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% of the US population.

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DOJ terminates justice and public safety-focused grants

On April 22, the U.S. Department of Justice’s largest grant-making arm—the Office of Justice Programs—abruptly cancelled hundreds of grants awarded to county governments and other local jurisdictions and organizations. Approximately 365 grants have been identified for termination, which were estimated to be valued at $811 million at the time of awarding; it is unclear how much funding remained at the time of termination.

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Advocacy

NACo offers new Medicaid resources as Congress advances Budget Resolutions with major Medicaid reform implications

On April 10, the U.S. House of Representatives voted to adopt a Senate-passed budget resolution, marking the next step in the budget reconciliation process. The proposed funding levels therein represent significant potential cost shifts to counties, particularly in the area of Medicaid financing. To help county leaders understand what’s at stake, NACo has developed two new resources.

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Advocacy

County Countdown – April 21, 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 the ARPA reporting deadline, a budget reconciliation update and more

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Advocacy

U.S. House reintroduces legislation to address the Medicaid Inmate Exclusion Policy

Two bipartisan bills aimed at addressing the Medicaid Inmate Exclusion Policy (MIEP) were recently reintroduced in the U.S. House of Representatives.

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Advocacy

House E&C Committee advances SUPPORT Act reauthorization

On April 9, the U.S. House Energy and Commerce Committee marked up the SUPPORT for Patients and Communities Reauthorization Act of 2025. The bipartisan bill aims to reauthorize critical programs that target overdose prevention amid the renewal of the opioid crisis Public Health Emergency declaration.

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County News

Bird flu update: What county leaders should know

As of April 7, there have been 70 confirmed cases of bird flu in the United States, but no person-to-person spread has been detected.