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Center for Financing Reform & Innovation (CFRI)


Learn about behavioral health financing mechanisms, options, and innovations through CFRI reports and webinars.

What is CFRI?

What is CFRI?

The Center for Financing Reform and Innovation (CFRI) is a SAMHSA contract that seeks to understand financing mechanisms of behavioral health care to identify opportunities, innovations, and challenges to service delivery and access. CFRI provides SAMHSA with a dynamic mechanism to further its leadership and the field on immediate and relevant behavioral health financing and delivery issues.

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In addition, CFRI provides information and analysis to address changes in the organization and financing of behavioral health care as well as guidance on the most effective and efficient use of available resources to meet the prevention, treatment, and recovery support needs of the American public.

What’s New

BestPractices4Data: Sharing Innovations and Best Practice for Grantees, from Grantees

The BestPractices4Data includes six (6) issue briefs that share innovative and best practices from grantees, for grantees, that seasoned grantees use to address the most common and complex challenges associated with grantee required data collection activities. The series aims to improve efficiency in the use of grant funds by providing opportunities for grantees to learn from one another on how to reduce costs and optimize the data collection processes.

Financing Peer Recovery Support: Opportunities to Enhance the Substance Use Disorder Workforce
This report provides background history of the development of Peer Recovery (PR), including an overview of the current landscape of PR Programs. This report also provides a description of the variation in peer recovery rates, supervision, credentialing, and substance use disorder vs mental health.

Examining the Use of Braided Funding for Substance Use Disorder Services
This report looks at state and federal laws and policies that encourage braided funding to provide substance use disorder services, best practices for braiding funds, and pathways to sustainability for substance use disorder programs.

Medicaid Coverage of Medications to Reverse Opioid Overdose and Treat Alcohol and Opioid Use Disorders
This report provides an update on the present state of coverage, availability of, and access to, medications for treating ongoing alcohol use disorder (AUD) and opioid use disorder (OUD) and reversing an opioid overdose within state Medicaid plans. It also includes examples of innovative efforts to increase access to medications for the treatment of SUDs.

Exploring Value-Based Payment for Substance Use Disorder Services in the United States 
This report and webinar explore the use of Value-Based Payment (VBP) models and their potential to improve delivery of integrated and coordinated substance use disorder (SUD) treatment services.

Coordinated Specialty Care for First Episode Psychosis: Costs and Financing Strategies
This report includes data on the cost of CSC programs; how they are financed; case studies of cost reimbursement methodologies; funding options; trends in costs and financing for CSCs; and data evaluation of Medicaid and private insurance coverage and barriers.

Upcoming Reports & Events

Upcoming Reports & Events

Learn about new CFRI projects underway. Report release dates and webinar registration will be added as projects near completion.

Peer-operated crisis respites have emerged as a promising approach to provide trauma-informed care to individuals experiencing behavioral health crises. This report analyzes secondary data to describe organizational characteristics, leadership, and financing of peer-run crisis respites.

Measurement based care (MBC) for behavioral health care is a clinical process that uses standardized measurements to track a client’s progress over time that inform shared patient-provider treatment planning and decision-making. One significant challenge to the broader adoption of MBC is financing. This report uses analyses based on discussions with payers, policy makers, financing experts, and providers and an environmental scan to explore MBC reimbursement options and to identify challenges and potential solutions for increasing use of MBC across diverse community behavioral health care settings.

The prevalence of behavioral health problems among older adults (65+) is on the rise. Although Medicare, Medicare Advantage, and Medicaid provide coverage for mental health and substance use disorder services, there are gaps in eligibility requirements and additional out-of-pocket costs that differ across payer sources. This report analyzes costs and disparities for key behavioral health services among older adults enrolled in Medicaid, Medicare, or Medicare Advantage.

In 2020, U.S. behavioral health spending totaled nearly $280 billion, a considerable portion of which came from publicly funded sources such as Medicaid, Medicare, and SAMHSA. However, there is little current data about what types of services are publicly funded, and how the funding is used. This report synthesizes data on public funding for behavioral health services from 2016-2021 and analyzes is by service type, state, provider type, and demographic disparities.

Findings from the 2023 SAMHSA publication Lesbian, Gay, and Bisexual Behavioral Health: Results from the 2021 and 2022 National Surveys on Drug Use and Health (PDF | 682 KB) revealed elevated rates of substance use, suicidality, and mental illness among LGB individuals compared to straight individuals. This project investigates whether these findings remain statistically significant when controlling for factors such as age, race, educational attainment, marital status, and financial hardship using propensity score matching. By pooling NSDUH data from 2015 to 2019, this report aims to provide a more nuanced analysis of these disparities, and also examines health insurance coverage and barriers to care within this population.

Community-based organizations (CBOs) provide services to underserved racial and ethnic communities, and generally do not receive federal funding on a recurring basis, potentially exacerbating existing behavioral health disparities. This report analyzes national data on CBOs to describe funding strategies and innovations, and how financing impacts capacity, service provision and sustainability.

Additional Financing, Payment, and Innovative Resources

Additional Financing, Payment, and Innovative Resources

Last Updated
Last Updated: 01/24/2024
Last Updated