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Biden Administration's FY24 Budget Proposal Reaffirms Urgency of Addressing Nation's Behavioral Health Needs
Earlier this month, President Joe Biden released the administration’s proposed federal budget for fiscal year 2024. As he did for FY23, the president again has proposed historic investments to “transform behavioral healthcare” to address our current mental health and substance use crises.
As in the FY23 budget, the president again focuses on 3 major goals for behavioral healthcare, noting that major efforts are needed in each of the following areas:
- Strengthen system capacity;
- Connect people to needed care; and
- Develop the continuum of support in the community.
Below, I present some highlights from the FY24 budget that address these 3 themes.
Strengthen System Capacity
Grow the workforce. The COVID-19 pandemic has highlighted our long-developing workforce crisis: Today, we have capacity to serve only about one-quarter of all persons with behavioral health conditions. The president’s budget proposes almost $390 million for the Health Resources and Services Administration (HRSA) to train more than 18,000 clinicians, peer support specialists, and others, as well as to increase the number of providers practicing in high-demand areas. Further, the budget includes $37 million for the SAMHSA Minority Fellowship Program to expand the number of minority providers who can offer culturally competent services.
Implement the 988 system. Although the new 988 crisis response system has been initiated, it remains far from being fully implemented. In some states, the relationship between state call centers and local crisis call numbers has yet to be worked out. Further, many counties and communities lack the capacity to respond to 988 calls and to staff mobile crisis response teams. The budget proposes $836 million to continue implementing the 988 system, particularly at the county and local level. And it proposes an additional $100 million to continue to recruit, train, and implement mobile crisis response teams.
Connect People to Needed Care
Grow essential services. In the past quarter century, Community Mental Health Centers (CMHCs) repeatedly have been dramatically underfunded. Similarly, the Certified Community Behavioral Health Clinics (CCBHC) demonstration program has struggled financially for more than a decade. The FY24 budget proposes $124 million to make permanent the funding of CMHCs. Similarly, the CCBHC demonstration would become a permanent program with more than $20 billion in federal funding over the next 10 years.
Improve school services. Schools are a particular area of concern. In addition to the $1 billion already enacted in the Budget Reconciliation Act of 2023, the FY24 budget includes $578 million to hire more mental health workers to provide care in schools and to link more behavioral health providers with schools.
Improve Medicare services. Large numbers of persons with behavioral health conditions are eligible for Medicare services either because of the program’s disability or age provisions. The budget proposes extending to Medicare the parity requirements of the 2008 Mental Health Parity and Addiction Equity Act. It also would require 3 behavioral healthcare visits without cost sharing each year, paid with federal funding of $1.45 billion over 10 years, and it would remove the 190-day lifetime limit for inpatient psychiatric services, paid with federal funding of $1.78 billion over 10 years.
Develop the Continuum of Support
Extend insurance coverage. Good health insurance coverage is difficult to acquire and maintain for persons with mental health conditions, particularly for those who are poor. The president’s FY24 budget proposes enhanced premium tax credits for those who receive their insurance through the state marketplaces set up under the Affordable Care Act. The federal funding would be $183 billion over 10 years. Similarly, the budget proposes extending health insurance coverage to low-income individuals in states that have not extended Medicaid, at a cost of $200 billion over 10 years.
Expand home- and community-based services (HCBS). As behavioral healthcare shifts from inpatient toward community services, Medicaid HCBS are assuming a much larger role for care of persons with mental health conditions. To address this need, the budget proposes $3 billion in FY24, and $156 billion over 10 years for this program.
Moving Forward
The FY24 budget proposal assumes even more importance for behavioral healthcare as the federal government simultaneously begins “unwinding and returning to regular operations after COVID-19” under legislative mandate. This action requires that states reinstitute regular Medicaid coverage determinations for beneficiaries. Clearly, it has the potential to remove millions of persons from the Medicaid rolls in a short period. Because the Centers for Medicare and Medicaid Services assume that this problem will be very severe, it has prepared detailed guidance for persons who are removed from the Medicaid rolls.
As a field, we must do much better in advocating for the president’s FY24 budget than we did for FY23. It is obvious that we need absolutely everything the Biden administration has proposed. The federal government’s action to require states to reinstitute Medicaid coverage determinations renders such advocacy critical. I hope that you will join this essential effort.
Ron Manderscheid, PhD, is the former president and CEO of NACBHDD and NARMH, as well as an adjunct professor at the Johns Hopkins Bloomberg School of Public Health and the USC School of Social Work.
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
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