Six years of the SUPPORT Act: Ongoing behavioral health policy priorities for counties

Key Takeaways

On October 24, 2018, the bipartisan Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act (P.L. 115-271) was enacted. It represented the largest Congressional investment in overdose prevention at the time, aiming to strengthen the nation's response to the substance use crisis. The legislation included provisions for Medicaid and Children's Health Insurance Program (CHIP) coverage, as well as discretionary funding for services for individuals with substance use disorders (SUDs) and mental health conditions. Some provisions were permanent, such as the requirement for state CHIP programs to cover mental and behavioral health services. Others were temporary and required Congressional reauthorization after expiring in 2023.

In March 2024, Congress passed the Consolidated Appropriations Act (P.L. 118-42), which modified or made permanent several expiring SUPPORT Act provisions, including:

• Requiring state Medicaid plans to cover Medication-Assisted Treatment (MAT).
• Making permanent the state option for exemption to the Medicaid IMD Exclusion for individuals with SUD.
• Expanding the requirement for HHS to collect state-by-state data on SUD and mental health service provision under Medicaid and CHIP.

County priorities for policy reauthorizations

Despite these updates, Congress has yet to fully reauthorize the SUPPORT Act, leaving several key policy provisions and funding opportunities unaddressed. As we recognize the six-year anniversary of SUPPORT Act, counties are urging Congress to enact additional policies included in both House and Senate reauthorization bills:

• Funding for residential treatment recovery services for pregnant and postpartum women with SUD
• Support for training programs for first responders and community members to reverse overdoses
• Grants for community recovery services
• A national peer-run training and technical assistance center for addiction recovery
• Loan repayment programs for the SUD treatment workforce
• A task force focused on best practices for addressing trauma in children and youth
• Allowing states to use grants for fentanyl or xylazine test strips where legal
• A grant program for youth prevention, recovery support, and SUD treatment
• Extending DEA flexibilities for telehealth prescribing of Medication for Opioid Use Disorder (MOUD)

Additional Policy Considerations

Counties are also advocating for additional reforms to reduce overdose rates through improved care continuity:

• Reentry Act (H.R. 2400/S.1165): Allows Medicaid-eligible individuals to resume benefits 30 days before release from jail or prison, helping prevent overdose deaths post-release and reducing recidivism. Supported by over 125 organizations.
• Due Process Continuity of Care Act (H.R. 3074/S. 971): Permits incarcerated individuals to remain eligible for Medicaid until conviction, with support from over 65 organizations.

Counties play a vital role in the nation’s mental and behavioral health system, administering services through nearly 750 behavioral health authorities and investing over $80 billion in community health. A full reauthorization of the important programs included in the SUPPORT Act would strengthen counties' ability to respond effectively to the ongoing behavioral health crisis.