Beltway Update is an occasional column keeping you up to date on timely Congressional and administrative action on mental and behavioral health bills and policy in Washington, DC.

We are 15 months into the 118th Congress, and the low expectations for the gridlocked body have been both affirmed and defied. Flashing back to January 2023 and the start of the new Congress, most observers assumed that its intense partisan divisions would usher in an era where little policymaking would get done and that the robust funding approved by the previous Congress – including in the mental health space – was all but over.

It turns out that popular wisdom was only half right. The funding packages that were finally approved last month to keep the government open also continued to provide significant funding for mental health and substance use services.

Last year went pretty much as expected: Fewer than 30 bills became law. Many policies up for reauthorization did not move forward. Opportunities for further bipartisan, bicameral work scarcely materialized.

On the spending side, Congress eschewed the traditional funding route of an end-of-year omnibus bill. At the start of February 2024 – a full five months into Fiscal Year 2024 – zero of the 12 funding bills had been signed into law. Requirements to make across-the board 1% cuts in all discretionary spending– a process known as sequestration – seemed all but guaranteed to go into effect in April.

Then came March.

On March 8, a “minibus” appropriations package (P.L. 188-42) was signed into law by President Joe Biden for six of the 12 funding bills. While the appropriations portion of the bill did not contain health funding, it did include several health policies in an additional section.

One was reauthorization of the Medicaid policies in the SUPPORT Act, the landmark bipartisan opioid package from 2018. The bill made permanent a provision allowing states to use Medicaid funds to pay for substance use disorder (SUD) treatment in residential facilities with 16 or more beds, known as “Institutions for Mental Disease” (IMDs).

The bill also included several other important policies. One was a provision requiring that when people insured through the federal Medicaid program are in jail or prison, their coverage will be temporarily suspended rather than fully terminated – thus allowing them to reactivate their coverage and more easily access health services upon release.

Another is a new requirement that the Department of Health and Human Services (HHS) issue guidance on ways that states can access funds through Medicaid and the Children’s Health Insurance Program (CHIP) to improve mental health and substance use disorder services.

Finally, it defines a relatively new type of mental health treatment center known as Certified Community Behavioral Health Clinics (CCBHCs) in Medicaid statute. And it makes permanent the requirement that state Medicaid programs cover all forms of medications for the treatment of opioid use disorder.

Two weeks later, the final six appropriations bills – including funding for HHS – were passed after another round of “beat the clock.” The final numbers suggest that, at least for the moment, funding for mental health retains strong – almost unique – bipartisan support, despite the push by the House majority to make severe cuts across non-defense appropriations bills.

The bill provides significant funding to the Substance Abuse and Mental Health Services Administration (SAMHSA), including:

• $7.4 billion for SAMHSA, an increase of $19 million above fiscal year 2023
• $1.93 billion for Substance Use Prevention, Treatment, and Recovery Services Block Grant
• $1.58 billion for State Opioid Response Grants
• $1 billion for the Community Mental Health Block Grant, including a requirement that each state continue to devote at least 5% of its grant to build out crisis care services
• $520 million for the 988 Suicide & Crisis Lifeline, an increase of $20 million over the level in FY23
• $385 million for Certified Community Behavioral Health Clinics, continuing the FY23 funding level
• $55.9 million for Primary and Behavioral Health Care Integration program
• $28.2 million for National Strategy for Suicide Prevention
• $26.2 million for Zero Suicide Program
• $27.9 million for Mental Health Awareness Training
• $20 million for Mental Health Crisis Response Grants, continuing the FY23 level

While it’s clear that more is needed to tackle the scale of mental health and substance use crises the United States faces, this bill makes one thing clear: Mental health funding is still a bipartisan priority on Capitol Hill.

Sarah Corcoran is senior vice president & chief operating officer 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.