The Trump administration released its proposed budget for fiscal year 2021 Monday.
On the behavioral health front, the budget aims to expand and extend the Certified Community Behavioral Health Clinic (CCBHC) Medicaid demonstration, significantly boosting funding to that program and a variety of others focused on mental health and the opioid epidemic. It also promises to take aim at the Institutions for Mental Diseases (IMD) exclusion rule, modifying it to allow states more flexibility.
However, the $4.8 trillion budget proposal would also mean big cuts to Medicaid, the single largest payer for behavioral health services nationwide.
While the budget proposal highlights President Donald Trump’s priorities and provides insight into the issues he will likely campaign on, the proposal has a slim chance of passing unchanged. Democrats and Republicans in Congress have already voiced concerns about various areas of the proposal.
Still, Chuck Ingoglia, President and CEO of the National Council for Behavioral Health, is chalking part of the proposed FY 2021 budget up as a win.
“In an era defined by partisan differences, one thing is clear: There is broad bipartisan support across the nation and in Washington, D.C., for addressing the nation’s suicide and opioid epidemic with expanded access to mental health and substance use treatment,” Ingoglia said in a statement.
CCBHC expansion, extension
If passed, the FY 2021 budget would allot $906 million to extending and expanding the CCBHC Medicaid demonstration program.
The program gives CCBHCs a higher Medicaid reimbursement rate in exchange for providing a comprehensive range of mental health and substance use disorder (SUD) services to the under- and uninsured. However, the demonstration program is currently only available to providers in a select few states and is set to run out this year.
The proposed budget would extend the program through 2021 for the eight states currently in the demonstration.
While providers nationwide who are not part of the Medicaid demonstration may apply for federal expansion grant money to develop CCBHC models of their own, funding for grantees is capped and runs out after two years.
The budget also includes $225 million for those CCBHC expansion grants.
“We applaud the White House and bipartisan leaders in Congress for their continued efforts to expand access to high-quality addiction and mental health treatment,” Ingoglia said in the staetment. “Much work remains to ensure that every American has access to life-saving treatment available at CCBHCs and we are grateful for the bipartisan support that has brought us this far.”
Opioid funding boost, IMD exclusion ‘modifications’
The budget proposal also aims to give the Department of Health and Human Services (HHS) $5 billion in new federal funding to fight the opioid epidemic, with $1.6 of that going to states in the form of opioid response grants. The rest of the money would go toward research, prevention, treatment and other initiatives.
On top of that, the budget proposes $44 million in distance and telemedicine grants, of which 20% would be dedicated to combating the opioid crisis in rural communities.
The FY 2021 budget also suggests changes to the IMD exclusion rule, which prevents Medicaid for paying for beneficiaries to be treated in behavioral health facilities with more than 16 beds.
The budget “modifies the Medicaid IMD exclusion to provide targeted flexibility to states to provide inpatient mental health services to Medicaid beneficiaries with serious mental illness, as part of a comprehensive strategy that includes improvements to community-based treatment.”
But, on a less positive note for behavioral health providers, the budget proposes major cuts to Medicaid and parts of the Affordable Care Act to the tune of about a trillion dollars. It also calls for Medicaid work requirements. The cuts would reduce coverage and benefits for beneficiaries, Larry Levitt, a health policy expert at the Kaiser Family Foundation, said in a tweet.
“President Trump’s budget is not going to be passed this year,” Levitt tweeted. “But, it signals that he would look to dramatically scale back the Affordable Care Act and Medicaid if he’s reelected and Republicans control Congress.”
Overall, the administration says the budget would lead to a total savings of $4.4 trillion over a decade.