The CCBHC Demonstration and How States Certify Clinics

A certified community behavioral health clinic (CCBHC) is a clinic that meets SAMHSA's certification criteria and is recognized as one by its state or, for grant-funded clinics, by SAMHSA. The label matters because of what it unlocks: in states that take part in the federal demonstration, certified clinics are paid through a prospective payment system that SAMHSA describes as providing "cost-based reimbursement for the nine required CCBHC services."

A clinic cannot sign itself up. SAMHSA's FAQ is explicit that only formal demonstration members receive the demonstration payment: "your state must be a selected Demonstration participant and ... you (the CCBHC) have been selected by your state and certified by your state." That makes the state's choices the first thing to understand.

Are there different routes to CCBHC funding?

• The Section 223 Medicaid demonstration. Created by Section 223 of the Protecting Access to Medicare Act of 2014. States apply to SAMHSA and CMS; selected states certify clinics and pay them through the prospective payment system. CMS oversees the payment rules and cost reports.
• Independent state programs. States outside the demonstration, or alongside it, can define a CCBHC service array and payment in their Medicaid state plan or under section 1115 authority. SAMHSA notes these clinics are subject to state oversight through Medicaid. CMS approved Missouri's CCBHC state plan change in 2019, the first, and Kansas's outside the demonstration in 2022.
• SAMHSA CCBHC Expansion grants. Grants paid directly to providers. A grantee submits an attestation to SAMHSA and is designated a CCBHC only during the period it is authorized to receive the federal funding (2023 criteria, 6.c.2). SAMHSA encourages grantees in certifying states to seek state certification too.

SAMHSA says more than 500 CCBHCs now operate across these routes.

Which states joined, and when?

SAMHSA's history page sets out the timeline:

• 2015: SAMHSA and CMS released the first certification criteria and payment guidance, and SAMHSA awarded planning grants to 24 states.
• December 2016: eight states were selected: Minnesota, Missouri, Nevada, New Jersey, New York, Oklahoma, Oregon and Pennsylvania. Their demonstrations began in 2017 with 67 clinics. Texas began its own state-led effort the same year.
• 2019: Pennsylvania withdrew. Congress extended the original demonstration.
• 2020: Congress added Michigan and Kentucky.
• 2022: the Bipartisan Safer Communities Act allowed up to 10 more states to join every two years.
• 2023: SAMHSA released the updated certification criteria, and Nevada moved its program out of the demonstration into its permanent Medicaid program.
• 2024: ten more states joined: Alabama, Illinois, Iowa, Indiana, Kansas, Maine, New Hampshire, New Mexico, Rhode Island and Vermont. CMS issued updated payment guidance, and the Consolidated Appropriations Act created a permanent state option for CCBHC services in Medicaid.

Is another round of states coming?

SAMHSA's Section 223 page posts a 2026 Demonstration Application for eligible states, with applications due April 1, 2026, and its CCBHC map marks states approved to launch demonstration programs starting July 1, 2026. SAMHSA's page shows those states on the map rather than in text, so check your own state's Medicaid agency or behavioral health authority before assuming it is in or out. States also need a planning phase first: SAMHSA says a state must complete a planning grant, which helps it certify clinics, set up payment and prepare its application. A round of 15 planning grants was funded in 2023.

Demonstration states can also add clinics over time. Effective July 15, 2024, they may add new CCBHCs at the beginning of any fiscal quarter of their demonstration year, using SAMHSA's guidance and compliance checklist. Starting in 2026, states must report changes that deviate from their original application.

How does a state certify a clinic?

Against SAMHSA's 2023 criteria, usually with the compliance checklist SAMHSA publishes for states. The criteria give states room: certifying states may add community needs assessment requirements (1.a.1), decide what counts as a state-sanctioned crisis system (SAMHSA FAQ), and certify for a period they choose, up to three years before recertification. They may decertify a clinic that stops meeting the criteria. The criteria let a certifying state use an independent accrediting body as part of its certification process, and encourage states to require CCBHC accreditation (6.c.2 and 6.c.3); read your state's own certification guide for its method.

Expect the state to look at the basics before anything else. A CCBHC must be enrolled in Medicaid and licensed, certified or accredited to provide both mental health and substance use services (6.c.1). A clinic missing either is not ready to be considered, whatever its clinical quality.

Before its state is selected, what can a clinic do?

1. Get the foundations in place. State facility licensing for both mental health and substance use services, and Medicaid enrollment. See the state licensing index and Medicaid enrollment for behavioral health facilities.
2. Measure the gap against the criteria. Staffing, access timelines, crisis coverage, the sliding fee schedule, care coordination agreements, quality reporting and governance. The requirements are in CCBHC certification: the nine services and the 2023 criteria.
3. Watch the state's process. Planning grants, requests for applications and certification guides come from the state, often through its Medicaid agency or behavioral health authority.
4. Look at the grant route. SAMHSA's expansion grants fund providers directly, including in states without a demonstration, on the terms of each funding notice.

What can we do, and what can we not?

We cannot certify a CCBHC, file a state's demonstration application or influence which clinics a state selects. Only the state certifies demonstration and state-program clinics. What we offer is a flat-fee CCBHC Readiness Gap Assessment at $2,495: a criterion-by-criterion read of your clinic against the 2023 criteria and SAMHSA's compliance checklist, with a written list of gaps and what each would take to close. If your clinic still needs the state license or Medicaid enrollment underneath, those are separate flat-fee packages on the pricing page, and Medicaid managed care paneling goes to our sister site White Glove Credentialing.