From Medicaid Changes to Parity Enforcement: What a Biden Administration Means for Behavioral Health

It seems America has spoken: Joe Biden will be the next president of the United States. 

While it’s still too early to know exactly what Biden’s policy platform will look like, experts anticipate the new administration will usher in a number of positive changes for the behavioral health industry.

“Biden and his history indicate that he’s somebody who knows how to make the trains run and find opportunities where there are opportunities to work together,” Shawn Coughlin, president and CEO of the National Association for Behavioral Healthcare (NABH), told Behavioral Health Business. “We are cautiously optimistic — or just optimistic. I wouldn’t even say cautious.”

Coughlin’s optimism is rooted largely in Biden’s track record as the vice president under Barack Obama and as a longtime senator in the state of Vermont. In his nearly 50 years in federal government, the president-elect has frequently shown his support for behavioral health initiatives.

He was a strong supporter of the Mental Health Parity and Addiction Equity Act and went on to ensure parity was included in the Affordable Care Act (ACA). Additionally, he was instrumental in making sure that substance use disorder (SUD) treatment and mental health treatment were defined as essential benefits under the ACA.

On top of all that, Biden has been open about his son Hunter’s past struggles with drug abuse.

Combined, all that history also has leaders at the National Association of Addiction Treatment Providers (NAATP) feeling hopeful about the behavioral health industry’s outlook under the Biden administration.

“He understands that addiction is a medical condition and not a moral failing,” Mark Dunn, director of public policy for NAATP, told BHB. “So we’re encouraged, and we think he’ll be very supportive of the field.”

Already, Biden’s actions as president-elect have proved promising for the behavioral health industry. On Monday, he announced the creation of a 13-person Transition COVID-19 Advisory Board, which will be co-chaired by former Surgeon General Dr. Vivek Murthy, a longtime behavioral health advocate.

“If President Biden will be listening to people like him, we feel really good about it,” Dunn said.

Meanwhile, Coughlin said he hopes and expects the advisory board will be indicative of what to expect during Biden’s tenure: a host of seasoned health care professionals in leadership roles.

Issues to watch

Under the Biden administration, big issues for behavioral health providers to watch include the ACA, Medicaid and COVID-19 relief, according to Andrew Sperling, director of legislative affairs for the National Alliance on Mental Illness (NAMI). 

“The attacks and efforts to undermine the Affordable Care Act will cease,” he told BHB. “That’s probably the first, biggest thing that’s going to happen.” 

The Trump Administration has attempted to strike down the ACA, asking the Supreme Court to overturn the health care reform law, which has helped millions gain access to behavioral health coverage.

While the high court heard arguments in the case Tuesday, it’s unlikely they’ll reach a decision before late spring or early summer, according to Matt Wolfe, partner at the law firm Parker Poe. However, the Biden administration will likely act before then, Wolfe predicted. 

“I don’t think that the Biden administration is going to just sit on its hands until the Supreme Court decides,” Wolfe told BHB. “I think they’re going to move forward with the presumption that the ACA will be upheld as constitutional.”

Sperling agreed, saying he expects the president-elect to act early and aggressively as it relates to the ACA. Specifically, he speculated Biden may restore funding for care navigators, who assist with and promote ACA enrollment and were defunded by President Trump. Additional Sperling believes Biden could pursue rule-making to reverse short-term limited duration policies and restore advanced premium tax credits. 

In addition to the ACA, Biden is likely to make changes to Medicaid, the nation’s single largest payer of behavioral health services, Sperling said. For example, he expects to see the administration move away from Medicaid block grants, which many providers fear would limit beneficiaries’ access to behavioral services.

Finally, Sperling predicts the industry will see some movement on the COVID-19 relief front.  

“Both the House and the Senate bills … include funding for substantial one-time increases for the mental health block grant and the substance abuse treatment and prevention block grants. So both of those block grants would get a lot of money — in fact, a lot more than their current appropriations.”

In addition to those three issues, other big policy point is likely going to be the enforcement of parity, according to Wolfe. While parity has been the law of the land for years, enforcement is lax to say the least. However, Wolfe anticipates that could change under Biden. 

“A lot of people are expecting that a Biden administration would put more resources into doing [enforcement],” Wolfe said. 

Despite all these predictions, it’s worth noting that Biden’s policy progress will somewhat depend upon who controls the Senate, which will likely come down to a Jan. 5 runoff in Georgia.