The report reviewed barriers and gaps in insurance coverage for mental health and substance use services prior to the Affordable Care Act (ACA). The report found that, prior to the ACA:

  • 28 states had no requirement that individual market health insurance plans cover or even offer mental health services;
  • Health plans avoided enrolling individuals with mental health or substance use conditions by screening applicants;
  • Even when individual market insurance was accessible, insurers effectively fined people with a history of mental health or substance use conditions by applying a 20–50% increase in premiums while also excluding needed mental health and substance use services; and
  • Plans often used lifetime caps, limits on outpatient visits, limits on inpatient days covered, restricted access to mental health medications and high cost-sharing for mental health services.

While the Affordable Care Act (ACA) made mental health and substance use services an essential health benefit (EHB), there are new threats that would weaken protections in insurance coverage and hurt people with mental illness.

NAMI released a report, Mental Health Parity at Risk. The report, written by researchers at Georgetown University, highlights how badly health insurance plans treated people with mental illness before the Affordable Care Act (ACA). For the first time, comprehensive data has been gathered showing barriers and gaps in mental health and substance use coverage in the individual insurance market prior to the ACA. It highlights just how horrible things were for people with mental illness, and emphasizes the dangers of turning back the clock. You can learn more and read the report at

To discuss this report as well as other challenges we are facing, NAMI participated in a live event at Washington Post this morning. The event, Mental Health and Well-being in America, featured policymakers including Sens. Schatz and Tillis, health care experts including Dr. Josh Gordon, and others. To view this event, you can access it at

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.

Parkland Tragedy

NAMI, the National Alliance on Mental Illness, is deeply saddened by the tragic school shooting that occurred in Parkland, Florida. These tragedies impact our communities –our parents, our children, our school professionals, our first responders –the mental health of our whole country.

The details are still unfolding and there are still unanswered questions, but what we do know is that there were warning signs and that the shooter had received mental health treatment. As we continue the national discussion about what we can do to prevent further tragedies, we need to be willing to engage in an honest conversation about what allowed this young man to fall through the cracks, and the broader personal and societal factors that may have fueled his actions.

It is paramount for us to ensure the safety and wellbeing of our children and youth, and to remember that 1 in 5 people, potentially hundreds of students in a high school, have or will experience a mental illness. We need to be very careful that the response to these tragedies by the media and others does not discourage students from seeking help.

There are steps we can take now to educate and intervene early to break down barriers of understanding, and put an end to the stigma that often prevents people from getting the help they so desperately need:

1. Increase mental health awareness and availability of counselors in schools. Students should be encouraged to seek help for themselves or a friend. School  based mental health has also proven extremely effective in engaging students who would not otherwise seek help. Some states have made significant investments in school based mental health and more needs to be done

2. Train school staff, administrators, parents and youth, and provide the tools necessary to have conversations about the signs and symptoms of mental health conditions and where they can turn to for help. Far too often, when families are most in need, there isn’t a clear pathway to getting help.

3. Develop a comprehensive response program for youth who have demonstrated behavioral issues including involving family and mental health providers. Take steps to avoid expelling and suspending students as this only exacerbates the situation.

4. Increase the ability of the mental health system to be proactive in reaching out to youth, particularly those with the most serious conditions. Young people in distress will not seek help so there need to be mobile outreach responses that are funded and easily available. This requires sustained and expanded funding for coverage for mental health, not cuts.

Another part of the conversation that cannot be ignored is acting on common sense approaches to ending gun violence such as gun violence prevention restraining orders, which can allow for the removal of guns from people who may pose a risk of violence to themselves and others. While the relationship between mental illness and gun violence is very low, we need reasonable options, including making it
possible for law enforcement to act on credible community and family concerns in circumstances where people are at high-risk.

We all want an end to these horrific acts of violence.To achieve this, we need to understand the full picture of what is really driving increased violence and take sensible steps. Only then can we find meaningful solutions to protecting our children and communities.About NAMI NAMI, the National Alliance on Mental Illness, is the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness.

We support efforts to make mental health treatments and services available to all Floridians, including supportive housing and employment. We also strongly encourage the Legislature to invest in efforts that increase public awareness around the signs and symptoms of mental illness and ways that Floridians can find help.