Legislative
and
Advocacy
Update

April 2019
The Federation is involved at the national level in monitoring
legislation, advocacy and funding opportunities and resources that could aid your work as the voice for families.
Legislation
Legislative Actions
The Federation actively represents you as part of the  Mental Health Liaison Group  (MHLG) .  The MHLG is a forum for collaboration among the leading national mental health and addiction-focused organizations. Together, we provide policymakers with information and support in advancing our shared policy priorities. The MHLG hosts congressional staff briefings to share information on trends and best practices in the field; provides annual recommendations on mental health and addiction funding in the federal appropriations bills, writes letters to Congress outlining our position on important legislation or offering suggestions for improving proposed policies and more.

  • We joined American Psychological Association, NAMI, the Eating Disorders Coalition and the Residential Eating Disorders Consortium in a letter supporting the Protecting Pre-Existing Conditions and Making Health Care Affordable Act of 2019, introduced by Reps. Pallone, Neal and Scott.  
  • The bill, introduced by Reps. Frank Pallone, Richard Neal, and Bobby Scott (chairs of the three committees with jurisdiction over major health care programs), would substantially improve financial assistance for people purchasing coverage through the Affordable Care Act (ACA) marketplaces, strengthen protections for people with pre-existing health conditions, ”
  • Read the summary of the bill and its effects
  • Coalition Health Care Task Force Co-Chairs Statement on ACA Bill Introduction

  • We joined MHLG in support for an additional $35 million for the Community Mental Health Services Block Grant for FY 2020, to fund a five percent set-aside for states to fund crisis care services. These funds would enable states to implement the Crisis Now strategies recommended by the Crisis Services Task Force of the National Action Alliance for Suicide Prevention (Action Alliance), which have been shown to be highly effective in improving care and reducing costs. 

  • We supported ZERO TO THREE's letter to Congressman Cole, Congresswoman DeLauro, and Senators Blunt and Murray requesting that they fund SAMHSA’s Infant and Early Childhood Mental Health grant program at a level of $20 million in FY20. 

  • The Federation was part of the MHLG support letter for the TAPS Act. The TAPS ACT:
  • Will identify a behavioral threat assessment and management process that can be adapted and used across the nation while recognizing the unique needs of different communities
  • Will provide States the training, resources, and support needed to start community-based, multidisciplinary behavioral threat assessment and management units
  • Recognizes that the behavioral threat assessment and management concept should become part of the culture and fabric of contemporary law enforcement
  • Urges that this is a matter of national security


  • The Federation joined MHLG in a letter of support for H.R. 2021 – the Investing for the People Act of 2019. This important legislation would raise both the defense and nondefense discretionary caps by $88 billion each in Fiscal Years 2020 and 2021.
IDEA Full Funding Act
Congress has a responsibility to fulfill its promise to support special education. The Individuals with Disabilities Education Act (IDEA) was a historic step forward in 1975, but since its passage, Congress has failed to provide full funding promised under the law. That’s why Senator Chris Van Hollen and Senator Pat Roberts have introduced the IDEA Full Funding Act, to ensure that every child with a disability has access to educational opportunities. We urge Congress to pass this important legislation immediately!

IDEA Full Funding Act introduced by Sens. Chris Van Hollen (D-Maryland) and Pat Roberts (R-Kansas) and Reps. Jared Huffman (D-California), John Katko (R-New York), David McKinley (R-West Virginia), Glenn Thompson (R-Pennsylvania) and Brian Fitzpatrick (R-Pennsylvania). This legislation would fulfill a commitment made in 1975 to provide states with 40 percent of the average per-pupil expenditure for students with disabilities:
Weekly Legislative Roundup
Check out Campaign for Youth Justice's weekly legislative roundup, a national snapshot into current #youthjustice legislation being introduced that removes children from the adult system . Here is the update for last week, April 8-12th .
Keep up with the latest federal legislation here .
 STOP School Violence Act FY20
STOP School Violence Act (Division S, Title V of Public Law 115–141) is increased at a level of $125,000,000, a $25,000,000 increase over FY19 funding. This increased funding will allow even more states, localities, and tribes to provide evidence-based violence prevention programming to students and teachers.

As a result there are some funding opportunities availiable.

FY19 STOP School Violence Act Grants:
  • These grants have a very strong mental health component including student and school personnel training on school violence prevention including suicide as well mental health crisis training for school personnel.
  • The FY19 grant applications are slowly being released. COPS has just one RFP and BJA will have a total of 3 (1 of 3 are released at this point).
  • COPS RFP: https://cops.usdoj.gov/svpp due May 31st
  • BJA Technology and Threat Assessment RFP: https://www.bja.gov/funding/STOPTech19.pdf due June 11th
  • Mental Health RFP- Still not released
  • Training & Technical Assistance RFP- Still not released
  • To help others apply for this grant, Sandy Hook Promise & The Superintendents Association are hosting a webinar on April 24th at 3:00PM. 
Advancing Care for Exceptional (ACE) Kids Act of 2019 ( S. 317/ H.R. 1226) PASSED
The  Advancing Care for Exceptional Kids Act  (ACE Kids Act) is a congressional proposal to improve how care is delivered to America’s children with complex medical conditions on Medicaid.

The ACE Kids Act passed both the U.S. House and Senate as part of H.R. 1839 . The bipartisan legislation was championed by Charles Grassley (R-IA) and Michael Bennet (D-CO) in the U.S. Senate, as well as Kathy Castor (D-FL), Jaime Herrera Beutler (R-WA), Anna Eshoo (D-CA), and Gus Bilirakis (R-FL) in the U.S. House

Once signed into law, the ACE Kids Act will:
  • Improve coordination of care for children to reduce the burden on families
  • Address problems with fragmented care across state lines
  • Gather national data on complex conditions to help researchers improve treatments for rare diseases
  • Potentially reduce health care spending, compared to the current system 
The Mental Health Services for Students Act
HR1109/S1122 Reintroduced
Rep. Grace F. Napolitano has reintroduced the Mental Health in Schools Act in the House and Senator Tina Smith has reintroduced the companion bill in the Senate.By providing increased federal funding for therapists and mental health services in our schools, this bill will help youth with preventable mental illnesses get access to the services they need.

Facts on the Mental Health in Schools Act
The Mental Health in Schools Act would provide funding for public schools across the country to partner with local mental health professionals to establish on-site mental health care services for students.
The Mental Health in Schools Act will help students by:
  • Providing professional help for the 1 out of 5 youth who suffer from some form of mental illness
  • Addressing mental health problems when students are young, instead of waiting until they have drifted into drug use, crime, depression, or suicide
  • Keeping costs low, because mental health costs are very little compared to the costs placed on social services and the prison system when mental health is neglected
  • Saving lives, by funding school employed or community employed mental health professionals who help prevent suicide by identifying at-risk youth and counseling students before their problems spiral out of control
The Mental Health in Schools Act will provide $200,000,000 in competitive grants of up to $2 million each. It expands the scope of the Safe Schools/Healthy Students Program by providing on-site licensed mental health professionals in schools across the country. Funding will be distributed by the Substance Abuse and Mental Health Services Administration (SAMHSA), which will set guidelines and measure the outcomes of the funded programs
For More Details about National Issues
For more details about the latest in National Legislation and Advocacy, watch our April update video and visit our National Legislative and Advocacy webpage .
In the News
President Trump's 2020 Budget
Summary of Budget Items that Will
Affect People with Mental Health Conditions
Adapted from Mental Health America

The Fiscal Year 2019 budget requests $68.4 billion for the Department of Health and Human Services (HHS) , which is a $17.9 billion (or 21 percent) decrease from 2017. These are the critical changes identified by Mental Health America.

Opioids/ Serious Mental Illness
  • Includes $10 billion over five (5) years to combat the opioid epidemic and serious mental illness to build upon the 21st Century Cures Act.
  • Assertive Community Treatment - Includes $15 million for a new Assertive Community Treatment for Individuals with serious mental illness.

Medicaid
  • Promotes structural reforms to Medicaid to eliminate the funding gap between states that expanded Medicaid under Obamacare and those states that did not expand Medicaid, and asks states to chose between a per capita cap and a block grant.
  • Reduces Medicaid by $1.4 trillion
  • Proposes to align the MarketBased Health Care Grant Program, Medicaid per capita cap, and block grant growth rates with the Consumer Price Index (CPI-U) and allows states to share in program savings.

Medicare
  • Reduces by ~$500 billion
  • Reduces Social Security Disability Insurance by $10 billion over ten (10) years. 
  • Medicaid and Medicare are currently the largest payers of behavioral health services in the country.
  • For Medicare, proposes to test and expand nationwide a bundled payment for community-based medication assisted treatment, including, for the first time, comprehensive Medicare reimbursement for methadone treatment.

Substance Abuse and Mental Health Services Administration (SAMHSA)
  • Reduces funding for the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Mental Health and Substance Abuse Treatment Programs of Regional and National Significance by ~$600 million.
  • Discontinues funding for the Screening, Brief Intervention, and Referral to Treatment program.
  • Eliminates funding for Minority Fellowship programs at SAMHSA.

Criminal Justice
  • Increases funding for the Criminal Justice and Juvenile Justice programs by $10 million to a total of $14 million.

Healthcare Professional Training
  • Consolidates federal graduate medical education spending from Medicare, Medicaid, and the Children’s Hospitals Graduate Medical Education program into a single grant program for teaching hospitals, and directs funding toward physician specialty and geographic shortages.
  • Eliminates $451 million in other health professions and training programs.

National Institutes of Health
  • Includes $500 million for the National Institutes of Health (NIH) to support and supplement existing efforts with a publicprivate collaborative research initiative on opioid abuse.

I ntegrates Into One Agency
  • The Agency for Healthcare Research and Quality
  • The National Institute for Occupational Safety and Health
  • The National Institute on Disability, Independent Living, and Rehabilitation.

Supplemental Nutrition Assistance Program (SNAP)
  • Slashes the Supplemental Nutrition Assistance Program (SNAP), also known as food stamps, by $17.2 billion or 16 percent

Department of Housing and Urban Development(HUD)
  • Cuts funding for the Department of Housing and Urban Development (HUD) by 18 percent.
  • Does not request any of $8 billion in funding currently allocated to the HUD public housing capital fund.
Focus on Family and Youth Services
Adapted From Youth Services Insider & The Chronicle for Social Change

The Trump budget includes level funding for most of the lines tracked by Youth Services Insider along with some steep cuts that were in previous proposals. Here are a few of the items of note.

Block grants: Several of the large block grants overseen by the Department of Health and Human Services, all of which deliver fairly flexible pots of money to states were cut.
  •  Temporary Assistance for Needy Families (TANF, $17.3 billion in 2019), which states use for cash assistance to poor families and other anti-poverty programs, would be cut by $2.1 billion.
  •  Social Services Block Grant, which is funded at $1.7 billion and would be all but eliminated in this budget.
  • Community Services Block Grant ($725 million) would be eliminated.

A few of the smaller youth and family programs would be eliminated.
  • The 21st Century Learning Account, a $1.2 billion program to help states pay for after-school programs, would go away.
  • GEAR Up ($360 million), Teen Pregnancy Prevention ($101 million)
  • Promise Neighborhoods ($78 million).

More Child Care funds:
  • The Trump budget leaves the Child Care and Development Block Grant alone, level funded at $5.3 billion.
  • The budget uses about $1 billion of the savings from the TANF cutback to fund a new competitive funding program under the Child Care Entitlement stream. This would grow that account from $2.9 to $4.2 billion.

Child Welfare Block Grant:
  • The administration has again included a proposed block grant option for states as an alternative to Title IV-E, the entitlement through which most child welfare funding is passed from the federal government to states. Were the plan to get congressional approval, states could use IV-E money for any of the purposes and services authorized under IV-E and IV-B, which is a block grant states can use for the prevention of abuse and neglect, and family preservation.
  • This option would run alongside the Family First Prevention Services Act, which was passed in 2018 and takes effect in October. That law opens up more flexibility on the front end of IV-E to permit spending on some efforts to keep families together, but also limits federal funding for group homes and other congregate care placements.

Head Start:
Head Start, the national program that provides early childhood care to many low-income families, would be cut by $359 million.

Service Learning :
  • The Corporation for National and Community Service would be all but shuttered.
  • The AmeriCorps program – which supplies much-needed, low-cost workers to many nonprofits – would lose all but $2 million of its $423 million budget.
  • The Foster Grandparent program ($111 million), which funds service programs that put the elderly together with kids, would go away entirely.

Juvenile Justice:
  • Office of Juvenile Justice Delinquency and Prevention,
  • Trump proposes a $10 million raise for the Missing and Exploited Children account. He would make that the biggest spending line at the agency.
  • There would be cut backs on mentoring, delinquency prevention and the grants given to states for complying with the Juvenile Justice and Delinquency Prevention Act.
  • A $2 million carve out to support the improvement of juvenile indigent defense would be split that between juvenile defense and juvenile prosecution. And $500,000 would also be added to the account .

Youth Services Insider combed through the various budget justifications and appendices to produce a handy-dandy guide to spending related to youth and families.
Court Blocks Medicaid Work Requirements
in Arkansas and Kentucky
From the Capitol Connector

U.S. District Court Judge Boasberg ruled against CMS medicaid work waivers in Arkansas and Kentucky. The district court judge issued a pair of decisions blocking Medicaid work requirements in Kentucky and Arkansas. Consistent with an earlier ruling , the court found that the federal government had failed to justify how adding employment requirements advanced Medicaid’s central statutory objective to provide medical assistance to the state’s citizens. The impact of the ruling is likely to extend beyond these two states and complicate Trump Administration plans to expand Medicaid work requirements more broadly.

HHS must now reevaluate Kentucky and Arkansas’ waiver approvals and decide whether they will seek an appeal. As a result, HHS may hold off on announcing any additional work requirement approvals — and states may wait to submit their requests — until this legal battle reaches its conclusion.
Enhancing Your Advocacy
Robert Woods Johnson County Health Rankings & Roadmaps
How Healthy is Your Community?
The annual Rankings provide a revealing snapshot of how health is influenced by where we live, learn, work and play. They provide a starting point for change in communities.

The annual County Health Rankings & Roadmaps from the Robert Wood Johnson Foundation shows that where you live influences how well and how long you live. The Rankings allow counties to see areas of progress and areas in need of progress on more than 30 factors that impact health - such as housing costs, child poverty, tobacco use, and much more - and help communities move with data to action in new and creative ways to improve health outcomes. See how your county measures up in health factors and outcomes in latest Rankings
The Importance of the Census
Unfortunately, the 2010 census missed more than 10 percent of young children – one of every ten children aged 0-4, or about 2.2 million children. That’s newborns, babies, toddlers and young children in day care or pre-k programs.

When we miss young children in the census it has serious consequences for them, their families, their communities and our nation – with many of those consequences lasting for at least 10 years (for most of their childhood).
Consequences include:
  • diminished representation in Congress, state legislatures, and school boards;
  • less federal funding for children’s programs in states and communities;
  • inadequate data and planning information for policymakers, researchers, business leaders and advocates; and
  • distorted data in all Census Bureau surveys for the next decade.
Children should matter in policy discussions at the national, state and local levels. Now – with the 2020 census fast approaching – it is time to make sure we count all our children.
Families First Prevention Act Toolkit
The Annie E. Casey Foundation has developed a downloadable tool kit to help child welfare leaders, advocates, private providers, and others talk about how the Family First Prevention Services Act can help improve outcomes for children and families.  The tool kit features talking points for agency staff, guidance for media interviews and text to incorporate in public remarks.
News from the States
P Most of the states legislative sessions have ended or on a break.
That means we have a lot of news about what has been done this session . For more details on the state sessions, visit the From the States section of our website or watch the adjacent video.
Idaho

House Bill 277 partially repeals Medicaid expansion and leaves thousands of Idaho parents with no coverage option.House Bill 277 partially repeals Medicaid expansion and leaves thousands of Idaho parents stranded with no coverage option. If families between 100 percent and 138 percent of the Federal Poverty Level (FPL) are removed from the Medicaid expansion population, Idaho parents may not be eligible for tax credits. 
Iowa

Iowa House passes Children's Mental Health bill
A bill that would create a mental health services program for children is moving on to the Iowa Senate. The bill would create a mental health system similar to the current one for adults. A children's mental health system is one of Governor Reynolds' top priorities for 2019. In a statement, the Governor said, "We are one step closer to an integrated health care system that recognizes children's mental health needs. We've been talking about this for decades, but now is the time to act."
Kentucky

  From the Kentucky Youth Advocates

Changes to Kentucky’s 1115 Medicaid Waiver Implementation - a federal judge halted the April 1 st implementation of the Bevin Administration’s 1115 Medicaid Waiver, also known as Kentucky HEALTH .
Though several vulnerable populations are exempt from the 1115 waiver, as it protects children, pregnant women, and transition-aged youth in foster care from the potential negative impacts of premiums, reduced benefit packages, and lockout periods, questions may arise from Medicaid-eligible parents or individuals, health providers, and advocates.
Here’s what we know:
  • The Kentucky HEALTH requirements will not begin on April 1st.
  • There will be no coverage or benefit changes for Medicaid-eligible beneficiaries.
  • If Medicaid-eligible beneficiaries received Kentucky HEALTH related notices or a notice of eligibility statement, the legal decision makes those notices outdated.
Updated information and resources will be available on the Kentucky HEALTH website .
Michigan

 Michigan has a new cyberbullying law.
The law makes it illegal to harass another person online. That includes posting messages or statements in public media forums with the intent to threaten someone, or making posts that are intended to put someone in fear of bodily harm or death.

  • Someone found guilty of a misdemeanor could face up to 93 days in jail, a maximum fine of $500, or both.
  • Someone who commits two or more separate acts of harassment could face a five year sentence and a $5,000 fine.
  • If the harassment results in the death of the victim, a person found guilty could face up to 10 years in jail, a $10,000 fine, or both.
New York

N ew York has become the first U.S. state to make mental health classes mandatory for all grades — starting with kids as young as 3 years old. The change comes thanks to a new law, passed on July 1 of this year, which requires mental health education be part of the standard health curriculum for all students.According to the New York State Mental Health Advisory Council, the curriculum will begin to be taught this fall in health and physical education classes, starting in preschool, all the way up through high school. Nine key points will be incorporated into the curriculum — including how to identify the signs of mental illnesses and how to find appropriate resources for getting help — though how exactly each school accomplishes this will be up to administrators.
  • Nine key points must be taught including: identifying signs of mental health issues, resources for help, and the negative stigma that surrounds mental illness
  • New York is the first state to require that mental health be taught to all grades
The mandate is intended to help students understand more about emotional and mental wellness, and help them understand when to seek help for themselves and others. 
Tennessee

Tennessee would become the first, and only, state to fund its Medicaid health care program through a block grant — an annual lump sum payment from the federal government.
  • Tennessee could become the first state to fund its Medicaid health care program through a block grant.
  • The federal rules that now apply to TennCare's funding come with protections, funding and oversight that affect all Tennesseans
  • Opponents fear that a block grant could come with unintended consequences for all Tennesseans, not only the 1.3 million low-income pregnant women, children, seniors and people with disabilities on TennCare.
Staying Connected
New Legislation and Advocacy Pages
  • Learn how to keep up with news and updates
  • Finding your legislator, state Medicaid Director and state Mental Health Commissioner
  • Tips on committees
  • Live streams of the House and Senate
  • Information on highlighted National legislation
  • Information on highlighted legislation from the states
  • State tabs where, for each state, you will find:
  • The General Assembly page
  • How to find your state legislator
  • Link to state legislative advocacy organization
  • Links to the live stream sessions from the state
  • Tips on how to advocate
Facebook Page
Following our dedicated Legislative and Advocacy News and Resources Facebook page is a great way to keep up with what is going on in all the states and to share what is happening in yours.
Alerting us to what is happening on the state level will aid not only those in your state but others nationally as ideas spread. As you become aware of state or national legislative alerts, funding and advocacy opportunities or resources that could be used to build funding requests, please let us know by emailing mcovington@ffcmh.org .