Connecticut children can’t wait any longer for more investment in behavioral health
By Jeff Vanderploeg, PhD, President and CEO and Aleece Kelly, MPP, Director of System Development and Policy
Since the 1990s, Connecticut’s behavioral health system for children has been on a transformation journey guided by the system of care approach, which emphasizes youth- and family-driven, community-based, coordinated, and culturally appropriate service delivery. And we’ve come a long way: our state now has one of the nation’s best youth mobile crisis systems, a wider array of high-quality evidence-based services, and stronger connections between providers, schools, families, and communities. Over the years, the state has also invested in numerous reports, studies, and plans to identify and understand systemic challenges like long waitlists, clinician shortages, fragmented data, and insufficient funding. Thanks to these efforts, we now have a deep understanding of the remaining gaps—and more importantly, we’ve identified promising, research-backed solutions. Now, it’s time to roll up our sleeves and work together to implement those solutions with the urgency our children deserve.
For more than 25 years, the Child Health and Development Institute (CHDI) has been proud to partner with state agencies, policymakers, providers, and family advocates on many of these studies and reports. Back in 2014, we were commissioned by the Department of Children and Families (DCF) as the lead developers of the Connecticut Children’s Behavioral Health Plan, part of the state’s legislative response to the Sandy Hook tragedy. This comprehensive, cross-agency plan sought to better align policy, system infrastructure, and services to promote the well-being of all children in our state. Since then, we’ve continued to provide staff support to the state advisory board charged with implementing the plan and also serve on the Transforming Children’s Behavioral Health Policy and Planning Committee. In 2023, with DCF’s support, we collaborated on a study and strategic plan to tackle one of the top barriers to care identified in the 2014 plan: chronic shortages in the behavioral health workforce.
Our 2023 findings highlighted the simultaneous challenges of workforce shortages and rising behavioral health needs among youth: Connecticut providers reported an average vacancy rate of over 20% and annual turnover rates of nearly 40%, while youth surveys and family focus groups have revealed increasing need and difficulty finding timely treatment. The impact was particularly severe among community-based nonprofit providers, which are more likely to serve children and families relying on Medicaid and those with more complex needs. Nonprofit providers often cannot compete with the flexibility and compensation of private practice, where clinicians have the option of accepting out-of-pocket payments instead of relying on insurance. Nor can they compete with public sector salaries, which are also less dependent on reimbursement rates and can be up to 30% higher than their nonprofit counterparts. Some clinicians reported working more than one job to make ends meet.
As a result, the 2023 plan’s first recommendation was to increase Medicaid rates to allow providers to raise salaries and improve recruitment and retention. This recommendation was reinforced by subsequent findings from the State’s own 2024-25 Medicaid rate study, which found a $42 million gap in behavioral health reimbursement rates compared to similar states. Last year, a statewide survey of licensed behavioral health providers conducted by our team further bolstered the case: while clinicians shared how rewarding they find their work, those in nonprofit settings described high caseloads, low salaries and insurance reimbursement rates, and challenges meeting the high cost of living.
But since the release of these studies, only nominal reimbursement rate increases have occurred for children’s services, leaving a continued gap between Connecticut and other states. While there was $45 million additional allocation for Medicaid funding within the state’s approved FY 2027 budget, only limited increases were intended for behavioral health services. We have been heartened to see the additional $30 million in the Appropriations Committee’s budget proposal and encourage the legislature and the Department of Social Services to allocate that to help close the gap in rates for children’s behavioral health services.
To be clear: it will not be possible to meet the needs of children and families without raising reimbursement rates so that we can adequately compensate and expand the workforce.
Connecticut already has the information and the framework we need to make our behavioral health system work better for all youth and families. Beyond increasing reimbursement rates, the state can follow the system of care framework as a roadmap for continued progress on this journey. This includes fully investing in remaining service array gaps, expanding workforce development efforts—including to non-clinical roles, such as family and youth peer support specialists—and continuing to build critical system infrastructure: a robust blended funding approach, timely and integrated data systems, and streamlined governance that includes youth and family voices. These system shortcomings have been explored in depth in other recent reports, and the path forward is clear.
If we do not build on our existing strengths and finish the job begun more than 30 years ago, we will continue to see significant workforce challenges and an eroding service array while more children and their families wait for the care they desperately need. It is time for Connecticut to act on the research and recommendations already in hand: raise reimbursement rates, sufficiently fund nonprofit providers, and invest in the system infrastructure that makes equitable, high-quality behavioral health care possible for every child in our state.
We know what to do. Our kids cannot wait any longer for us to do it.