Mobile Crisis Teams and Medicaid Funding: Advancing Behavioral Health Crisis Response Across the United States

Mobile crisis teams (MCTs) are key in responding to individuals experiencing behavioral health crises across the United States.¹ MCTs typically are multidisciplinary, including behavioral health professionals and peer-support specialists. Their role as responders in the crisis continuum involves three vital functions: addressing and resolving behavioral health crises for individuals in need, engaging with them in a familiar environment, and providing appropriate care and support.² MCTs aim to minimize law enforcement involvement, reduce reliance on emergency departments, prevent avoidable hospitalizations, and improve service connections. However, variations in funding and access to MCTs persist across the United States, which the increased Medicaid funding under the American Rescue Plan Act (ARPA) of 2021 aimed to address.

In this commentary, we will first outline the landscape of MCTs in the United States, highlighting the variations in their funding and access. We then explore how changes in Medicaid funding under ARPA aimed to address these variations, using examples of MCTs to illustrate their impact. We conclude with recommendations for improving behavioral health crisis response.

Variations Among Mobile Crisis Teams

MCTs have operated in the United States since the 1960s, emerging in response to deinstitutionalization and the transition toward a community-based mental health care system^.3 Over the decades, local MCTs have evolved to address the unique needs of their communities^.1 For example, Oregon’s Crisis Assistance Helping Out on the Streets (CAHOOTS) program was established in the late 1980s as a non-police responder model. Since then, CAHOOTS has become a nationwide model, with counties across the United States launching similar programs tailored to their local contexts.³ While MCTs vary, the three main models currently include behavioral health practitioner-only MCTs, co-responder MCTs involving law enforcement, and MCT services delivered through mobile response and stabilization service programs.

In recent years, there has been growing momentum toward behavioral health crisis responses led by MCTs.^3,4 Recent federal initiatives to improve behavioral health crisis services include SAMHSA’s National Guidelines for Crisis Care, first released in 2020 and updated in 2025, as well as the establishment of the 988 crisis line in 2022.⁵ In 2023, 40 states saw a 21% increase in individuals served by MCTs compared to 2022.⁶ A 2024 study found that approximately 40% of US counties have at least one MCT.¹

Across the country, the implementation of mobile crisis services tells a story of potential and peril. In Ramsey County, Minnesota, billing Medicaid and private insurers has turned MCTs into a sustainable, replicable model. San Mateo County, California, has shown how embedding behavioral health professionals in mobile teams can de-escalate emergencies without police involvement. But not every story is one of success. Duluth, Minnesota, is a reminder of the fragility of these systems, as proposed city budget cuts threaten to dismantle progress.

Funding for MCTs has historically varied significantly across states.² These services have primarily been financed through the State Mental Health Authorities, with most funding coming from general state funds, local funds, and Medicaid waivers pre-ARPA. However, the payer mix for MCT services differs considerably across states and may include federal block grants and private insurance.^2,7 In 2022, approximately three-quarters of state Medicaid programs reported offering some form of coverage for MCTs.⁸ However, the specific MCT services reimbursed by Medicaid vary widely across states, influenced by factors like crisis service definitions, provider qualification criteria, and state-specific Medicaid billing policies.⁷

Variations in MCTs across states also extend to their services, access, and quality. While previous research suggests that behavioral health crisis services reduce the likelihood of hospitalizations and emergency department visits, recent studies critique these findings for inadequately addressing variations in the settings, program designs, and implementation approaches of MCTs across states.⁹ As a result of these variations, it remains uncertain to what extent state MCT services align with Substance Abuse and Mental Health Services Administration’s (SAMSHA) National Guidelines. Additionally, pay scales for MCT professionals are frequently not competitive with similar roles in other healthcare sectors, posing additional challenges for recruitment and retention.¹⁰ Moreover, many teams lack access to training programs, and inadequate supervision and mental health support for crisis responders contribute to job dissatisfaction and higher turnover rates.¹⁰ Overall, MCTs have varied considerably across states regarding financing, organization, quality oversight, and outcomes.

Medicaid Funding Changes Under the American Rescue Plan Act

The enhanced federal match under ARPA is an opportunity for states to address variations and provide timely, equitable responses to behavioral health crises. Under ARPA, qualified states can receive an 85% federal match for expenditures on community-based MCTs over a three-year period. This enhanced Medicaid reimbursement covers services that would otherwise be funded under the state plan or a state plan waiver. To qualify, states must meet criteria closely linked to SAMHSA’s National Guidelines, which require 24/7 availability of multidisciplinary mobile teams, including a behavioral health clinician. By meeting these requirements, ARPA funding can potentially improve both the access to and quality of MCT services across qualified states.

Medicaid, as the largest payer for MCTs, is uniquely positioned to anchor a sustainable crisis response network. It already serves many of the most vulnerable people—those at greatest risk of behavioral health crises. Through waivers and enhanced matching rates, Medicaid enables states to build and sustain these services in ways that align with broader public health priorities, including setting targets for ongoing implementation and evaluation. Integrating crisis services into Medicaid emphasizes that crisis care is a fundamental component of health care. This is particularly significant, given that nearly 40% of nonelderly adult Medicaid enrollees (13.9 million people) experienced a mental health or substance use disorder in 2020.

Yet, progress has been uneven; by September 2024, only 21 states had opted into the enhanced match under ARPA. One potential barrier is the variations in volume and billing practices among MCTs both within and between states, which may challenge the sustainability of a fully fee-for-service reimbursement model.³ Furthermore, these variations within states could make it particularly difficult to meet the 24/7 availability requirement for ARPA funding. While the incentives provided by ARPA may reduce financial burdens for establishing new MCTs, their long-term sustainability will depend on building the necessary infrastructure and securing stable funding beyond the planned sunset of the enhanced Medicaid reimbursement in 2027.

Improving Behavioral Health Crisis Response

Several policies and funding initiatives could strengthen crisis response. First, standardizing Medicaid reimbursement approaches across states could improve support for and access to MCTs. SAMHSA should issue clear guidelines on optimal support, training, and compensation standards, ensuring that team members receive a living wage and making these positions more competitive. Additionally, investment in workforce development is needed to address staffing shortages and equip providers with the skills needed to provide evidence-based care.

Second, states should have the option to extend their state plan amendments for the increased Medicaid match for MCTs beyond the initial three-year period provided by ARPA. Extending this match would secure funding streams and help states develop sustainable infrastructures. Since states are starting from different baselines in support for MCTs, the current timeframe may be insufficient for establishing robust systems. As part of this extension, policymakers should assess the feasibility of meeting the current requirements for the increased Medicaid match, including 24/7 availability within states. The ongoing debates over scaling back Medicaid funding may put these crucial services at risk. Moreover, a shift toward block grants and reduced federal matching funds for Medicaid could return MCTs to the pre-ARPA era, exacerbating disparities in access to and quality of care for individuals experiencing behavioral health crises across states.

Third, monitoring disparities in access to MCTs over time requires tracking demographic, geographic, and socioeconomic characteristics of both recipients and providers. Analyzing service availability, utilization rates, and outcomes can identify and address gaps, helping MCTs better reach underserved populations.

Finally, a ‘firehouse model’—a staffing approach ensuring crisis teams are always available and deployable 24/7, like firefighters—could greatly enhance the scalability, accessibility, and efficiency of crisis response nationwide. Unlike traditional inpatient and outpatient settings, this rapid response model integrates crisis services within the broader continuum of mental health care, potentially leading to improved outcomes. By continuing to innovate their crisis response and prevention capabilities, states have a unique opportunity to address persistent behavioral health crises and the disparities that drive them.

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