November 17, 2024

New Congress and Federal Government Leadership

In January, the Republicans will have control of the Executive Branch of the federal government as well as the US House of Representatives and the US Senate. Republicans have indicated they are planning changes to healthcare policy (ACA, Medicaid, Medicare). Note that NAMI Minnesota is nonpartisan, but we do monitor and provide opinions on changes to healthcare policies in our efforts to expand access to mental health care.

President-Elect Trump has not released details of his plan for healthcare, however, Vice President-Elect J.D. Vance said they plan to "deregulate the insurance market" and separate people with and without health conditions into different pools with different plans. This would drive up costs for people with chronic illnesses, such as mental illnesses. There is also talk about block granting Medicaid or adding work requirements.

House Speaker Johnson said Republicans will not repeal the Affordable Care Act, but would look at passing reforms.

On Thursday, President-Elect Trump chose Robert F. Kennedy Jr. to be the secretary of the Department of Health and Human Services (HHS). In that role, Kennedy would oversee the operations of the Affordable Care Act, Medicare, and Medicaid. Kennedy has been publicly skeptical of vaccines and spread misinformation about vaccines, such as the claim that they cause autism (they do not). He has also claimed that certain antidepressants are to blame for the rise in school shootings (they are not).

Kennedy said if he is confirmed by the Senate to lead HHS, his priorities would include children's health - in particular removing unhealthy additives from food; increasing transparency and eliminating corruption in the department; and reducing chronic illnesses nationwide.

In the House of Representatives, the Bipartisan Mental Health and Substance Use Disorder Task Force is losing both Democratic co-chairs. Additionally, at least nine members of the Health Subcommittee of the House Energy and Commerce Committee will not return. Among those leaving are Chair Michael C. Burgess as well as Democratic Ranking Member Anna Eshoo, who advocated for lower prescription drug costs and expanding access to health insurance. Another legislator leaving the Subcommittee and Congress is Rep. Tony Cárdenas, who has been a great ally to NAMI, pushing for the 988 suicide and crisis hotline and helping to found the Bipartisan House 988 and Crisis Services Task Force. Another is Rep. Larry Bucshon, who wrote part of the 2016 opioid law that expanded access to medication-assisted treatment.

The Senate Finance Committee, which oversees Medicare and Medicaid and parts of the Administration for Children and Families, will see at least six of its members leaving. One departing senator, Sen. Debbie Stabenow, has advocated to expand Certified Community Behavioral Health Clinics.

Mental health care often receives bipartisan support, but Medicaid is the largest payor for mental health care so we will be watching proposed legislation carefully.

Information from Roll Call, Punchbowl News and Kaiser Family Foundation

Updates From the Local and State Level

St. Paul Residents: Check your Mail! The City is Erasing the Medical Debt of 32,000 Residents and you may be One of Them

The city of St. Paul is erasing $40 million in medical debt of 32,000 residents this week. Residents did not need to apply to have their debt canceled. The City prioritized those who had medical debts equal to or greater than 5% of their total income and made no more than 4 times the federal poverty level. Letters will be sent to the qualifying residents, so the city is urging residents to carefully check their mail over the next week.

St. Paul’s Mayor Melvin Carter remarked that nearly 50% of adults delay or don’t get medical treatment due to medical debt. Medical debt is a significant source of stress which can lead to high levels of anxiety, depression, and other mental health challenges. This local measure could help those who have medical debt to reestablish care. If successful, this program could be a model to create more equitable and accessible mental health care.

Department of Commerce Reviewing Health Benefit Mandates

The Minnesota Department of Commerce (Commerce)—in coordination with the Department of Health and the Department of Management and Budget—is conducting an evaluation of the economic cost and health benefits of nine proposed health benefit mandates. As part of this evaluation process, the Department is seeking input from the public and other interested parties.

A high-level summary of the proposed health benefit mandates and more information on how to submit comments can be found on their website. This includes coverage for children's mental health and maternal mental health. Unfortunately, NAMI Minnesota's request to look at private coverage for first episode of psychosis programs was not included.

To ensure Commerce has sufficient time to review suggested data sources and incorporate new information into the final evaluation report, interested parties should submit comments by November 18, 2024. 

Continuous Eligibility for Medicaid

On Nov. 14, the Centers for Medicare and Medicaid Services (CMS) approved five Section 1115 demonstration amendments that will authorize Colorado, Hawaii, Minnesota, New York and Pennsylvania to provide additional years of continuous CHIP eligibility for children beyond the minimum 12 months required by law, and to newly provide continuous Medicaid eligibility to individuals leaving incarceration in Colorado and Pennsylvania. CMS has previously approved nine other states’ requests for continuous eligibility for different populations: Kansas, Massachusetts, Montana, New Jersey, New Mexico, New York, Oregon, Utah and Washington. Check out the press release.

In Minnesota, continuous eligibility until the child's 6th birthday and 12 months of continuous eligibility for individuals aged 19 up to 21. With continuous eligibility, children do not lose health coverage and it decreases administrative burdens.

Undocumented Minnesotans are now Eligible for MinnesotaCare

The 2003 Legislature passed a law making MinnesotaCare accessible to undocumented immigrants. Beginning on Tuesday, November 12th, the law was implemented and immigration status stopped being a barrier to MNCare.

Lack of access to health insurance is a major cause of health disparities between undocumented migrants and migrants with legal status and citizens. Expanding MNCare access is an important step in making sure everyone in Minnesota has the healthcare they need and deserve. You can find more information on applying for MNCare here.

Mail Delivery System Change at Department of Corrections

Effective November 1, 2024, a new mail delivery system will be put into operation at all Minnesota State Correctional Facilities, affecting all incarcerated individuals, their families, their friends, and anyone else corresponding with them. The Department of Corrections (DOC) now requires all regular mail be sent to an address of an organization called TextBehind, based in Phoenix, Maryland. When a piece of mail arrives at TextBehind, it is opened, scanned, then copied, and finally, the printed copies are forwarded to their specified facility for distribution.

According to the DOC, this change is due to an increase in contraband, and also serves as a means to increase the overall safety and well-being of everyone at their facilities. The only direct mail allowed from now on is books purchased and shipped directly from a pre-approved list of publishers and legal documents relating to court cases, all of which will be opened under supervision. Incarcerated individuals who are sent prohibited materials of any variety are offered 10 days to appeal to an internal review authority for potential reversal. For more specific information on new regulations, please visit Minnesota DOC’s website at https://mn.gov/doc/family-visitor/contact-and-general-information/how-send-mail/. 

Updates From the Federal Level

Department of Health and Human Services Launches National Behavioral Health Workforce Career Navigator

The Substance Abuse and Mental Health Services Administration (SAMHSA) announced Wednesday the launch of the Behavioral Health Workforce Career Navigator. The Navigator is designed to help current and aspiring mental health and substance use disorder professionals professionals identify state requirements for different mental health professions.

The tool helps those considering entering the mental health workforce find education, regulatory, credentialing, licensing, and renewal information for behavioral health careers by state. Additionally, the navigator supports existing mental health workers who may be considering moving or working in different states by identifying credential reciprocity.

SAMHSA also published this guide for expanding the community-based mental health workforce.

Ghost Networks

Ghost networks is when the providers listed in a health plan's directory don't exist, are no longer in network or aren't taking new patients. A recent article from Propublica examined how states are not enforcing the law. They found:

• Extensive Errors: Many states have sought to make insurers clean up their health plans’ provider directories over the past decade. But the errors are still widespread.
• Paltry Penalties: Most state insurance agencies haven’t issued a fine for provider directory errors since 2019. When companies have been penalized, the fines have been small and sporadic.
• Ghostbusters: Experts said that stricter regulations and stronger fines are needed to protect insurance customers from these errors, which are at the heart of so-called ghost networks.

Mental Health Disparities Among LGBTQIA+ Students in Higher Education

A study published last week in the Journal of American College Health found that LGBTQIA+ full-time students in higher education were over three times as likely to report major depression and suicidal ideation than their cisgender, heterosexual counterparts. Experiences of discrimination and a lack of belonging were named as two major causes of the disparity.

Rates of depression grew across all students, and reached a peak of 23% of all students and 36% of LGBTQIA+ students reporting depression in 2022 (the most recent year of the study). Transgender and genderqueer students had particularly high rates of depression (57%) and were also more likely to report having trouble getting access to mental health care.

You can read the full report here.

Updates From NAMI Minnesota

Sign up to take NAMI Smarts for Advocacy Workshops

Grassroots advocacy can be simple. You don’t have to be an expert in politics or policy to make a difference. Your lived experience can influence policymakers and affect change.

Make your voice heard. Take our trainings on legislative advocacy as a 2-part online workshop or as one in-person workshop.

Legislative Advocacy 1 (Telling Your Story and Contacting Your Policymakers) will be offered on Tues. January 7th from 6-8 PM via Zoom. You can register here.

Legislative Advocacy 2 (Intro to Policymaking and History of Mental Health Policy) will be offered on Thurs. January 9th from 6-7:30 PM via Zoom. You can register here.

Or you can take both trainings, combined into NAMI Smarts for Advocacy, on Sat. January 11th 10 AM - 2 PM at the NAMI office in St. Paul. Lunch will be served! You can register here.

Save the Date: Mental Health Day on the Hill