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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CMS announces new funding opportunity for the Innovation in Behavioral Health Model
On October 16, the Centers for Medicare & Medicaid Services (CMS) released a Notice of Funding Opportunity (NOFO) for Cohort II of the Innovation in Behavioral Health (IBH) Model. This new round of funding builds on the initial IBH model announced in 2024 and continues CMS’s efforts to improve outcomes for individuals with moderate to severe mental health conditions and substance use disorders (SUDs) by advancing integration between behavioral and physical healthcare.
Michelle Alyssa Go Act reintroduced in the 119th Congress, a critical step for county behavioral health systems
On September 18, the Michelle Alyssa Go Act was reintroduced in the U.S. House of Representatives. This bipartisan legislation aims to increase the number of federal Medicaid-eligible in-patient psychiatric beds from 16 to 36, providing critical support for individuals seeking treatment for mental health and substance use disorders.
County Countdown – October 6, 2025
Every other week, NACo's County Countdown reviews top federal policy advocacy items with an eye towards counties and the intergovernmental partnership. This week features a federal shutdown FAQ, overdose prevention funding and more.