CCBHC Certification in 2026: How the Funding Model Actually Works

CCBHC certification lets a behavioral health clinic bill Medicaid at an enhanced, cost-based rate under a Prospective Payment System (PPS) created by Section 223 of the Protecting Access to Medicare Act (PAMA) of 2014, instead of standard fee-for-service. As of September 2026, the trade is real on both sides: a clinic must meet six program requirements and deliver nine required services to anyone who needs them, regardless of diagnosis, insurance status, or ability to pay, and in exchange it gets a Medicaid rate built from its own cost data rather than a capped per-visit fee.

This guide explains what CCBHC certification requires in 2026, how the payment model actually works, the pathways available to get certified, where Oregon, Washington, and Idaho each stand, and where programs most often get stuck. CCBHC status is available to nonprofit organizations, local government behavioral health authorities, and clinics operated under Indian Health Service, tribal or urban Indian organization authority. For-profit operators generally partner with an eligible organization, for example as a management services provider or a Designated Collaborating Organization, and should confirm structure with legal counsel.

What Is a CCBHC?

A CCBHC is a behavioral health organization certified to deliver a comprehensive, coordinated set of mental health and substance use services to anyone who needs them, regardless of diagnosis, age, insurance status, or ability to pay. The model was created under Section 223 of PAMA 2014 and launched as an eight-state Medicaid demonstration in 2017. Oregon was one of the original eight states in the federal demonstration, which began in 2017 and ended September 30, 2025. Since October 1, 2025, Oregon has covered CCBHC services through its Medicaid State Plan. OHA reports 12 certified CCBHC provider organizations and began accepting new certification applications in January 2026.

What separates a CCBHC from a conventional community mental health center is the combination of scope, access, and accountability. A CCBHC cannot cherry-pick payers or turn away people who lack coverage. It must stand up around-the-clock crisis services, coordinate care across physical and behavioral health, and report a defined set of quality measures to the state, or to SAMHSA for expansion grantees. In exchange, it receives an enhanced, cost-based Medicaid rate designed to cover the true cost of that expanded scope.

Why Does CCBHC Certification Matter in 2026?

Two forces make this the moment operators are paying attention: money and expansion.

Fee-for-service reimbursement rarely covers the real cost of crisis care, care coordination, and the wraparound services that keep people stable. The CCBHC Prospective Payment System, jointly administered by SAMHSA and the Centers for Medicare & Medicaid Services (CMS), replaces that math with a clinic-specific rate built from the program's own cost data.

On expansion: the Bipartisan Safer Communities Act of 2022 created a rolling expansion of the Medicaid demonstration, adding up to ten new states every two years beginning July 1, 2024. The first expansion cohort, Alabama, Illinois, Indiana, Iowa, Kansas, Maine, New Hampshire, New Mexico, Rhode Island, and Vermont, began between 2024 and 2025. On May 28, 2026, SAMHSA and CMS named the second cohort: Alaska, Colorado, Hawaii, Louisiana, Maryland, Mississippi, Montana, North Dakota, Washington, and West Virginia, with demonstrations beginning between July 2026 and July 2027. For operators in Washington, a state-administered CCBHC pathway is opening now; for those in Oregon, an established program continues to certify new clinics; Idaho, notably, sits outside both demonstration cohorts and reaches CCBHC status through a different route (more on that below).

Because the model is administered state by state, the exact certification standards, application windows, and payment details vary, but they all build from the same federal criteria. Operators should also keep an eye on federal Medicaid policy, since the model's long-term reach depends on continued federal and state funding commitments, and it sits alongside broader Medicaid billing and Medicare enrollment work most behavioral health programs are already doing.

What Are the Six CCBHC Program Requirements?

SAMHSA's certification criteria, updated in March 2023, with most CCBHCs required to comply by July 1, 2024, are organized into six program requirements. Every certifying state builds its standards on top of them.

• Staffing. The clinic must complete a community needs assessment and build a staffing plan driven by it, with credentialed, trained, and appropriately licensed staff to deliver the full scope of services.
• Availability and accessibility. Services must be genuinely accessible, timely routine access, 24/7 crisis response, reasonable proximity, language access, and no exclusion based on ability to pay or place of residence.
• Care coordination. The clinic must actively coordinate care across settings, including primary care, hospitals, criminal justice, schools, and social services, with the partnerships and health-information agreements to support it.
• Scope of services. The clinic must make all nine required service types available, directly or through formal partners.
• Quality and other reporting. The clinic must collect and report a defined set of quality measures and cost data, which also feed the payment rate.
• Organizational authority and governance. The clinic must meet governance standards, including a board in which at least 51 percent of members are individuals with lived experience of mental health or substance use conditions and family members, or another SAMHSA-approved method for meaningful participation.

What Are the Nine Required CCBHC Services?

Scope of services is where many programs discover how much they need to build. A CCBHC must make nine service types available:

• Crisis services. Twenty-four-hour crisis care, including mobile crisis, crisis intervention, and stabilization, closely tied to the 988 Suicide and Crisis Lifeline system.
• Screening, assessment, and diagnosis. Comprehensive screening, assessment, diagnosis, and risk assessment, including for substance use and suicide risk.
• Person-centered treatment planning. Individualized, recovery-oriented plans developed with the client and, where appropriate, family.
• Outpatient mental health and substance use services. Evidence-based outpatient treatment for both mental health and substance use conditions.
• Outpatient primary care screening and monitoring. Screening and monitoring of key physical health indicators to close the mortality gap for people with serious mental illness.
• Targeted case management. Services that connect clients to medical, social, educational, and other supports.
• Psychiatric rehabilitation services. Skills-building and recovery services that support community functioning.
• Peer and family support. Peer specialist and family/caregiver support services delivered by people with lived experience.
• Community-based care for veterans. Care coordinated with the Department of Veterans Affairs for service members and veterans.

A CCBHC is responsible for access to all nine services but does not have to deliver them all itself. Under SAMHSA's 2023 criteria it must deliver directly the majority, 51 percent or more, of encounters across the required services, excluding crisis services, and it can provide any of the nine through a Designated Collaborating Organization.

How Does CCBHC Payment (PPS) Actually Work?

The financial engine of the model is the Prospective Payment System (PPS). Instead of billing fee-for-service, a CCBHC is paid a cost-based, clinic-specific Medicaid rate. States in the demonstration choose among four PPS methodologies: PPS-1, a daily all-inclusive rate; PPS-2, a monthly all-inclusive rate with outlier payments; PPS-3, a daily rate with separate payments for crisis services; and PPS-4, a monthly rate with separate crisis payments and outlier payments. Quality bonus payments are available under the methodologies.

Because the rate is built from the clinic's own cost report, the quality of your cost accounting directly determines your reimbursement. Programs that under-document cost, or that set a rate before their true crisis and care-coordination costs are visible, leave money on the table for the life of the demonstration. The same denial-avoidance and rate-negotiation discipline that governs any other payer contract applies here.

Designated Collaborating Organizations (DCOs) are the mechanism for delivering required services you do not provide directly. Under a DCO arrangement, a partner organization furnishes a required service on the CCBHC's behalf. The critical point for operators: the CCBHC remains responsible for assuring access to, and coordinating, DCO-delivered care, and states generally include DCO services in the CCBHC's rate. A DCO relationship is a formal contract with real oversight obligations, not a casual referral.

What Are the Pathways to Becoming a CCBHC?

There is no single door. In 2026, programs generally pursue one of three routes:

• State Medicaid Section 223 demonstration. The route that carries PPS reimbursement. Available only in states participating in the demonstration, and governed by that state's certification standards and application timeline.
• SAMHSA CCBHC Expansion (CCBHC-E) grants. Direct federal grants that fund clinics to operate as CCBHCs outside a state's Medicaid demonstration. These are competitive, time-limited awards rather than a permanent payment model.
• State-established CCBHC programs. A growing number of states certify and pay CCBHCs through their own programs, independent of the federal demonstration, with structures that vary widely.

Which path is realistic depends entirely on your state: Washington is a newly opening demonstration, Oregon a Medicaid state plan benefit, Idaho the grant-and-state-match route described below. Confirming your state's current status and timeline is the first practical step.

Where Do Oregon, Washington, and Idaho Stand on CCBHC?

The three states share a region but not a CCBHC pathway, and that difference should shape how an operator plans a certification project.

Oregon was one of the original eight states in the federal demonstration, which began in 2017 and ended September 30, 2025. Since October 1, 2025, Oregon has covered CCBHC services through its Medicaid State Plan. OHA reports 12 certified CCBHC provider organizations and began accepting new certification applications in January 2026. For an Oregon operator, certification is open and non-competitive. OHA accepts applications on a rolling basis after an orientation session, so the work is building the staffing, crisis and reporting infrastructure to meet the criteria and sustain the rate.

Washington joined the second expansion cohort named by SAMHSA and CMS on May 28, 2026, with its demonstration set to begin sometime between July 2026 and July 2027. Washington's demonstration will be administered through the Washington State Health Care Authority (HCA), which already runs Apple Health, the state's Medicaid program. Washington's HCA is administering the state's CCBHC program. Check the HCA CCBHC page for the current certification standards and application timeline.

Idaho is not part of either federal Medicaid demonstration cohort. Instead, the state built its CCBHC presence through the grant pathway: four Idaho organizations, Heritage Health, Community Health Association of Spokane, Terry Reilly Health Services, and Family Health Services, became SAMHSA CCBHC-Expansion grant recipients starting in the fall of 2022, worth up to $1 million per year per recipient. The Idaho Department of Health and Welfare (IDHW) and the Idaho Legislature backed those grants with roughly $12 million in additional state funding over two years to help the clinics sustain the model. For an Idaho operator today, the realistic path to CCBHC status runs through a future SAMHSA expansion-grant cycle or a state-established program, not a Medicaid Section 223 demonstration, since Idaho has not yet joined one.

The three states share a region but not a CCBHC pathway, which shapes how an operator plans certification.

What Does CCBHC Certification Actually Require?

State applications differ, but readiness comes down to a consistent set of build-outs, where the gap between "we provide behavioral health services" and "we meet CCBHC criteria" becomes real.

• A community needs assessment. A documented assessment of the population and its needs that justifies your staffing plan and service design.
• A defensible staffing plan. Credentialed, trained staff mapped to the full nine-service scope, including crisis and peer roles many programs have never staffed.
• A complete policy and procedure set. Written policies spanning access standards, crisis response, care coordination, governance, and quality, implemented, not just drafted.
• Care coordination agreements. Executed partnerships and data-sharing arrangements with hospitals, primary care, and social services.
• A quality and data infrastructure. The systems and workflows to capture required quality measures and cost data reliably, usually inside your EHR.
• A governance structure that meets the board standard. A board composition or participation method that satisfies the lived-experience requirement.

Most programs can describe these on paper. Far fewer have them implemented, staffed, and survey-ready, which is exactly what a state certification review tests.

Where Do CCBHC Programs Get Stuck?

The failure points are predictable. Crisis services are the biggest lift: standing up genuine 24/7 capacity, directly or through a DCO, is operationally and financially demanding. Quality reporting is next: programs discover their EHR was never configured to capture the required measures. Cost reporting is third: an inaccurate cost report locks in an inadequate PPS rate for years, the same claims and denial-management discipline that protects revenue everywhere else in the program. Governance catches leadership teams that have never structured a board around lived experience. None of this is insurmountable, but each piece takes months to build correctly, and they interact, so sequencing matters as much as doing the work.

Frequently Asked Questions

What is a CCBHC?

A Certified Community Behavioral Health Clinic (CCBHC) is a behavioral health organization certified under Section 223 of PAMA 2014 to deliver a defined scope of mental health and substance use services to anyone who needs them, regardless of diagnosis, insurance status, or ability to pay, in exchange for an enhanced, cost-based Medicaid rate.

How is a CCBHC different from a regular community mental health center?

A CCBHC has to meet accountability standards a standard clinic does not: 24/7 crisis access, coordinated care across physical and behavioral health, defined quality reporting, and a governance structure with meaningful lived-experience representation. It also cannot turn away people based on ability to pay or place of residence.

How does CCBHC funding (PPS) work?

Instead of fee-for-service billing, a CCBHC is paid under a Prospective Payment System. States in the demonstration choose among four PPS methodologies: PPS-1, a daily all-inclusive rate; PPS-2, a monthly all-inclusive rate with outlier payments; PPS-3, a daily rate with separate payments for crisis services; and PPS-4, a monthly rate with separate crisis payments and outlier payments. Quality bonus payments are available under the methodologies. The rates are built from the clinic's own reported costs.

What are the nine required CCBHC services?

Crisis services, screening/assessment/diagnosis, person-centered treatment planning, outpatient mental health and substance use treatment, outpatient primary care screening and monitoring, targeted case management, psychiatric rehabilitation, peer and family support, and community-based care for veterans. A CCBHC must deliver at least 51 percent of encounters across the required services directly, excluding crisis services, and may deliver the rest through a Designated Collaborating Organization.

Is Idaho part of the CCBHC Medicaid demonstration?

No. Idaho is not in the Section 223 demonstration. Four organizations received SAMHSA CCBHC-Expansion grants in fall 2022, with state funding of about $12 million over two years. Confirm with the Idaho Department of Health and Welfare how its Medicaid payment for these clinics works today.

When does Washington's CCBHC demonstration start?

Washington was named to the second expansion cohort on May 28, 2026, with its demonstration set to begin sometime between July 2026 and July 2027, administered by the Washington State Health Care Authority.

Build Your CCBHC Infrastructure With One Accountable Partner

CCBHC certification is not a form you file; it is an operating model you have to build, staff, and prove. That is the kind of engagement Saint Health Group runs end to end: we conduct the community needs assessment, write and implement the policies and procedures, design the staffing and crisis model, stand up the quality-reporting and cost infrastructure inside your EHR, structure DCO and care-coordination agreements, work the payer and PPS-rate side with your state Medicaid agency, and run a full readiness review so your program walks into the state's certification survey prepared rather than hopeful.

If you operate in Oregon, Washington, or Idaho, or anywhere else the CCBHC model is expanding, and you want a single, accountable partner for behavioral health licensing and accreditation, compliance and risk, program operations, and revenue cycle and payer strategy, schedule a consultation. We build behavioral health infrastructure on results, not advice.