Virginia has undertaken a major multi-phase initiative to enhance the delivery of Medicaid-funded behavioral health services. The primary goals of the initiative are to increase service access, strengthen service quality, and improve service cost effectiveness. To fulfill these goals, Virginia plans to build a continuum of behavioral care in which each Medicaid member can receive the level of care needed in the most appropriate setting (Exhibit 1-1). The first phase of this enhancement was named Behavioral Health Redesign for Access, Value, and Outcomes (Project BRAVO). Planning for Project BRAVO started in 2019, and its services launched in 2021. It has addressed services for individuals in acute need, adding intensive community- and facility-based services and expanding the crisis services available. The second phase, Behavioral Health Redesign (BHR), will focus on rehabilitative services that Medicaid members rely on to stay in the community long-term. BHR is scheduled to take effect in July 2027. Additional phases were anticipated when enhancement efforts began but have not yet been designed or funded.

The Behavioral Health Commission (BHC) is tasked with conducting ongoing oversight of behavioral health services and programs, including this enhancement initiative. The primary purpose of this oversight is to ensure that the initiative is satisfying legislative intent, and this report provides a status update on the initiative's progress in meeting its goals.