Budget proposal offers new money, but possible Medicaid changes could offset that

On the campaign trail, President Donald Trump pledged to expand mental health programs. His fiscal year 2019 budget takes some steps forward, but other parts of his budget blueprint — as well as other legislative efforts — are a step back.

The president's budget highlights several line items that enhance efforts on mental health.

• $8.6 billion "to expand and transform VA's focus on mental health services." This includes efforts to boost earlier identification and intervention for at-risk veterans

• Increases in funding for community, non-hospital treatment and mental health services for individuals involved with the criminal justice system, as well as maintaining funding for community mental health services block grants.

One of the biggest components of the budget's focus on mental health concerns efforts to curb opioid addiction:

• $5 billion over five years in "new resources" to combat the opioid epidemic, including efforts to prevent abuse and to help addicts secure access to overdose reversal drugs, treatment, and recovery services. Other efforts under this umbrella would be a national media campaign and assistance to states' prescription drug monitoring programs.

• $43 million for "school climate transformation grants" aimed at preventing opioid misuse and the related behavioral and academic challenges. The grants would fund such efforts as trauma counseling, violence prevention and targeted academic support.

• $41 million for specialized opioid efforts by the Drug Enforcement Administration, an increase over the $26 million currently provided.

• $381 million for the Department of Veterans Affairs "to reduce over-reliance on opioids for pain management and to promote the safe and effective use of opioid therapy."

• $123 million in opioid-related funding for the Substance Abuse and Mental Health Services Administration.

Advocates for mental health praised these efforts. However, they expressed concerns about other parts of the budget and the administration's agenda.

For starters, the budget reiterates the administration's desire to repeal the Medicaid expansion enacted in some states under the Affordable Care Act, sometimes called Obamacare. That's a problem for this promise because "upwards of 40 percent of adults covered through Medicaid expansion are people with behavioral health conditions," said Paul Gionfriddo, the president and CEO of the advocacy group Mental Health America.

The proposed changes and cuts to Medicaid "would devastate this critical source of coverage for mental health and addiction care," said Chuck Ingoglia, the senior vice president for public policy and practice improvement at the National Council for Behavioral Health.

Ingoglia's group also opposes the administration's proposal to permit states to require work as a condition of Medicaid coverage.

In addition, the administration's continued position against the Affordable Care Act is problematic, Gionfriddo said, because "as more healthy people choose less-regulated plans, those that are left for people who need comprehensive coverage, including those with mental illnesses, will become significantly more expensive."

On balance, Gionfriddo said, "the budget is more a retreat from the pledge than an advance on it. While there are a couple of good provisions in it, if enacted it would likely do far more harm than good to millions of people with serious mental illnesses."

Despite some new investments, including a significant outlay for opioid addiction, the newly released budget, along with other administration's policies, shows at best a mixed bag for supporting Trump's promise on mental health. But since these are only proposals at this point — including the potentially most problematic elements — we're rating this In the Works.