Starting this past July 1, Colorado’s Medicaid program, Health First Colorado, began reimbursing primary care clinics for mental health services provided through the Collaborative Care Model, or CoCM. This change puts Colorado alongside 35 other states that now cover CoCM under Medicaid.

CoCM brings mental health care into primary care by creating a team made up of the patient’s primary care doctor, a behavioral health coordinator, and a psychiatrist who consults as needed. These team members regularly discuss patients’ progress and work together to update care plans, helping identify and treat mental health concerns earlier rather than later.

For patients, this means they can access support for conditions like depression, anxiety, or ADHD during regular doctor visits, without needing a referral to a specialist or facing long wait times. For clinics, especially those in rural areas, this new reimbursement may be key to maintaining behavioral health services that otherwise might not be sustainable.

According to the Colorado Department of Health Care Policy and Financing (HCPF), clinics must meet certain requirements to bill Medicaid: they need to have a contract with a Regional Accountable Entity (RAE) or Managed Care Organization (MCO), employ or contract behavioral health care managers and psychiatric consultants, and conduct regular case review meetings between care managers and psychiatric consultants.

“ This behavioral health coordinator who’s been added to the care team … helps the patient overcome known barriers like scheduling, stigma, transportation, social determinants of health, and medication adherence,” said Anna Bobb, executive director of Path Forward, a nonprofit advocating for the CoCM. “This person puts the patient directly at the center of care.” She added that psychiatrist time is “leveraged eight times over by using this model.”

HCPF estimates the program will cost the state’s general fund about $368,000 in its first year, unlocking roughly $1.1 million in federal matching funds.

“The fact that Health First Colorado is now going to be reimbursing for Medicaid is a huge step forward for the state,” Bobb said. “We have to think about the children of Colorado and what a huge impact this can have for them.”

Early intervention, Bobb emphasized, is one of the model’s greatest strengths, especially for young people.

“We know there’s often a 10-year delay between the start of symptoms and a diagnosis,” she said. “During that time, mental health conditions can worsen significantly. Collaborative care brings treatment into primary care, helping to intervene much earlier.

“Half of all people with mental health conditions experience their first symptoms by age 14; three-quarters by 25,” she said.

Still, access remains limited. Although Collaborative Care is technically available in all 50 states, only about 100,000 people received these services through commercial insurance in 2023, less than 1% of the nearly 60 million Americans with mild to moderate mental illness who could benefit, according to a Milliman data analysis cited by Path Forward.

That said, some clinics in Colorado have been offering this kind of care for years. Sunrise Community Health is a federally qualified health center serving communities across northern Colorado, offering comprehensive medical, dental, and behavioral health services all in one place. Mark Wallace, Sunrise’s chief operating officer, said the Medicaid policy could help other clinics develop integrated behavioral health services like Sunrise’s, which includes behavioral health providers in all 15 of its primary care clinics.

He explained that these providers are fully involved in daily care.

“They’re on all the floors of our clinics,” Wallace said. “We do warm handoffs (with them) throughout the day … all day long there is this interchange between the behavioral health team and our clinical medical team.”

But implementing the model in smaller or rural clinics may come with challenges. Wallace noted that many practices may not have the staff or systems in place yet to take advantage of the new reimbursement structure.

“In some practices that are rural, they might not have a care coordinator or a care manager,” he said. “But if one of their medical assistants spends 25% of her time doing that kind of connection to behavioral health, now that practice has a source of funding to offset the cost.”

Setting up these systems, especially billing, will require time and training.

“Most clinics use electronic systems, so training will be really important,” Wallace said.

He warned that excessive auditing and paperwork can be frustrating if staff spend a lot of time on unreimbursed tasks: “If clinics don’t know how to document and bill properly, the system can fall apart quickly, and people get discouraged.”

Wallace also raised concerns about workforce shortages in behavioral health.

“It’s a tough world right now … employees often move between clinics and behavioral health companies,” he said. “There is a shortage (of trained staff) right now, and I do worry we’re not going to suddenly find a lot of new employees.”

He emphasized the need to support existing staff to prevent turnover, suggesting that Medicaid reimbursement could help clinics offer pay raises or other incentives to retain employees involved in care coordination.

However, despite challenges with implementation and workforce shortages, both Wallace and Bobb agree this policy marks important progress toward a more accessible mental health system.

“Having this best practice covered by your Medicaid program is going to be a game changer,” Bobb said.

She hopes the move toward broader integration, earlier care, and a system where mental health help is available in doctor’s offices will help close long-standing gaps in mental health access. This is especially important for communities that have been underserved for too long, she said.