Section 223 Medicaid CCBHC Demonstration and State Programs
Starting in 2017, 67 CCBHCs were established in eight states through the Section 223 CCBHC Medicaid Demonstration (Demonstration). These CCBHCs are certified by their states as being in compliance with the CCBHC Certification Criteria and are reimbursed via a prospective payment system (PPS) for 9 required services defined in the criteria. The prospective payment system provides cost-based reimbursement for the nine required CCBHC services. You can learn more about the CCBHC PPS on the Centers for Medicare & Medicare Services website. CCBHCs in state Demonstration programs may also receive SAMHSA expansion grants. In 2019, Pennsylvania withdrew from the Demonstration and in 2023 Nevada moved their CCBHC program out of the Demonstration in made it a permanent part of their state Medicaid program.
In order for states to join the demonstration, they must first complete a SAMHSA planning grant. The CCBHC planning phase assists states in certifying clinics as CCBHCs, establish prospective payment systems for Medicaid reimbursable services, and prepare an application to participate in a four-year demonstration program. The first round of 24 SAMHSA state planning grants was awarded in 2015. Another round of 15 grants was funded in 2023, and SAMHSA anticipates funding an additional round of planning grants in 2025.
Independent State Programs
Independent state programs are CCBHCs funded through state Medicaid programs which are separate from the Section 223 CCBHC Demonstration. These states use a Medicaid state plan or section 1115 demonstration authority, not the Section 223 CCBHC Demonstration, to define the CCBHC array of services and payments for CCBHC services. These CCBHCs are subject to state oversight through their Medicaid programs and may also receive SAMHSA expansion grants.
Map of CCBHCs Across the United States*
*Current as of March 6, 2023.
Currently, there are over 500 CCBHCs operating across the country, as either CCBHC-E grantees, as clinics participating in their states’ Medicaid demonstration, or as a part of independent state CCBHC programs.
Federal CCBHC Medicaid Demonstration (And SAMHSA Expansion Grants)
State contains at least one local SAMHSA expansion grantee
CMS-approved payment method for CCBHCs via a SPA or 1115 waiver separate from Demonstration
2026 CCBHC Compliance Checklist (PDF | 947 KB): The updated CCBHC Compliance Checklist helps states to ensure CCBHCs meet the required criteria. States use this checklist when they apply for the Section 223 CCBHC Demonstration Program and when they request to add new CCBHCs to their Demonstration.
2026 Updated Guidance on Addition of CCBHCs to Section 223 State Demonstration Programs (PDF | 206 KB): States participating in the Section 223 Protecting Access to Medicare Act of 2014 CCBHC Demonstration Program are permitted, effective July 15, 2024, to add new CCBHCs to their Demonstration Programs at the beginning of any fiscal quarter during state’s Demonstration Year. This updated guidance helps states understand what information they need to submit with their request
2026 Demonstration Application (PDF | 677 KB): The 2026 Demonstration Application is used by eligible states to apply for participation in the CCBHC Demonstration. Applications are due on April 1, 2026.
Guidance for Reporting Changes in State CCBHC Demonstration Program (PDF | 215 KB): Beginning in 2026, states participating in the Section 223 CCHC Demonstration Program are required to inform SAMHSA when changes that deviate from the originally submitted application are made to the state’s CCBHC Demonstration. This guidance helps states understand which changes must be reported, how to report changes, and when changes should be reported.