Top 10 County Policy Priorities for Behavioral Health Reform
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County Behavioral Health Landscape
America’s 3,069 counties are integral to America’s behavioral health system. Counties annually invest $83 billion in community health systems, including behavioral health services. Through 750 behavioral health authorities and community providers, county governments plan and operate community-based services for persons with mental illnesses and substance use conditions. County-based behavioral health systems exist in 23 states that represent 75 percent of the U.S. population.
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NACo Commission on Mental Health and Wellbeing
(2023-2024) Counties increasingly handle direct mental health service. NACo’s Commission on Mental Health and Wellbeing developed reports and united county leaders to address the mental health crisis through key policy priorities.
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U.S. House reintroduces legislation to address the Medicaid Inmate Exclusion Policy with NACo support
Two bipartisan bills aimed at addressing the Medicaid Inmate Exclusion Policy (MIEP) were recently reintroduced in the U.S. House of Representatives.
U.S. House of Representatives re-establishes Bipartisan Mental Health Caucus with NACo support
On May 7, members of the U.S. House of Representatives appointed new leadership to the Bipartisan Mental Health Caucus, reaffirming their commitment to addressing the nation’s mental health crisis through cross-party collaboration.
House passes SUPPORT Act reauthorization
On June 4, the U.S. House of Representatives passed the SUPPORT for Patients and Communities Reauthorization Act of 2025 (H.R. 2483) by a strong bipartisan vote of 366–57. The bill, which reauthorizes billions of dollars for critical programs that target overdose prevention, now heads to the Senate Committee on Health, Education, Labor and Pensions, where a version of the bill was overwhelmingly advanced with bipartisan support in the 118th Congress.