CMH director outlines how Medicaid managed care and CCBHC grants create fiscal risk

CMH leadership and counsel presented technical details Nov. 21 about how Medicaid managed care, regional payment formulas and recent CCBHC (Certified Community Behavioral Health Clinic) demonstration grants create exposure for county-run CMH programs.

The CMH director said the behavioral Medicaid program provided roughly $52 million last year in regional payments and that the funding model allocates money by the number and type of Medicaid beneficiaries rather than by local need. "We have some clients that cost between 300,000 and $1,000,000 a year because of that," the director told commissioners when explaining why entitlement-based costs can quickly strain county budgets. Presenters also warned that the LRE/ISF backup funds that previously smoothed deficits in some years could be exhausted and that CCBHC grants come without a reserve, increasing near-term risk.

CMH staff recommended a detailed impact analysis and public hearings focused on options (including dropping CCBHC participation, maintaining status quo, or forming a county authority). They emphasized that an authority structure is intended to preserve local services while reducing direct liability to the county general fund, not to increase total Medicaid funding.