Field Denounces Budget ‘Attack’ on Medicaid, Critical MH Supports
Mental Health Weekly May 29, 2017
The field is calling on Congress to fund critical programs and services for consumers with mental illness. They also are advocating for a bipartisan solution to ensure that everyone receives the health care they need.
Cuts to Medicaid, research, prevention programs and behavioral health workforce investments proposed in President Donald Trump’s FY 18 budget would be devastating to the mental health community, represent an “attack” on the needs of vulnerable Americans and roll back many of the advances the field has witnessed, say advocates.
Trump’s budget calls for more than $252 million in cuts to the Substance Abuse and Mental Health Services Administration (SAMHSA). Programs potentially affected include the Community Mental Health Services Block Grant, the Primary and Behavioral Healthcare Integration Program and the Behavioral Health Workforce Education and Training Program.
The U.S. Department of Health and Human Services budget is set at $69 billion for FY 18, representing a $15.1 billion decrease from the FY 17 budget.
Included in the proposal is a 13.2 percent cut for the U.S. Department of Housing and Urban Development, including elimination of the Community Development Block Grant. The budget would also cut $7.2 billion from the National Institutes of Health (NIH) — approximately a 21 percent decrease from the FY 17 level, which would result in 1,946 fewer grants.
The Trump proposal contains more than $600 billion in reductions over the next decade from the Medicaid program, which could eliminate Medicaid benefits for about 7.5 million people, according to the American Psychological Association (APA). The proposal also includes the option for states to choose between a per capita cap or a block grant beginning in FY 2020.
What would this mean for Medicaid? The recently passed GOP House reform bill, the American Health Care Act, proposes that Medicaid be slashed by $839 billion over the next decade.
“The only silver lining is that the budget likely will never become law, but it is troubling to see the administration pricing directly matching what’s in the House health care reform bill,” Chuck Ingoglia, senior vice president of public policy and practice improvement for the National Council for Behavioral Health, told MHW.
Congress completed its 2017 appropriations bill on April 28. Lawmakers worked cooperatively and in a bipartisan fashion to put the FY 17 bill together, said Ingoglia. The FY 18 proposed appropriations bill is substantially different from what Congress passed, he said.
“Trump is attacking everything from research to services, disability supports — everything anyone with mental illness [needs] to live in the community,” Ingoglia said.
Ingoglia pointed to the 21st Century Cures Act (H.R. 34), which provides major investments in opioid treatment and other prevention and treatment supports. The bill passed Congress last December (see MHW, Dec. 12, 2016). “It’s like they’re giving with one hand and taking away with the other,” he said.
Public education nixed
One of the National Council’s signature programs, Mental Health First Aid, would be “zeroed out,” according to the budget proposal, Ingoglia said. The public education program is helping communities understand mental illness and seek timely intervention.
“The budget proposal attacks so many different areas fundamental to people with mental health and addictions disorders,” Ingoglia said. Discretionary programs, the Substance Abuse and Mental Health Services Administration budget, Social Security, disability programs and the Medicaid program itself are all facing cuts, he said.
Ingoglia added, “Taken together, the budget proposal [represents] an unprecedented attack on vulnerable Americans living with mental illness.”
Services in jeopardy
The president of the American Psychological Association said the proposed cuts threaten critically needed services. “This budget, if enacted, would jeopardize our nation’s educational, scientific and health enterprises and limit access to critically needed mental and behavioral health services,” Antonio E. Puente, Ph.D., said in a press release.
Puente added, “These cutswould disproportionately affect people living in poverty, people with serious mental illness and other disabilities, women, children, people living with HIV/AIDS, older adults, ethnic and racial minorities, immigrants and members of the LGBTQ [lesbian, gay, bisexual, transgender and queer] community.”
“APA would like Congress and the administration to follow through on the intentions of the 21st Century Cures Act,” Karen Studwell, J.D., associate executive director of education government relations at the APA, told MHW. Congress makes mental health one of its priorities in the legislation, she said.
Making sure mental health is important and improving services to individuals with serious mental illness is essential, Studwell said. “Mental health was a priority for them in December,” following passage of the 21st Century Cures Act “and should continue to be so,” she said. The Senate passed H.R. 34 with a 94–5 vote on Dec. 7, 2016, following an earlier victory when the House passed it 392–26 on Nov. 30, 2016.
Studwell noted that the legislation includes provisions from the Helping Families in Mental Health Crisis Act of 2016 (H.R. 2646) and the Mental Health Reform Act of 2016 (S. 2680).
Congress was working to increase services for individuals with mental health disorders and serious mental illness by investing in those programs, said Studwell. “They’ve just reauthorized them; now fund them,” she said.
One of the priorities for the APA is an investment in the workforce programs. Trump’s budget proposal eliminates the Graduate Psychology Education Program, the Behavioral Health Workforce Education and Training Program and the Geriatric Workforce Enhancement Program, which together would reduce mental health workforce training by nearly $100 million.
One of the biggest challenges to access mental health services is the lack of a workforce, including psychologists, she said. “We need to develop programs that are training the mental health workforce,” Studwell said. “This budget would undermine the progress we’ve made on integrating mental and behavioral health with primary care.”
The Graduate Psychology Education Program represents “a two-for-one benefit because graduate students provide services at the same time they’re being trained,” said Studwell. The program is part of the Health Resources and Services Administration, she noted. Interns in psychology programs, similar to medical residents, are primarily providing clinical services under supervision, Studwell said. Funding for the program was $59 million, and the geriatric training program represented $38 million, she said. “The proposed cuts would reduce access to these critical services,” she said.
“We have a lot of population in need, such as older adults and children, and people in underserved and rural communities,” she said. Psychologists are trying to work where many people receive services, she said. “The budget would eliminate the program,” Studwell said.
The loan forgiveness program would also be eliminated under the budget proposal, she said. “That program should not be considered under appropriations,” said Studwell. “Rather, it should be addressed in the reauthorization of the Higher Education Act.”
“We’re looking forward to working with Congress to make mental health a priority and address these issues as the process moves forward,” Studwell said. •