Update on Federal Opioid Legislation and FY 2019 Budget

Congress has been busy this month advancing several priority items before it adjourns for the November elections. Below is an update on the opioid package and the fiscal year (FY) 2019 budget, and the impact of both pieces of legislation on mental health.


Opioid Legislation

Last week, the Senate passed opioid legislation with overwhelming bipartisan support. The Senate’s bill had several key differences from the version the House passed in June. The House and Senate have reconciled their respective versions of the bill, and, earlier today, the House voted to pass the new version of H.R. 6, the SUPPORT for Patients and Communities Act. We expect the Senate to vote on this bill next week and that the President will sign it into law.


Even though the House voted by an overwhelming bipartisan margin of 357-57 to modernize 42 CFR Part 2, which treats substance use information differently than other health information, this provision is not included in the final bill. NAMI believes that Congress cannot adequately address the opioid problem unless it aligns this outdated federal regulation with HIPAA, which protects health information for all other medical conditions.


By eliminating this provision, we continue a history of unequal treatment of substance use information that can result in tragic consequences for individuals in recovery. While we are disappointed, our work on this issue will not end. NAMI will continue to advocate in the future to make sure all health information is treated equally.


Fortunately, there are many provisions important to people with mental illness and co-occurring substance use conditions that are included in the bill, such as:

  • Requiring state Medicaid programs to suspend—not terminate—a juvenile’s Medicaid eligibility while incarcerated;

  • Expanding the use of telehealth services for substance use and co-occurring mental health conditions in Medicare;

  • Requiring state Medicaid programs to report on behavioral health quality measures;

  • Promoting incentives to help spur the use of electronic health records for behavioral health providers;

  • Mandating loan repayment for substance use treatment professionals in mental health professional shortage areas; and

  • Authorizing a pilot program to provide stable, temporary housing for individuals in recovery.


The bill also includes several changes to the IMD exclusion that are focused solely on the treatment of substance use disorders. NAMI will continue to advocate for changes that include people with mental health conditions.


FY 2019 Budget

Earlier this week, the House passed an $855.1 billion FY 2019 appropriations bill to avert an October government shutdown. The bill, already passed by the Senate, will fund the Departments of Defense, Labor, Health & Human Services (HHS) and Education for the fiscal year beginning October 1. It also includes a continuing resolution (CR) to extend current funding for agencies not included in the bill through December 7. The bill is now with the President, who has promised to sign it.


A smaller appropriations package was signed by the President on September 21 to fund several other agencies, including Veterans Affairs (VA).


Below is a summary of key provisions that impact people with mental illness and their families (increases noted below reflect additional funding over FY 2018 numbers):


Department of Health & Human Services (HHS)

National Institutes of Health (NIH)

NIH will receive $39.1B, a $2B increase, which includes:  

  • National Institute of Mental Health (NIMH): $1.812B, a $101M increase

  • The BRAIN Initiative: $429.4M, a $29M increase
    The BRAIN Initiative is a collaboration between 10 institutes at NIH, including NIMH.

  • All of Us—the Precision Medicine Initiative: $376M, an $86M increase


Substance Abuse and Mental Health Services Administration (SAMHSA)

SAMHSA will receive $5.7B, a $584M increase, which includes:

  • Community Mental Health Block Grant (MHBG): $722.6M (flat funding)
    The MHBG includes a 10% set-aside to support evidence-based programs that provide treatment for first episode psychosis (FEP).

  • Certified Community Behavioral Health Centers (CCBHCs): $150M, a $50M increase
    This funding is for states that received previous CCBHC planning grants and brought their CMHCs up to the CCBHC standards but are not the 8 states in the Excellence in Mental Health Act Demo.

  • Children’s Mental Health: $125M (flat funding)

  • Primary Behavioral Health Integration: $49.9M (flat funding)

  • Suicide Lifeline: $12M, a $4.8M increase


Department of Veterans Affairs (VA)

VA funding for mental health and suicide prevention programs includes:

  • VA Mental Health and Suicide Prevention Programs: $8.6B, a $220M increase

  • VA Medical and Prosthetic Research: $779M, a $57M increase

  • Veterans Choice Program for FY 2019: $1.25B
    The Veterans Choice Program allows veterans to receive treatment, including mental health services, in community provider settings. This program will need an additional $18.2B in funding for FY 2020 and FY 2021.


Funding for the Department of Housing and Urban Development and the Department of Justice is included in the continuing resolution.

BudgetLindsay Wallace