The 1115 Delivery System Reform Incentive Payment (DSRIP) program has been a game-changer for behavioral health care in Texas, advancing services for persons with serious mental illness (SMI), including people with co-occurring conditions of substance use disorders, intellectual disabilities and chronic health conditions.

Like every state, Texas cooperates with the federal government to ensure its citizens with disabilities can access quality healthcare through the Medicaid program. In recognition of the distinct characteristics of each state, the federal government allows states to waive certain uniform Medicaid requirements in order to experiment with innovative strategies to manage complex healthcare systems. Lessons learned from these innovations are then employed to expand services to broader populations. Since 2011, Texas has relied on the 1115 Texas Healthcare Transformation and Quality Improvement Program (1115 Waiver) as the primary vehicle for systems change in public mental health.

Since inception of the 1115 Waiver, every Community Mental Health Center (CMHC) has actively participated in the Delivery System Reform Incentive Payment (DSRIP) program, one component of the waiver. As public entities, CMHCs conduct intergovernmental transfers (IGTs), a process by which allowable public funds are transferred to the state Medicaid agency to serve as the non-federal share of the relevant Medicaid funds. Over the past 10 years, the DSRIP program has provided substantial resources, allowing CMHCs to expand and enhance mental health and substance addiction services while building collaborative relationships among regional healthcare providers and a wide range of local community partners.

In State Fiscal Year 2020 alone, the DSRIP program generated more than $367 million in federal funds for the public mental health system, representing 31% of CMHC expenditures for the community mental health priority population. With these funds, CMHCs were able to provide enhanced or expanded services for more than 296,000 clients. Services include:

  • Integrated physical and behavioral health care
  • Expanded access to treatment in rural, frontier, and underserved areas
  • Evidence-based interventions for people with serious mental illness
  • Crisis stabilization services
  • Mobile crisis outreach teams
  • Expanded use of remote technology for service delivery
  • Substance addiction services
  • Peer services for individuals with mental health conditions and substance addictions
  • Care coordination