Overview of FY2024 Presidents Budget Request – Mental Health Programs

By: LSN Partners on March 28, 2023

The Biden Administration’s budget request for fiscal year (FY) 2024 calls for a significant increase in funding for mental health and substance abuse programs. The President’s Budget Request (PBR) comes after the release of data from the Centers for Disease Control and Prevention in February that showed “mental health challenges, experiences of violence, and suicidal thoughts and behaviors” rose sharply during the pandemic among all teens, but particularly among girls. 

Further, more than two-thirds of public schools reported an increase in students seeking mental health services, according to an April survey by the Department of Education. However, it is essential to note that at the time of the study, only about half of the schools felt they could effectively provide the mental health services students needed. As a result, the PBR seeks higher funding levels for mental health programs throughout the federal government, including:

Mental Health Workforce

• $2 billion for a Mental Health System Transformation Fund.
• $387 million to train about 18,000 behavioral health providers.
• Expanding the types of mental health providers covered by Medicare to include clinical social workers, peer support workers, and certified addiction counselors.

Crisis Response

• $836 million for the 988 and Behavioral Health Services program to ensure 988 can respond to an anticipated 9 million contacts in 2024.
• $100 million for mobile crisis response.

Parity & Access

• $1.7 billion for the Community Mental Health Block Grant.
• $125 million to states to enforce mental health and substance use disorder parity requirements and require Medicare Advantage and private health plans to improve coverage of mental health and substance use disorder services.
• Requiring three free mental health visits annually under Medicare and private health insurance plans.
• Eliminating Medicare’s discriminatory 190-day Lifetime Limit on inpatient psychiatric hospital services, a limit that doesn’t exist for other types of inpatient care.

Children & Youth

• $578 million to increase the number of school-based counselors, psychologists, and social workers.
• $50 million to develop, expand and enhance community-based alternatives to youth incarceration.

Congress has begun the federal appropriations process on Capitol Hill and will make the final decisions on funding levels over the next nine months. While it is unlikely that the PBR’s proposals will survive intact, there is strong bipartisan support for programs focused on mental health on Capitol Hill.

Medicare & Medicaid

The budget proposes to expand access to behavioral health services for Medicare beneficiaries by requiring Medicare to cover three behavioral health visits without cost-sharing and allowing Medicare to identify and designate additional behavioral health professionals to enroll in and be paid by Medicare. The PBR also proposes to apply the 2008 Mental Health Parity and Addiction Equity Act to the Medicare program and eliminate the 190-day lifetime limit on psychiatric hospital services under Medicare. For those with commercial insurance, the PBR seeks to expand mental health coverage and strengthen the network of providers of mental health services.

The PBR proposes $150 billion to expand Medicaid home and community-based services and health centers over the next decade. In addition, the proposal seeks to lower consumer costs for Medicare beneficiaries and require parity in coverage between medical and mental health services.

Department of Education

The PBR provides $578 million toward President Biden’s goal of doubling the number of certified school-based counselors, psychologists, social workers, and other mental health professionals available to students in school. This funding is in addition to the $1 billion the Bipartisan Safer Communities Act (BSCA) provided to address school mental health staffing shortages. Additionally, the PBR includes $150 million for a new School-and Campus-Based Mental Health Service program that provides competitive grants to higher education institutions to develop a campus-wide strategy that addresses the mental health needs of students.

Department of Health & Human Services (HHS)

The PBR includes an 11% increase for HHS which consists of some of the most extensive federal mental health programs:

Health Resources and Services Administration (HRSA) – HRSA seeks to improve access to healthcare services, and the PBR includes a total of $9.2 billion which includes $1.1 billion for the Title VII health professions and Title VIII nursing workforce development and diversity programs, a $220 million (25%) increase over FY2023 enacted levels. The PBR would invest $387.4 million toward behavioral health workforce development programs to train 18,000 behavioral health providers. In addition, $1.9 billion is proposed for the Alliance for Innovation on Maternal Health (AIM) to reduce maternal mortality and reduce maternal postpartum illness and death.

The administration’s Budget Request proposes converting the Certified Community Behavioral Health Clinic (CCBHC) demonstration model into a permanent program. Established in 2014, the CCBHC demonstration model provides states with enhanced federal Medicaid funds to support participating behavioral health clinics in providing a wide range of community-based mental health, substance use, and crisis response services.

Regarding telehealth services, the PBR reiterates the Biden administration’s commitment to expanding access to telehealth services. The budget requests $45 million for HRSA to promote telehealth, an 18% increase over FY2023 enacted levels. Substance Abuse and Mental Health Services Administration (SAMHSA) – The PBR would provide more than $10 billion for SAMHSA, an increase of $3.3 billion above the FY2023 enacted level. This funding would be used to expand access to behavioral health care and grow investments in crisis response, harm reduction, the behavioral health workforce, services to people experiencing homelessness, and recovery services.

The PBR includes $4.9 billion for SAMHSA’s mental health and crisis response activities, a proposed increase of $2.2 billion, which encompasses continued investments in the 9-8-8 and Behavioral Health Crisis Services program, including a dedicated $836 million to increase capacity for 9-8-8 to respond to 100% of the estimated 9 million contacts in 2024. In addition, the budget invests in the crisis response continuum to provide the proper care to people in need when they need it most, including mobile crisis response, to which the budget allocates $100 million to expand partnerships with 9-8-8 local crisis centers, community providers, 9-1-1 centers, and first responders, to reduce reliance on law enforcement and lower the risk of excessive force in crisis response.

SAMHSA’s proposed mental health budget also includes continued mental health infrastructure investments, including $1.7 billion for the Community Mental Health Block Grant program and $553 million for the Certified Community Behavioral Health Clinics grant program.

Department of Veterans Affairs (VA)

Suicide prevention is the VA’s top clinical priority and a top priority of the Biden Administration and Congress. This budget provides $16.6 billion in FY2024 for mental health efforts, including suicide prevention, an increase over the current year’s $15 billion budget.

The PBR includes $559 million for veteran suicide prevention outreach programs and an estimated $2.5 billion in suicide-specific medical treatment. These funds will support the VA’s initiatives to provide free emergency health care to veterans in suicidal crisis at VA or non-VA facilities. The funds will also help local organizations that provide or coordinate suicide prevention services for veterans, other eligible individuals, and their families.