Congress Focuses on Mental Health, Medicaid Gains Attention

photo of lonely boy looking at his shadow

This week has been a busy one on Capitol Hill as it relates to congressional efforts on mental health. On Sunday, a bipartisan group of twenty Senators announced they had reached an agreement on a framework related to gun safety including investments in child and family mental health services. On Wednesday, the Senate Finance Committee released a discussion draft focused on mental health care for youth in Medicaid. And yesterday, the House Rules Committee announced it will be meeting next week on the Restoring Hope for Mental Health and Well-Being Act of 2022, indicating expected House floor action on the mental health package.

For our readers here on Say Ahhh! trying to keep track of the various actions, here’s a breakdown on the Medicaid front:

Specifics remain sparse as we await legislative language on the agreement related to gun safety, but public announcements include mention of a national expansion of the community behavioral health center model and support for school-based services.

For those who may be less familiar with the community behavioral health center model – first included in the 2014 Protecting Access to Medicare Act, today, the Certified Community Behavioral Health Clinic (CCBHC) program includes various funding streams including under SAMHSA grant programs and under a Medicaid demonstration program to improve community mental health services. As we highlighted in our summary of the Build Back Better Act coverage provisions, the reconciliation package included a provision that would expand access to the Medicaid demonstration program from the current 10 states to all states for a period of two years. The President’s Budget also has a provision to expand the Medicaid CCBHC demonstration nationally and convert it into a permanent program.

So far, it’s not yet clear what the national expansion will look like or how it will be structured. According to a report by HHS on the existing Medicaid demonstration, about 23 percent of CCBHC clients were children or adolescents (ranging from 8% to 27% depending on the demonstration state). Announcements on the bipartisan agreement also mention support for school-based mental health services. Details of that support remain unclear, however, as we’ve written about here on Say Ahhh!, Medicaid can play a critical role in supporting school-based health services.

Also this week, the Senate Finance Committee released a discussion draft focused on youth in Medicaid as part of the Committee’s ongoing bipartisan mental health working group process. The draft comes on the heels of a telehealth discussion draft released last month as well as markup and committee passage of H.R.7233, the KIDS CARE Act, by the House Energy and Commerce Committee, which focuses on a number of provisions related to children and behavioral health in Medicaid and CHIP. Notably, a number of provisions from the KIDS CARE Act have been included in a manager’s amendment to be considered by the House Rules Committee as they meet on H.R. 7666, the Restoring Hope for Mental Health and Well-Being Act of 2022 next week.

Both the Senate Finance Committee discussion draft and the KIDS CARE Act have an emphasis on Medicaid and school-based services, review of state EPSDT implementation, screenings and services for youth in the juvenile justice system, and mandated HHS guidance and best practices on various topics related to youth behavioral health and Medicaid. The Senate Finance Committee discussion draft also includes a policy on same-day billing for primary care and mental health services and a provision related to out-of-state enrollment for providers serving children in Medicaid and CHIP.

While helpful first steps, to date, the efforts have largely been limited in the provision of significant new investments or enhanced funding targeted at mental health services for youth under Medicaid such as seen in standalone bills related to pediatric behavioral health services and school-based behavioral health services. As part of its declaration of a National Emergency in Child and Adolescent Mental Health, national children’s provider groups, including the American Academy of Pediatrics, have called for increased funding dedicated to ensuring all families and children, from infancy through adolescence, can access needed mental health services. Medicaid, as the single largest payer of behavioral health care and now (alongside CHIP) covering approximately half of all children in the US, plays a critical role in serving families and youth with mental health needs.

Stay tuned as we will have more updates to come as we continue to monitor these ongoing activities and unpack the legislative language.

Anne Dwyer is an Associate Research Professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.