Congress Includes Medicaid, CHIP Mental Health Provisions in End of Year Funding Bill

[The bipartisan spending plan was approved by Congress and signed into law by the President on December 29, 2022. Read CCF’s brief to learn more.]

As my colleagues on Say Ahhh! have highlighted the omnibus appropriations bill released earlier today includes a number of provisions related to Medicaid and CHIP such as funding for Puerto Rico and the territories and policies related to Medicaid’s continuous coverage protection and children’s continuous eligibility. Yet, also tucked in the four-thousand-plus page package are a number of Medicaid and CHIP provisions related to mental health.

For those of you who are interested, here’s a high-level rundown of the Medicaid and CHIP mental health-related provisions included in the bill:

  • Required screenings, referrals, and case management for eligible juvenile youth in public institutions: Starting January 1, 2025, the bill would require state Medicaid and CHIP programs to provide: (1) in the 30 days prior to release, medically necessary screenings and diagnostic services in accordance with EPSDT requirements, including behavioral health screenings or diagnosis services to eligible juvenile youth in public institutions and (2) in the 30 days prior to release and for at least 30 days following release, targeted case management services, including referrals to appropriate care and services. It would also align CHIP rules with existing Medicaid rules regarding suspension rather than termination of coverage while a child is an inmate of a public institution and related requirements regarding redetermining coverage. These provisions could be particularly helpful for youth in the juvenile justice system who are more likely to have mental health needs.
  • State option to provide Medicaid and CHIP coverage to juvenile youth in public institutions (pending disposition of charges): Under the bill, starting January 1, 2025, states would also have the option to provide Medicaid and CHIP coverage to juvenile youth in public institutions during the initial period pending disposition of charges. Under current law, states are generally prohibited from using federal funds such as Medicaid and CHIP to provide medical care to inmates of a public institution – often referred to as the inmate exclusion. Notably, a number of states have pending 1115 demonstration requests focused on improving health outcomes for justice involved individuals.
  • Improved Medicaid and CHIP provider directories: Starting July 1, 2025, the bill would require state Medicaid and CHIP fee-for-service programs and managed care plans to publish searchable provider directories including information on whether the provider is accepting new patients, the provider’s cultural and linguistic capabilities, whether provider offers services via telehealth and other information. Often referred to as ghost or phantom networks, network directories with listings of providers who did not see Medicaid patients have been linked to access barriers.
  • Guidance and technical assistance center on continuum of crisis response services: The bill would require HHS to issue guidance to states and set up a technical assistance center by July 1, 2025 on the continuum of crisis services in Medicaid and CHIP, including how Medicaid and CHIP can support crisis call centers including the 988 crisis services hotline and best practices for the operation of a continuum of crisis response services under Medicaid and CHIP. It would also provide $8 million in funding to the Secretary to carry out the activities.
  • Extension of the Money Follows the Person Rebalancing Demonstration through FY 2027: The bill would extend funding for the Medicaid Money Follows the Person Rebalancing Demonstration (MFP) for four additional years through fiscal year 2027 at current funding levels of $450 million per year. Initially created in 2005 under the Deficit Reduction Act, current funding for the program is set to expire at the end of this fiscal year. While the MFP provision  is not directly included in the Medicaid and CHIP mental health section of the bill, as noted by CMS in 2013 guidance, MFP provides an opportunity for states to offer community-based services and supports to youth transitioning from pediatric residential treatment facilities or psychiatric hospitals. As of May, 36 states were listed as MFP grantees yet according to a 2017 report to Congress, “few MFP participants are transitioning from psychiatric facilities.” Accordingly, with a four-year funding extension, states could leverage MFP to better support home and community-based services and supports for youth with behavioral health needs, especially in light of recent reports of states unnecessarily institutionalizing children with mental health needs.

In addition to the Medicaid and CHIP-related provisions, the bill also includes various public health-related provisions from the Restoring Hope for Mental Health and Wellbeing Act including policies related to maternal mental health. The omnibus bill does not however, include a number of other provisions from the bipartisan Senate Finance Committee working group drafts such as requiring states to allow same-day billing in Medicaid and creating a Medicaid provider capacity demonstration to provide extra funding support to build mental health provider capacity in Medicaid.

We will continue to watch closely as the bill makes its way through the legislative process. As always, keep your eye out on Say Ahhh! for updates.

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