Recent efforts to develop and improve behavioral health crisis response systems have been marked by several key federal initiatives. These include national guidelines for crisis care put forth by SAMHSA in 2020, an initiative for states to use Medicaid funding for mobile crisis services through the American Rescue Plan Act (ARPA) in 2021, and the 988 crisis line rollout in 2022. Most recently, the Consolidated Appropriations Act–passed in December 2022– included several provisions aimed at enhancing and evaluating the behavioral health crisis continuum. This surge in action has grown in light of longstandingand worsening behavioral health issues, tragic incidents involving law enforcement, and growing reports of psychiatric boarding in emergency departments (EDs).

Medicaid – the single largest payer of behavioral health services in the country – is particularly well positioned to partner with state behavioral health authorities and other stakeholders to plan, implement, and monitor the behavioral health crisis response systems.  Further, the Medicaid population may be particularly impacted by these changes, as 39% have mild, moderate, or severe mental health or substance use disorder conditions.

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