These insights—initially shared by Connections’ Vice President of Government Relations, Chris Santarsiero, at the National Council’s Crisis Summit—highlight a growing urgency to better align reimbursement models with the realities of crisis care delivery.
Currently, Medicare provides limited coverage for community-based crisis stabilization services, leaving a significant portion of the population dependent on a patchwork of funding sources, including Medicaid, federal block grants, and state, county, and local investments. For counties and regional systems, this often translates into a disproportionate financial burden, where public funding is used to offset gaps that exist across the broader payor landscape.
This dynamic has direct implications for access and system design. In many communities, the inability to secure consistent, multi-payor reimbursement limits the development and long-term viability of crisis infrastructure. Variability in Medicaid coverage across states further complicates scale, while the absence of Medicare participation contributes to hesitancy among commercial payors to reimburse for the full scope of services required—particularly the facility-based, interdisciplinary model that defines effective crisis stabilization.
At its core, this is a parity issue. Behavioral health crises should be treated—and reimbursed—with the same urgency and consistency as physical health emergencies. Without that alignment, systems will continue to rely on fragmented funding models that constrain access and place avoidable pressure on emergency departments, law enforcement, and inpatient settings.
“We cannot continue to treat behavioral health crises differently than medical emergencies. Sustainable, aligned funding across all payors is essential if we want to ensure timely, life-saving care is available in every community.” — Chris Santarsiero
A clear path forward is emerging. The bipartisan Crisis Care Access and Response Expansion (CARE) for Behavioral Health Act of 2024 (H.R. 10419) represents a meaningful step toward aligning reimbursement with care delivery. By introducing a Medicare pilot for crisis stabilization services, the legislation would begin to close critical funding gaps, create more consistent definitions for crisis facilities, and signal broader payor alignment around this level of care.
For payors and county stakeholders, the opportunity is clear: sustainable crisis systems require shared investment, aligned incentives, and reimbursement models that reflect both the acuity and value of timely crisis intervention. When these elements come together, crisis care can function as intended—not only improving outcomes for individuals, but also reducing downstream costs and system strain across healthcare and public safety.