5 things you need to know about Behavioral Health in Washington D.C.

As you know, County Behavioral Health Departments are regularly impacted by federal issues, policy changes and funding matters. Since federal laws and regulations supersede state authority, CBHDA is watching important issues and advocating for counties in the U.S. Congress.  Opioids, brain health, Value Based Purchasing, Inmate Medicaid eligibility and other important issues are a focus in Washington D.C. and California counties are doing their part on the national level.  Below is a short list of crucial issues you should be aware of:

1.     Medicaid - In addition to the broader policy strategy to preserve the Affordable Care Act, there are larger efforts to protect Medicaid and prevent changes to 1115b waivers that permit states to add work requirements or allow states to drop essential benefits, eliminate coverage for preexisting conditions, or limit those eligible for coverage.  Related legislation (Senator Brian Schatz) has also been introduced to place Medicaid on the ACA marketplace

2.     Mental Health Parity – Following many years after passage of the Mental Health Parity and Addiction Equity Act of 2008, the Centers for Medicare & Medicaid Services (CMS) issued in 2016 the Medicaid Mental Health Parity Final Rule (Parity Rule) to strengthen access to mental health and substance use disorder services for Medicaid beneficiaries.   This regulation requires that services for both Mental Health and Substance Use Disorder services be offered without restriction and with equal treatment.  This law is having a positive impact on strengthening the system, though over a decade later full implementation is still being realized. California has submitted a compliance plan for the Parity Rule. 

3.     Medicaid Inmate Exclusion Policy (MIEP) – Under current rules, states have the option to suspend or terminate Medicaid benefits for incarcerated individuals with behavioral health disorders. By suspending coverage, rather than terminating eligibility, the state ensures an easier and quicker transition when inmates are released from prison.  Currently 21 states utilize suspending techniques and 16 states still terminate coverage

4.     Comprehensive Addiction and Recovery Act (CARA) – Since enactment in 2015, little has been done to further fund and support recovery for opioid addiction.  Senators Whitehouse and Portman authored legislation on the subject that died during the last Congress.  Through the “State Targeted Grants Program” and the “State Opioid Response grant program” California has received over $230 million in Federal funds.  

5.     Care in Rural Environments – Network adequacy for providing care is challenging in a rural setting because of provider shortages and large service areas.  While a few bills have been introduced to bridge the gap between consumers and providers, more focus should be given to loan repayment programs and further investments should be made in telehealth.  Without further funding and policy changes rural communities will continue to struggle to provide quality care in frontier communities. 

This list of issues is limited but gives you a snapshot of a few important federal policy priorities.  Even though the current administration has been conservative in issues such as immigration and other issues the White House is continuing investments into divisions like the Office of National Drug Control Policy to address the opioid crisis. 

The 116th Congressional freshman class is showing more leadership than ever before.  Not only are they on track to be the most diverse group ever, but they have secured crucial positions in powerful committees and are already showing early wins.  A good example of this is representative Cortez’s seat on the House Financial Services Committee.  Women won about 60 percent of the flipped seats and over 20 new members have either worked in the CIA or served in the military.   This diversity has and will continue to shape the conversations on Capitol Hill. 

CBHDA will be updating you on these and other important federal issues and legislation; however, if you have any questions please contact me at rlayne@cbhda.org

Robb LayneCBHDA