Biden Budget Proposes Strong Support for Behavioral Healthcare

Ron Manderscheid, PhD

Adjunct Professor,

University of Southern California

&

Johns Hopkins University

For the past three years, President Biden and his Administration have placed great emphasis on improving mental health and substance use care in the United States. They have done this by proposing major investments in behavioral healthcare—training more professional and paraprofessional providers; sustaining Community Mental Health Centers; implementing a national Certified Community Behavioral Health Clinic system; extending care into schools, libraries, community centers, and homeless shelters; expanding parity to all insurance providers, including Medicare; and eliminating or reducing health insurance co-pays for behavioral healthcare.

In his 2024 State of the Union address on March 7, President Biden again spoke passionately about the need to expand community mental health and substance use services. He also reiterated his fervent desire to implement the Administration’s Unity Agenda for America including its behavioral healthcare initiatives.

In previous years, the Unity Agenda has included many proposals that would impact upon behavioral healthcare: extend parity to Medicare, finalize parity regulations for private insurance; close the Medicaid gap (specifically, for states that have not adopted the Medicaid expansion, close the health insurance coverage gap between state Medicaid programs and insurance offered through the state health insurance marketplaces); reduce and cap prescription drug prices; improve the range of Medicare services that address behavioral healthcare conditions; and expand Medicare incentive programs for behavioral healthcare providers. However, most of these provisions have not yet been enacted by the Congress.

The President’s Budget for FY2025 restates and expands many of these proposals. Below, I present a high-level overview of the Administration’s budget proposals for FY2025 that are crucial for behavioral healthcare.

Parity: The President’s proposal would require commercial plans to cover mental health and substance use care benefits and to provide adequate community behavioral health provider networks. Further, the Department of Labor would be given authority to monitor compliance and enforce these provisions ($275 million over 10 years) and to support state parity enforcement activities ($10 million, with $125 million over 10 years.

Strengthen Medicare and Medicaid: The Medicare Trust fund would be strengthened through new tax provisions; managed care companies would be required to pay Medicaid back when they charge the program more than they actually spend.

Home and Community-Based Services: This Program would be strengthened so that more disabled participants can stay in their own homes and remain active ($150 billion over 10 years).

Behavioral Health Workforce: The Health Resources and Services Administration would continue its behavioral healthcare professional and paraprofessional training program, with funding to train 15,500 persons, and would add a new Youth Behavioral Health Training Program, including for youth peers ($254 million).

Behavioral Health Service Infrastructure: SAMHSA would receive $8.1 billion, up $612 million from FY2024. This would include funding for the following programs: Substance Use Prevention and Treatment Block Grant ($2.0 billion); State Opioid Response Program ($1.6 billion); Community Mental Health Services Block Grant ($1.0 billion); Community Mental Health Centers ($413 million); Certified Community Behavioral Health Clinics ($450 million); 988 ($601 million), including mobile crisis response teams ($40 million); Project AWARE ($190 million); and Child Mental Health Services ($150 million).

Special Behavioral Health Initiatives:  The Administration also proposes to fund the following special initiatives: Improve behavioral health information technology infrastructure ($1 billion, with $2.1 billion over 10 years); eliminate the 190 day lifetime limit for inpatient behavioral healthcare in the Medicare Program ($140 million, with $2.1 billion over 10 years); and support a Mental Health Transformation Fund ($400 million, with $2.0 billion over 10 years).

Federally Qualified Health Centers: The Health Resources and Services Administration would receive $8.2 billion for the Centers Program, including funds for mandatory doubling of the Program ($6.3 billion) and for discretionary operations ($1.9 billion). Prior to COVID-19, more than 8 million people per year received behavioral health services from these Centers.

Veterans’ Behavioral Health Benefits: The President’s Budget invests in the Department of Veterans Affairs research programs ($135 million), together with the VA Medical Care program ($17.2 billion), to increase access to quality mental health care, with the goal of helping veterans take charge of their treatment and live full, meaningful lives. Also, this Budget provides funding to further advance the Administration’s veteran suicide prevention initiatives and to support the Department of Defense’s efforts on Suicide Prevention and Response.

Once again, President Biden has proposed urgently needed funding for behavioral healthcare. Now, it is our turn to step up, to organize, and to advocate strongly with the Congress to assure that the President’s proposals actually are enacted and implemented. We must set aside our disciplinary and personal interests, and we must seek what is best for the entire field. I implore you to urge your national organizations to join this essential effort, and for you to join as well. The behavioral wellbeing of all Americans depends upon the outcome.

© 2024 R.W. Manderscheid