.
• The federal Substance Abuse and Mental Health Services Administration increased financial investments ($1.5 billion) in the Community Mental Health Services Block Grant and the Substance Abuse and Treatment Block Grant programs, with a $75 million set-aside for crisis services. States are required to dedicate at least 5% of the mental health block grant to the support of crisis systems for adults or children with behavioral health conditions.

Mobile Crisis Teams: A State Planning Guide for Medicaid-Financed Crisis Response Services offers a review of the requirements of ARPA related to community-based mobile crisis intervention services. It also identifies planning considerations for states in developing or refining mobile crisis services that qualify for the enhanced FMAP. While the primary focus is on mobile crisis, this guide also highlights state considerations that will support a more robust crisis continuum, including 988 planning. It was authored by TAC’s Jordan Gulley, LICSW; Francine Arienti, MA; Rebecca Boss, MA; Alicia Woodsby, MSW; and Vikki Wachino, MPP.

This paper is a companion piece to Federal Policy Recommendations to Support State Implementation of Medicaid-Funded Mobile Crisis Programs, which identifies important issues in mobile crisis implementation and describes ways that federal agencies could support state and local efforts.

Both papers were published with support from CHCF and the Charles and Lynn Schusterman Family Philanthropies.

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