U.S. House of Representatives introduces legislation to expand Medicaid coverage for behavioral health treatment facilities

Key Takeaways

On June 20, a bipartisan group of lawmakers introduced the Increasing Behavioral Health Treatment Act (H.R. 4022) in the U.S. House of Representatives. This bill aims to improve access to behavioral health care nationwide by removing long-standing Medicaid funding restrictions for behavioral health treatment in certain facilities, providing new flexibility for states and counties to meet growing behavioral health needs.

What is the Increasing Behavioral Health Treatment Act

The Increasing Behavioral Health Treatment Act would remove the Medicaid Institutions for Mental Disease (IMD) payment prohibition for states that submit a plan to:

• Increase access to outpatient and community-based behavioral health care,
• Expand the availability of crisis stabilization services, and
• Improve data sharing and coordination among physical health, mental health, addiction treatment providers and first responders.

Read the Bill Learn More about IMD

Impact on counties

Counties play a pivotal role in the nation's behavioral health system, acting as the safety net for residents in need. They serve as first responders and operate crisis lines, public hospitals and detention centers. About two-thirds of the U.S. population relies on county-based behavioral health services through more than 750 county-supported or operated behavioral health authorities. In nearly every state and the District of Columbia, at least one mental health facility is operated by a county, local or municipal government. Furthermore, counties help finance and administer Medicaid services, the largest funding source for behavioral health services in the United States. 

Without reforms to the Medicaid IMD exclusion policy, patients will continue to be diverted from capable mental healthcare institutions, leading to an overreliance on emergency departments or leaving residents with no care at all. This diversion not only places financial burdens on counties but also creates administrative complexities.  

Enactment of the Increasing Behavioral Health Treatment Act would reform the IMD payment prohibition, which has long been a barrier for counties seeking to provide timely and comprehensive care for individuals experiencing mental health or substance use crises.