Top 10 County Policy Priorities for Behavioral Health Reform
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Blaire Bryant
Naomi Freel
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County Behavioral Health Landscape
America’s 3,069 counties are integral to America’s behavioral health system. Counties annually invest over $130 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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Reintroduced in the U.S. House of Representatives in September 2025, the bipartisan Michelle Alyssa Go Act (H.R. 5462) aims to modernize the IMD exclusion and expand access to care.
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On March 6, the Centers for Medicare & Medicaid Services (CMS) released a letter to State Medicaid Directors with implementation guidance on six-month Medicaid renewals required under H.R. 1.
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Counties can help improve health outcomes by prioritizing prevention over treatment, Robert F. Kennedy Jr., secretary of the U.S. Department of Health and Human Services told NACo Legislative Conference attendees.