How Trump's Budget Will Affect People with Mental Health Conditions

By Caren Howard, MHA Advocacy Manager

You may have heard that the President released the Fiscal Year 2019 budget.

Typically, much of the budget takes form as a narrative about the administration’s strategy and perspective about the nation over the next ten years.

And though Congress is not bound by the President’s budget - the House and Senate agree to their own separate budget deal - the President’s budget is a request to Congress that highlights the Administration’s priorities.

We combed through the budget and found several key provisions that could affect people with mental health and substance use disorders.

The Fiscal Year 2019 budget requests $68.4 billion for the Department of Health and Human Services (HHS), which is a $17.9 billion (or 21 percent) decrease from the 2017 enacted level.

And the budget:

• Includes $10 billion over five (5) years to combat the opioid epidemic and serious mental illness to build upon the 21st Century Cures Act.
• Promotes structural reforms to Medicaid to eliminate the funding gap between states that expanded Medicaid under Obamacare and those states that did not expand Medicaid, and asks states to chose between a per capita cap and a block grant.
• Reduces Medicaid by $1.4 trillion, Medicare by ~$500 billion and Social Security Disability Insurance by $10 billion over ten (10) years. Medicaid and Medicare are currently the largest payers of behavioral health services in the country.
• For Medicare, proposes to test and expand nationwide a bundled payment for community-based medication assisted treatment, including, for the first time, comprehensive Medicare reimbursement for methadone treatment.
• Includes $15 million for a new Assertive Community Treatment for Individuals with serious mental illness.
• Reduces funding for the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Mental Health and Substance Abuse Treatment Programs of Regional and National Significance by ~$600 million.
• Discontinues funding for the Screening, Brief Intervention, and Referral to Treatment program.
• Increases funding for the Criminal Justice and Juvenile Justice programs by $10 million to a total of $14 million.
• Proposes to align the MarketBased Health Care Grant Program, Medicaid per capita cap, and block grant growth rates with the Consumer Price Index (CPI-U) and allows states to share in program savings.
• Consolidates federal graduate medical education spending from Medicare, Medicaid, and the Children’s Hospitals Graduate Medical Education program into a single grant program for teaching hospitals, and directs funding toward physician specialty and geographic shortages.
• Eliminates $451 million in other health professions and training programs.
• Eliminates funding for Minority Fellowship programs at SAMHSA.
• Includes $500 million for the National Institutes of Health (NIH) to support and supplement existing efforts with a publicprivate collaborative research initiative on opioid abuse.
• Integrates into one agency: the Agency for Healthcare Research and Quality, the National Institute for Occupational Safety and Health, and the National Institute on Disability, Independent Living, and Rehabilitation.
• Slashes the Supplemental Nutrition Assistance Program (SNAP), also known as food stamps, by $17.2 billion or 16 percent.
• Cuts funding for the Department of Housing and Urban Development (HUD) by 18 percent.
• Does not request any of ~$8 billion in funding currently allocated to the HUD public housing capital fund.

While there are many additional changes made in the President’s budget, we thought these critical changes would be important to you.

We encourage your questions and comments which may be sent to our Advocacy Manager, Caren Howard or Senior Policy Director, Nathaniel Counts.

If you think of ways in which you or your loved ones will be affected by thie budget feel free to also share your thoughts about the impact with your Congressional representatives by:

• Tweet them. Not sure of the Twitter handle of your members of Congress? Find them here.
• Call your Senators' office or the Capitol Hill switchboard at (202) 224-3121. Press #2. Then enter your zip code.
• Write to your Senator using Facebook's Town Hall feature. If this feature is available in your area, make sure your Constituent Badge is on. Many legislators will not read the comments of individuals who are not marked as one of their constituents.
• Meet with your elected officials. Let them know that mental health is important to you, and that you are not just a number.