As a response to the growing behavioral health crisis, including increasing rates of suicide and drug overdoses, policymakers have been advancing proposals and legislation to reform the behavioral health system and address gaps in coverage, services, and treatment. In June 2022, President Biden signed the Bipartisan Safer Communities Act, which includes policies to support community mental health, particularly for children and adolescents. This is an important first step, but the work of reforming the nation’s behavioral health system is far from complete.
Congress and the Biden administration could pursue additional policies in four key areas to reverse the current behavioral health trends.
Advancing Integrated Primary Care and Behavioral Health
Integrating behavioral health services with primary care has been shown to increase use of behavioral health services, address stigma associated with behavioral health needs, and streamline care for providers and patients alike. Despite the strong evidence base, most Americans do not have access to integrated care. To encourage integration, policymakers could:
- provide additional supports to states in designing and implementing waivers, demonstrations, and state plan amendments that scale integrated care in Medicaid and the Children’s Health Insurance Program (e.g., implementing additional incentives for primary care providers that adopt effective integrated care models)
- remove regulatory or legal barriers to allow primary care providers to prescribe medication-assisted treatments for substance-use disorders
- align payments to incentivize the integration of primary care and behavioral health
- ensure adequate incentives and financing to promote integrated primary care in small, rural, and underresourced practices, and encourage alignment among different public and commercial insurers.
Strengthening and Diversifying the Behavioral Health Workforce
The current supply of behavioral health providers is insufficient to meet current needs and is not well-equipped to deliver culturally effective and linguistically appropriate care. Many behavioral health professionals, such as marriage and family therapists, or paraprofessionals, such as peer-support specialists and community health workers, are not fully integrated into the health care delivery system. To engage a broader and more diverse group of providers to meet current need, Congress could:
- evaluate the feasibility of allowing a wider range of behavioral health providers (such as peer-support specialists) to be reimbursed under Medicare; this would require adequately incentivizing licensed providers and paraprofessionals to participate in the program
- provide support and technical assistance to states, commercial payers, and health care providers on integrating peer-support specialists and other behavioral health paraprofessionals into behavioral health payment and delivery systems
- expand training grants and loan forgiveness programs that strengthen and diversify the behavioral health workforce.
Expanding Equitable Access to Behavioral Health Services
Reforms should extend beyond the most well-resourced behavioral health providers and be monitored to ensure they are not exacerbating disparities for people from BIPOC, rural, and LGBTQ+ communities. To attend to these issues, Congress could:
- provide additional resources to conduct oversight and enforce parity requirements, such as network adequacy
- enhance federal investment for equity planning and evaluation
- invest in data collection that emphasizes patient outcomes and experiences
- encourage testing and spread of innovative delivery models, including digital innovations, that expand access
- ensure incentives are designed to promote participation among providers serving people with the greatest need.
Leveraging Medicare and Medicaid
Medicare and Medicaid pay for a large proportion of behavioral health services in the United States, but both programs have restrictions that limit how they can address behavioral health needs. To fully realize the potential of these programs, Congress could:
- align Medicare coverage with principles of behavioral health parity and close existing gaps
- extend flexibilities for telehealth in Medicare and invest in provider and patient infrastructure to ensure that virtual care reaches those who would most benefit
- promote Medicare and Medicaid coverage of innovative technologies that could increase equitable access, such as digital therapeutics, and funding to ensure access in underresourced areas.
Conclusion
Federal policymakers have made important strides on behavioral health reform. There are opportunities to build on these advances and continue expanding equitable access to effective behavioral health care, but successful reform will require leadership at all levels of government. Policymakers have the tools to reform the behavioral health system and improve the well-being of all Americans, but there is limited time to move legislative priorities in this Congress.
