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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?

The Center for Financing Reform and Innovation (CFRI) is committed to strengthening America’s mental health and substance use service system, by improving how the nation funds and delivers vital services. CFRI offers a dynamic platform to tackle today’s most urgent behavioral health issues head-on. Through clear analysis and strategic guidance, CFRI promotes the smart, efficient use of resources that strengthen prevention, early intervention, treatment, and recovery to build a healthier, stronger America.

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What’s New

Integrating Substance Use Disorder Prevention with Physical Health Care: Progress in States

Over the past several decades, rising rates of substance misuse, substance use disorders (SUD), and related harms, including nonfatal and fatal overdoses, have placed a significant burden on individuals, communities, and the health care system. Expanding access to Preventing substance misuse, abuse, and addiction is one of the core strategic priorities for SAMHSA and aligns closely with the Make America Healthy Again initiative. Prevention is essential to avoid this chronic disease, and to improve public health. Integrating SUD prevention with physical health care is an effective strategy. This report explores how states are working to integrate SUD prevention into physical health care settings, particularly for adolescents.

Youth Inpatient and Residential Treatment Psychiatric Beds

Between 2010 and 2022, most states saw troubling declines in the number of youth in inpatient and residential psychiatric treatment facilities. Seventy-nine percent of states experienced a reduction in the number of youth in inpatient facilities, and 94 percent experienced a reduction in the number of youth in residential facilities. While further research is needed to understand the drivers behind these trends, the declines highlight an urgent need to strengthen the youth mental health infrastructure, expand access to a full continuum of care, and ensure that every child and family can receive timely support. These analyses draw on national surveys of mental health facilities and state mental health authorities.

Use of Alternative Payment Models for Substance Use Disorder Prevention: A Conceptual Framework

Alternative payment models (APMs) are a promising path for financing substance use disorder (SUD) prevention programs. APMs are extensively used to improve the value and quality of health care. While there is increasing use of APMs for SUD treatment services, they are rarely used for SUD prevention. In 2023, SAMHSA convened an expert panel to refine a conceptual framework for using APMs for SUD prevention and to identify strategies to encourage their adoption. The conceptual framework is a viable method for financing a variety of prevention programs across populations and settings.

Coverage of Selected Behavioral Health Services among Older Medicare and Medicaid Beneficiaries

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.

Financing Measurement-Based Care in Community Behavioral Health Settings

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.

Financing Peer Crisis Respites in the United States

Financing Peer Crisis Respites in the United States highlights the benefits of peer crisis respites within the recovery-oriented continuum of crisis care and identifies common components, operations, and funding of peer crisis respites in a national sample of programs across the United States.

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

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

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Recovery houses are sober-living environments that help individuals maintain recovery from substance use disorders by cultivating community and mutually accountable bonds with peers in recovery. Despite positive outcomes associated with recovery housing such as decreased substance misuse and reduced likelihood of recurrence, challenges remain to secure sustainable, long-term funding. This report and webinar discusses funding challenges and future strategies for expanding access to recovery housing.

In 2024, 12.8 million people in the United States were dually eligible for both Medicare and Medicaid. These individuals are among the most economically and medically vulnerable populations in the U.S. and represent a disproportionate share of Medicare and Medicaid spending. This report and webinar identifies publicly available data sources that researchers can use to analyze demographics, health outcomes, costs, and access challenges. These resources aim to support data-driven decisions to address health care providers and policymakers needs and improve health outcomes.

Community-initiated care (CIC) is a promising way to strengthen behavioral health (BH) support for conditions like substance use disorders. It involves trusted community members and uses local resources to complement traditional BH services. Input from 68 coalitions across 34 states shows CIC programs often operate through schools, faith-based organizations, and community centers. These programs rely on multiple funding sources, including federal, state, local, and philanthropic streams. They face sustainability challenges due to complex reporting and limited long-term funding. This report and webinar offer key considerations for implementation.

Additional Financing, Payment, and Innovative Resources

Last Updated: 01/28/2026
Source: https://www.samhsa.gov/libraries/cfri