Bipartisan Budget Deal Includes Wins for Health, MH Priorities

The bipartisan budget agreement Congress passed last month provides funding for important mental health initiatives for which APA lobbied hard, including earmarking $6 billion to confront the opioid epidemic as well as extending the state Children’s Health Insurance Program (CHIP).

The Bipartisan Budget Agreement of 2018 extends CHIP through 2028, marking the longest reauthorization in the program’s history. This decade-long renewal ends the recent uncertainty felt by families and state officials, as the program had technically expired and was relying on a temporary spending allotment for several months, with several states running critically low on funds.

CHIP is a federal-state partnership that provides comprehensive health insurance coverage for children whose families earn too much to qualify for Medicaid, but not enough to afford private insurance. CHIP insures 9 million children, including 850,000 children with serious behavioral or emotional disorders.

The agreement contains a new requirement for states to report pediatric health quality measures starting in 2024 and a continuation of CHIP’s “express lane eligibility,” which permits new participants based on their eligibility for other state welfare programs.

The CHIP extension became more politically palatable after a scoring by the nonpartisan Congressional Budget Office (CBO) showed that a 10-year extension would reduce the federal deficit by $6 billion. However, a sizeable portion of the cost savings comes from a reduction in the average federal match rate: 70 percent in 2021 and beyond, down from 93 percent in 2019. This will force states to shoulder more of the costs of the program.

The budget agreement, passed February 9, scraps the spending “caps” imposed during the Obama administration and increases government spending by $320 billion over two years, according to the CBO. The agreement keeps the federal government in operation through March 23, giving Congress time to refine the details of its plan in an omnibus spending package. Meanwhile, a White House tax and spending plan issued February 12 calls for $3 trillion in spending cuts to Medicare, Medicaid, food stamps, and other social programs.

APA applauded the Congressional budget agreement’s provision of $6 billion to help fight the nation’s opioid epidemic, primarily through state grants aimed at fighting drug abuse and expanding treatment for mental illness and substance use. Another $2 billion over the next two years will support research at the National Institutes of Health, including its study of nonopioid pain therapies.

“We are pleased that the budget deal includes $6 billion to fight opioid abuse, one of the most critical public health issues facing our nation today,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “The opioid crisis has taken a heavy toll on millions of families in America. Our members stand ready to provide our expertise in treating this epidemic.”

Additional mental health care provisions in the budget agreement include the following:

Levin sent a letter to congressional leaders to acknowledge their efforts to facilitate funding for mental health–related programs. “We recognize that Congress faces difficult decisions in funding myriad priorities with increasingly limited resources and appreciate your efforts to prioritize funding for mental health-related programs,” he wrote. “Through enhanced federal commitment to programs—stimulating the mental health workforce, furthering evidence-based practices, and advancing medical research—we can ensure the next generation of mental health professionals are well prepared to combat current and future health-related challenges.” ■

APA’s press statement on the budget legislation can be accessed here. Levin’s letter to congressional leaders can be read here.