Alaska adopts a behavioral health clinic model that can't turn crises away

Alaska is adopting a model of behavioral health clinic that has to take anyone who walks in during a crisis, 24 hours a day, regardless of whether they can pay, where they live, or how old they are. The catch, for now, is that only two clinics in the state qualify.

The model is the Certified Community Behavioral Health Clinic, and the federal rules are demanding. A certified clinic must offer around-the-clock crisis response and a full range of mental health and addiction treatment, and can't turn someone away for lack of insurance or money. The 24/7 crisis requirement is one of the hardest parts to build, requiring standing capacity most clinics don't have.

What makes it possible is a change in how clinics get paid. Under standard Medicaid, a clinic is reimbursed per service, which quietly punishes it for taking on the most complex patients, the ones needing crisis care and coordination the per-visit rate doesn't cover. The new model pays based on what care actually costs, removing that penalty and moving providers off the year-to-year grant funding many have depended on.

Federal officials picked Alaska as one of 10 states for a four-year demonstration, and Congress has separately made the model a permanent option going forward. Alaska has certified two providers so far, Alaska Behavioral Health in Fairbanks and JAMHI Health & Wellness in Juneau.

The requirements promise a kind of no-wrong-door access that's been scarce in a state with some of the country's hardest behavioral health needs. Two clinics in two cities is a long way from statewide.