CMS provides state Medicaid agencies (SMAs) with cooperative agreement funding to develop the necessary infrastructure and capacity to successfully implement the IBH Model in their state. In turn, SMAs recruit and fund specialty behavioral health practices and settings (Practice Participants) to deliver care to people with moderate to severe behavioral health condition(s), substance use disorder(s) (SUD(s)), or both.
Background
Medicaid populations experiencing mental health conditions, SUD, or both, account for nearly half of all Medicaid expenditures. These populations often encounter significant barriers to care, including stigma and limited access to treatment. They may also have untreated or poorly managed physical health conditions such as diabetes or heart disease, all of which can contribute to poor health outcomes or even death.
Providers face multi-faceted challenges in trying to deliver care to these vulnerable populations in large part because behavioral and physical health care are often not fully integrated in the health care delivery system. The IBH Model supports specialty behavioral health practices to lead interprofessional care teams covering all aspects of a person’s care. As a result, this model will help providers to more comprehensively address root causes of their patients’ conditions before they increase in severity.
Model Aims
The IBH Model seeks to:
- Improve behavioral and physical health outcomes for Medicare, Medicaid and dual-eligible populations who experience moderate to severe mental health condition(s), SUD(s), or both.
- Support integrated teams that coordinate community-based providers, behavioral health clinicians, primary care, and social services to create care plans that support each person’s needs and preferences
- Align Medicaid and Medicare payments to incentivize improved quality and better coordinated, person-centered care
Innovation
The IBH Model puts the behavioral health provider at the center of value-based integrated care to address physical, behavioral, and social health needs holistically.
The model also emphasizes multistate alignment in infrastructure, payment, and care delivery, better preparing specialty behavioral health providers (Practice Participants) for broader participation in value-based systems.
Design
On January 1, 2025, CMS issued cooperative agreements awards to three state Medicaid agencies in Michigan, New York, and South Carolina, and will award up to eight (8) state Medicaid agencies over the life of the model.
The selected states partner with their state’s mental health or SUD authorities or both to ensure alignment in clinical and payment policies. States delivering Medicaid services through the fee-for-service system are eligible to participate in the model, as well as those states that leverage their Medicaid managed care organization to deliver behavioral health services are eligible to participate in the model.
Practice Participants will receive a per-person-per-month payment from CMS to support required activities, including conducting screenings and assessments of behavioral and physical health, and other social factors like access to reliable housing and food. These payments will be further supplemented with additional performance-based payments throughout the Implementation Period (2028 – 2032). Practice Participants will provide closed-loop referrals to primary care providers, specialists, and community-based resources.
Targeted investments in interoperability and tools (including electronic health records) will help participants to improve quality reporting and data sharing.
Practice Participants serving Medicaid beneficiaries are initially recruited to participate in the model and those Practice Participants who want to serve Medicare and dually-eligible beneficiaries will have that opportunity through a Request for Applications.
All Practice Participants that are specialty behavioral health practices must meet the following criteria to be an IBH Model Practice Participant:
- Licensed by the state to deliver behavioral services, either mental health, substance use disorders, or both;
- Meet all state-specific Medicaid provider enrollment requirements;
- Eligible for Medicaid reimbursement;
- Serve at least 25 people enrolled in Medicaid on average per month (age 18 or older) with moderate to severe behavioral health conditions; and
- Provide mental or behavioral health, SUD services, or both at the outpatient level of care.
Pre-Implementation Period (2025-2027)
- States and Practice Participants will receive funding for infrastructure building and capacity building
Implementation Period (2028-2032)
- States and Practice Participants begin serving Medicaid, and Medicare and dually-eligible beneficiaries where applicable.
Selected states that have Medicaid Practice Participants who want to participate in the Medicare arm of the model, too, can apply in response to a competitive CMS Request for Application (RFA) process. All applications will be reviewed by a panel of technical experts.
