The Impact of Dual FQHC and Ccbhc Certification on Mental Health Care Quality

Background: Federally Qualified Health Centers (FQHCs) function as safety-net primary care providers for underserved populations with disproportionately high behavioral health needs. Although many FQHCs have expanded mental health services, persistent structural barriers, including inadequate reimbursement and workforce pipelines, continue to constrain their capacity to deliver comprehensive, integrated care at scale. The Certified Community Behavioral Health Clinic (CCBHC) model was developed to strengthen behavioral health infrastructure through enhanced, prospective payment systems and service delivery requirements. Early evidence suggests that CCBHC certification improves access and service capacity in community behavioral health settings, however, its applicability to FQHCs remains underexplored. The present study aims to (1) examine what FQHC characteristics predict transition to CCBHC status, and (2) explore how CCBHC designation changes mental health service access and capacity in FQHCs.

Methods: We analyzed site-level data from the Health Resources and Services Administration (HRSA) Uniform Data System (UDS) from 2015 to2024. These data include site-level performance indicators from all FQHC organizations in the US, and are collected annually. Pre-implementation differences between FQHCs that transitioned to CCBHC status and those that did not were examined using linear regression models with year fixed effects for continuous variables and chi-square tests for categorical variables. To estimate the impact of CCBHC certification, we employed a difference-in-differences design comparing changes in (1) the proportion of patients with documented mental health diagnoses and (2) the number of mental health visits among transitioning FQHCs relative to matched comparison sites. Inverse probability weighting was used to adjust for baseline differences, and weighted outcome trends were plotted to assess longitudinal patterns.

Results: Fifty-two FQHCs achieved CCBHC certification between 2017 and 2023. Prior to transition, these clinics were larger, more likely to serve economically disadvantaged populations, and more frequently located in urban areas compared to clinics that did not pursue dual designation. Transitioning clinics also had higher baseline levels of mental health service access and capacity. Difference-in-differences analyses indicated no statistically significant increases in mental health service volume or diagnostic prevalence attributable to CCBHC certification beyond the trends also observed in comparison sites. However, descriptive trends show that transitioning clinics delivered higher levels of mental health services both before and after certification.

Conclusion: Baseline findings suggest that organizations with higher capacity were more likely to pursue CCBHC certification than those that did not choose this path. As a result, CCBHC designation appears to support maintenance of existing service capacity rather than facilitating expanded access and capacity in FQHC clinics. As such, the model may function more effectively as a sustainability mechanism than as a pathway for initiating behavioral health integration in lower-capacity settings. Further research is needed to clarify organizational and policy factors that facilitate or hinder adoption of this model, and how it impacts the quality of care for those receiving care in FQHCs.