County mental health advocates take issues to Capitol Hill

Key Takeaways

Amid efforts of their own at home to better treat mental health, members of NACo’s Mental Health and Wellbeing Commission asked Congress for the tools to do that work more effectively.

They aimed their advocacy efforts at the Due Process Continuity of Care Act, the Institutions for Mental Diseases exclusion and reauthorizing the SUPPORT Act during a May 2 briefing on Capitol Hill in Washington, D.C.

Originally enacted in 2018, the SUPPORT Act contained important funding for community-based treatment and recovery programs and enacted key policy changes, including requiring state Medicaid programs to cover buprenorphine, methadone and naltrexone, all FDA-approved medications for opioid use disorder.

“This legislation emphasizes the need to address mental illness and substance use disorder concurrently, something that aligns with our commission’s priorities,” said Dow Constantine, King County, Wash. executive and a co-chair of the commission. 

David Crowley, Milwaukee County, Wis.’s executive, chair of NACo’s Large Urban County Caucus and a member of the commission concurred.

“Reauthorizing the SUPPORT Act is imperative for counties to continue to address the ever-growing needs of our residents and to make pivotal changes to reduce barriers to accessing services,” he said.

April Aycock, director of Monroe County, N.Y.’s Office of Mental Health and a member of the commission, noted that access to timely mental health services is severely limited, reforming the Institutions for Mental Diseases (IMD) exclusion could help by relaxing restrictions on residential facilities. Medicaid currently limits residential facilities to 16 beds, which creates significant barriers at the local level in providing clinically necessary inpatient care and exacerbated issues accessing care for low-income individuals.

“Reforming the IMD exclusion is critical to expanding access to crisis care and supporting building out the infrastructure in local communities to deal with the present behavioral health crisis,” she said.

“I want to urge how critical stable financing for service provision through Medicaid is to support the sustainability of local crisis response infrastructure,” she said. “Future and further federal investment will aid counties in providing crisis stabilization services for those with ongoing mental health and substance use issues, as the demand for crisis services continues to grow.”

The Due Process Continuity of Care Act would amend the Medicaid Inmate Exclusion Policy to allow access to Medicaid coverage for pretrial detainees.

Orange County, Fla. Mayor Jerry Demings, a former sheriff, noted that the cost of providing mental health services to pre-trial detainees creates an undue burden on counties, particularly because roughly half of the people in the criminal justice system suffer from mental illness and most of them have a co-occurring substance use disorder. The Due Process Continuity of Care Act would address the Medicaid Inmate Exclusion Policy, continuing coverage through adjudication. 

“Considering the significant changes in our national approach to healthcare and mental health over the past few years, and taking into account all that has, and will be presented today, it’s clear that a reevaluation of the federal Medicaid exclusionary policies is necessary if we want to address all barriers to community-based mental health and substance use disorder services,” Demings said. “Despite regulatory advancements in this space —  which have provided significant flexibilities for states and local governments to coordinate pre-release services and access to care — meaningful change can only be achieved through permanent federal policy change.” 

He noted that the change would have a net positive effect for the general population because 95% of incarcerated people return to their communities, “bringing their health conditions with them.”