Trump’s mixed record on mental-health services

The Trump administration did not pursue legislation specifically targeted at mental health, but it has pursued some actions, and avoided others, that had an impact on mental health services.

In one January 2018 decision that undermined Trump's promise, the Center for Medicare and Medicaid Services posted new guidance that allowed states that receive permission to require Medicaid recipients to meet a work requirement. 

While the program has been subject to litigation, a number of states have availed themselves of the opportunity. According to the Kaiser Family Foundation, six states have received federal approval for work requirements, and 10 more were pending as of June 26, 2020. 

While not specific to mental health care, the limits on who can receive Medicaid coverage leave some former beneficiaries in the lurch when seeking mental health coverage.

Meanwhile, the administration kept newly uninsured Americans from securing health coverage, including mental health coverage, when it decided earlier this year not to reopen enrollment for the Affordable Care Act after the coronavirus pandemic began.

In addition, the administration continues to back a lawsuit to eliminate the Affordable Care Act entirely. The lawsuit is being considered by the Supreme Court.

On the other hand, the administration did respond to the coronavirus pandemic by relaxing requirements for covering visits and allowing prescriptions by telehealth, a change that likely benefited patients with mental health concerns, said Paul Gionfriddo, the president and CEO of the advocacy group Mental Health America.

Finally, the administration, acting with bipartisan support in Congress, has substantially increased spending on a major mental health concern: opioid addiction.

Funding for treatment and recovery rose from $559 million to $2.12 billion between fiscal year 2017 and fiscal year 2018, according to calculations by the Bipartisan Policy Center. 

The administration has handed out nearly $2 billion in grants to boost treatment and services in communities hit hard by opioid addiction.

Given this mix of policies with contradictory impacts, we rate Trump's pledge a Compromise.