NAMI Advocacy: Wins for Mental Health in FY 2023 Federal Spending Package
To: NAMI Leaders
From: NAMI Government Relations, Policy & Advocacy Team
Date: December 22, 2022
RE: Wins for Mental Health in FY 2023 Federal Spending Package
This week, Congress released an “omnibus” year-end legislative package, which funds the federal government for the remainder of Fiscal Year (FY) 2023 (through September 30, 2023) and addresses many key mental health policy priorities. We anticipate the legislation will pass both the Senate and House before a funding deadline runs out on Friday, December 23.
For more than a year, key committees in both the House and Senate have worked in a bipartisan manner to address our nation’s mental health crisis. While not all proposed solutions made it in the final package, the legislation does take a significant step in addressing key areas, like telehealth, workforce and crisis services, among many others. NAMI released a statement today on the legislation.
In this email, we highlight the major policy wins in the bill that impact people with mental illness and their families, as well as provide details on appropriations for key mental health programs in the table below.
NAMI is committed to working with congressional leaders in the new Congress convening on January 3 to enact mental health proposals that did not make it into the end-of-year legislation.
Mental Health Policy Highlights from FY 2023 Spending Package
The omnibus legislation includes the “Health Extenders, Improving Access to Medicare, Medicaid, and CHIP, and Strengthening Public Health Act of 2022”, which has a heavy focus on mental health. The package included many wins for mental health, and many provisions that have been a specific goal of NAMI’s advocacy. Earlier this month, NAMI called on Congress to pass these provisions in a full-page ad in Politico.
Below is a high-level overview of key mental health policies in the bill, followed by a detailed overview on FY 23 appropriations related to mental health:
Focus on crisis services: The legislation provides $501.6 million for the 988 Suicide and Crisis Lifeline (“988”), a nearly $400 million increase from FY 22, supporting the 988 network to increase capacity as demand continues to grow. It also includes $20 million for the Mental Health Crisis Response Partnership Pilot Program, double the $10 million appropriated in FY 22, that will help communities establish mobile crisis teams that provide a non-law enforcement response to people in mental health crises.
The bill also focuses on the sustainability of a mental health crisis continuum of care by increasing Medicare payments for certain crisis services provided by a mobile crisis unit, starting in 2024.
The bill also requires the Department of Health and Human Services (HHS) to issue guidance on how to develop an effective crisis continuum of care. These provisions will support expansion of services for people in a mental health, substance use or suicidal crisis.
Crisis response services have been a focus of NAMI’s recent work. You can learn more and see our advocacy on this issue in a letter organized by NAMI to congressional leadership, a one-pager delivered by NAMI executive directors to Capitol Hill in late November, NAMI’s leadership in recruiting cosponsors for the 988 Implementation Act, and our work to engage multi-sector organizations in crisis response through the #ReimagineCrisis campaign.
The Mental Health Block Grant (MHBG) surpasses $1 billion! For the first time, funding for the MHBG surpasses $1 billion in annual funding. The block grant helps state and local governments address mental health gaps and needs in their communities, and the funding requires states to spend at least 5% of their block grant funds on mental health crisis services. See NAMI’s FY 23 funding requests to House Appropriations Committee leadership.
Two-year telehealth extension: The bill also includes a two-year extension of telehealth provisions in Medicare, lasting through the end of 2024. Telehealth, while not the best option for every person with mental illness, vastly improves accessibility, particularly in rural and frontier areas. The bill delays a requirement that a person meet with a provider in-person to receive tele-mental health and allows for audio-only telehealth, which is important for people with limited access to internet. Learn more and see our advocacy urging action in a year-end bill here, as well as joint letter with other mental health groups.
Improving mental health care for justice-involved youth: NAMI has long advocated for eligible people in the criminal justice system to be connected to care prior to their release from incarceration – reducing interruptions to their mental health treatment and recovery. Starting in 2025, this legislation requires states to provide screening, diagnostic care and case management services for justice-involved youth who are eligible for Medicaid or CHIP 30 days prior to their release from incarceration and to continue case management for at least days after release. These changes will help ease the transition back to the community by connecting youth to vital mental health services that can help reduce recidivism.
Learn more about the importance of improving transitions for people leaving incarcerated settings and see our advocacy in a letter to Senate Finance leadership, a briefing NAMI cohosted, and a joint statementreleased with partners.
Expansion of the mental health workforce, including peers: More than 150 million people live in a mental health provider workforce shortage area. Covering a range of mental health professionals is crucial to addressing that shortage, and the bill adds marriage and family therapists (MFTs) and mental health counselors (MHCs) to the list of covered providers in Medicare, starting in 2024. Medicare not only covers many people with mental illness, but it also impacts the coverage decisions of private health insurance plans. NAMI advocated for this issue in our Hill Day with NAMI executive directors in late November and included this in our top year-end legislative asks.
The bill also creates a new grant program to develop, expand and enhance access to peer-delivered services – at a national, state or local level – for activities like peer workforce development, expanding virtual peer support services and more.
Additionally, the legislation requires that Medicaid programs publish searchable and regularly updated directories of health care providers in their networks, including providers of mental health and substance use disorder services. This would take effect in mid-2025, and it would help alleviate a lot of the challenges that NAMI members face in finding providers in their network. Learn more and see our advocacy on this issue in a letter to House Ways and Means leadership.
SAMHSA reauthorization: Authorization for many SAMHSA grant programs, including Garrett Lee Smith Youth Suicide Prevention Program, the Mental Health Block Grant, Mental Health Training Awareness grants, Assertive Community Treatment grants, among many others, which expired in September 2022. They are now authorized through 2027. NAMI sent detailed requests on this reauthorization, available here.
Improvements for parity: The bill sunsets a provision that allows non-federal (state or local) government plans to opt out of providing certain health benefits, including mental health and substance use care. Now, the public employees covered by these plans will get mental health benefits at parity with their physical medical care. NAMI actively advocated for this change. The bill also creates new state grants to help enforce and ensure compliance with mental health and substance use disorder parity provisions, which NAMI joined partners in supporting.
Investments in housing: Congress increased Section 811 housing for people with disabilities to $360 million, which will provide $148.3 million for new capital advance grants. These are projected to create 1,600 new units.
Focus on Veterans’ mental health: The legislation also includes $13.9 billion for Mental Health and Suicide Prevention Programs at the Department of Veterans Affairs, an increase of $700 million from FY 2022. The legislation also eliminates copayments for the first three mental health outpatient visits for veterans in a calendar year, more fully recognizes peer support specialists and makes advancements for those with treatment-resistant depression.
In addition to the omnibus package, last week Congress also passed two bills that will help divert people with mental illness from the criminal justice system:
The Justice and Mental Health Collaboration Reauthorization Actreauthorizes a grant program by the same name, which provides resources to states and communities to address the high rates of people with mental illness involved in the criminal justice system. NAMI actively advocated for this legislation to advance our work to divert people from justice system involvement.
The Law Enforcement De-escalation Training Act creates a new funding stream through the Edward Byrne Memorial Justice Assistance Grant Program for states to train law enforcement in de-escalation, with support from the U.S. Department of Justice to evaluate and identify best practices in de-escalation training. NAMI fought for this bill, joining partners to make it possible.
Summary of Mental Health Provisions in FY 2023 Appropriations
(The table includes comparisons to FY 2022 funding levels for programs and funding changes between FY 2022 and FY 2023). All numbers are listed in millions: