We’ve all heard a lot about the so-called human infrastructure bill that Democrats are struggling to come to agreement on. Much less attention has been paid to a separate process – the yearly federal appropriation bills for FY 2022. In those bills, both the House and Senate propose to continue near-historic levels of funding for mental health and addiction services passed to address the devastating impacts of the coronavirus pandemic. As of now, it’s hard to predict whether and when Congress will finalize these numbers. Odds are, though, that we’ll end up with robust investment in mental health.
Back in July, the House passed a group of appropriations bills packaged into one larger bill known as an omnibus, which contained seven of the 12 appropriations subcommittees’ bills including the Labor, Health and Human Services, Education and Related Agencies (Labor/HHS) bill. The Labor/HHS portion of the omnibus contained many mental health and substance use provisions and substantial funding for the Substance Abuse and Mental Health Services Administration (SAMHSA).
In mid-October, Democrats on the Senate Appropriations Committee released their draft bills for FY22. The Labor/HHS bill also has a substantial investment in mental and behavioral health initiatives but isn’t identical to the House version. Now the two chambers must hash out their differences to produce a spending bill to send to the President for his signature before December 3, when the short-term continuing resolution currently funding the government expires.
Let’s break down what’s the same, similar, and different about the bills.
Equally Funded Items in House and Senate Bills:
- Creating a new $10 million Behavioral Health Crisis Coordinating Office within SAMHSA
- $1.582 billion for the Mental Health Block Grant, an $825 million increase over FY21
- Creates a new 10% set-aside within Mental Health Block Grant for early intervention and prevention
- $2 billion for State Opioid Response Grants, a $500 million increase over FY21
- $136.5 million for Medication-Assisted Treatment, a $56.5 million increase over FY21
- Creates a new 10% set-aside within the Substance Abuse Block Grant to support recovery services
Similarly Funded Items in House and Senate Bills (8% difference or less):
| House | Senate |
| SAMHSA funding at $9.16 billion, an increase of $3.14 billion above FY21 | SAMHSA funding at $9.1 billion, an increase of $3.1 billion above FY21 |
| $26.2 million for the Zero Suicide program, a $5 million increase over FY21 | $27 million for the Zero Suicide program, a $5.8 million increase over FY21 |
| $113.6 million for the National Suicide Prevention Lifeline (NSPL) for the implementation of 988, $89.6 million above FY21 | $108.8 million for the National Suicide Prevention Lifeline (NSPL) for the implementation of 988, $84.8 million above FY21 |
| National Institute of Mental Health funding at $2.223 billion, an increase of $119 million above FY21 | National Institute of Mental Health funding at $2.218 billion, an increase of $113 million above FY21 |
| $2.8 billion for the Substance Abuse Prevention and Treatment Block Grant, an increase of $1 billion above FY21 | $3.008 billion for the Substance Abuse Prevention and Treatment Block Grant, an increase of $1.15 billion above FY21 |
| $375 million for Certified Community Behavioral Health Clinic Program, a $125 million increase over FY21 | $350 million for Certified Community Behavioral Health Clinic Program, a $100 million increase over FY21 |
Funding Discrepancies in House and Senate Bill (15% difference or more):
| House | Senate |
| $150 million for the Children’s Mental Health program, a $25 million increase over FY 21 | $125 million for the Children’s Mental Health program, level with FY21 |
| $25 million for Infant and Early Childhood Mental Health, a $17 million increase above FY 21 | $15.8 million for Infant and Early Childhood Mental Health, a $ 7.8 million increase above FY21 |
| Creating $100 million Mental Health Crisis Response Partnership Pilot Program | Doesn’t include pilot program |
| Increasing the crisis care set-aside in the Mental Health Block Grant from 5% to 10% | Keeps crisis care set aside in Mental Health Block Grant at 5% |
In both the House and Senate bills, there is also funding for several mental health and substance use-related items within other agencies, including workforce programs in the Health Resources and Services Administration and school-based mental health funding for the Department of Education.
Congressional leaders will have to work out topline funding differences in short order if they want to have an omnibus ready to vote on by early December. Last week, Rosa DeLauro, chair of House Appropriations, formally invited the three other top leaders of the appropriations committees from both chambers to begin negotiations aimed at reaching a bipartisan agreement. It’s unclear whether Republicans are willing yet to take her up on that offer.
As we often see at the end of the year, lawmakers may scramble to put together a consolidated appropriations bill in time to avert a government shutdown. Additionally, there is always the option for another one or two-week stopgap to give lawmakers a little more time to find agreement before the holiday recess.
If they can’t come to an agreement, there is also a decent likelihood that another continuing resolution may have to punt things into next spring. Keep in mind that House and Senate Democrats continue to negotiate with the White House on the human infrastructure reconciliation package, and the Bipartisan Infrastructure Framework hasn’t moved since late August.
The details of the House and Senate health spending bills provide a sense of the Biden Administration and Congressional priorities in mental and behavioral health. We’ll have to wait a while longer to see exactly what makes it over the finish line – and when.
Sarah Corcoran is vice president of government relations at Guide Consulting Services (GCS), a government relations consulting practice based in Washington, DC. GCS represents mental health providers, technology companies, patient advocacy organizations and state mental health agencies before Congress and the administration. A complete list of GCS clients can be found here.
