House Appropriations Committee Recommends Increased Funding for Maternal Health Programs
By Shalini Wickramatilake, MHS
On July 15th, the House of Representatives’ Appropriations Committee considered and passed its fiscal year (FY) 2022 (October 1, 2021 - September 30, 2022) Labor, Health and Human Services, Education, and Related Agencies (L-HHS) funding bill. Building upon the work of the L-HHS Subcommittee on July 12th, the full Committee, which is led by Chair Rosa DeLauro (D-CT) and “Ranking Member” Kay Granger (R-TX), recommends increased funding for many mental health, maternal health, substance use, and other public health programs.
The Senate must also go through the process of marking up and passing their own L-HHS bill. If House and Senate lawmakers do not reach a final FY 2022 appropriations deal before October 1, 2021, they will need to pass a stopgap funding measure, called a continuing resolution, to keep the government funded at FY 2021 levels until they are able to pass a final FY 2022 bill. In the absence of a final FY 2022 deal or continuing resolution by October 1st, there is risk of a government shutdown.
2020 Mom will continue to track federal appropriations for crucial programs that serve moms and address mental health issues.
Below are some of the highlights from the funding bill and accompanying Appropriations Committee report, which offers specific details for funding recommendations. Note that the quoted sections below are from the Committee report.
Substance Abuse and Mental Health Services Administration (SAMHSA): $9.16 billion (+$3 billion compared to FY 2021)
Community Mental Health Services (CMHS) Block Grant: $1.582 billion (+$825 million compared to FY 2021) to support mental health service delivery
“The Committee includes a 10 percent set-aside in the MHBG for evidence-based crisis care programs addressing the needs of individuals with serious mental illnesses and children with serious mental and emotional disturbances. The Committee directs SAMHSA to use the set-aside to fund, at the discretion of eligible States and territories, some or all of a set of core crisis care elements including: local, regional or statewide call centers that have capacity to address distressed and suicidal callers and deploy mobile teams or direct persons to accessible crisis receiving centers or clinics with same day appointments, mobile crisis response teams and crisis receiving units. The goal is a crisis care system where a person in crisis will have someone to talk to, someone to respond, and/or somewhere to go for crisis intervention at any time.”
Perinatal Suicide Prevention: “Perinatal suicides, which occur during pregnancy or up to one year postpartum, are a leading cause of maternal mortality in the United States. The prevalence of suicidal ideation among pregnant and postpartum individuals was five times higher in 2017 than in 2006, and during that period, Black pregnant and postpartum individuals experienced larger increases in suicidality than other racial and ethnic groups. Given these trends, the Committee urges SAMHSA to develop and implement perinatal suicide prevention programs, including culturally appropriate resources and programs for Black and other at-risk pregnant and postpartum individuals.”
Project AWARE: $155 million (+$48.5 million compared to FY 2021) to support mental health services for youth
National Child Traumatic Stress Initiative $100 million (+$28 million compared to FY 2021)
Infant and Early Childhood Mental Health: $25 million (+$17 million compared to FY 2021)
“The Committee recognizes the importance of building mental health services for children under the age of six and includes an increase of $17,000,000 for Infant and Early Childhood Mental Health. This will support increased access to a range of evidence-based and culturally appropriate infant and early childhood mental health services, and aid in addressing the national shortage of mental health professionals with infant and early childhood expertise. The Committee urges SAMHSA to expand grants to entities such as State agencies, tribal communities, and university or medical centers that are in different stages of developing infant and early childhood mental health services. These entities should have the capacity to lead partners in systems-level change as well as building or enhancing the basic components of such early childhood services, including an appropriately trained workforce. The Committee is pleased with SAMHSA’s use of a portion of funding to provide technical assistance to existing grantees to better integrate infant and early childhood mental health into state systems and encourages that work to continue.”
Children’s Mental Health program: $150 million (+$25 million compared to FY 2021)
Zero Suicide: $26.2 million (+$5 million compared to FY 2021)
Suicide Lifeline: $113.6 million (+$89.6 million compared to FY 2021)
“The Committee includes an increase of $89,621,000, which is $12,000,000 above the fiscal year 2022 budget request, to enhance the National Suicide Prevention Lifeline’s (NSPL) infrastructure in preparation for the launch to a new 988 number in July 2022. 988 has the potential to make it simpler for people experiencing a mental health crisis to connect with lifesaving crisis intervention services. However, the Committee is disappointed that SAMHSA has not completed the report on the resources required to implement 988, as required by the National Suicide Hotline Designation Act (P.L. 116–172). This report is critical in ensuring the appropriate amount of funding is available to strengthen the infrastructure of the existing Lifeline to increase the capacity of Lifeline centers to be ready to respond to the expected increase in calls, chats, and texts from people in crisis seeking assistance.”
American Indian and Alaska Native Suicide Prevention: $3.4 million (+$469 thousand compared to FY 2021)
Mental Health Crisis Response Partnership Pilot Program: $100 million (+$100 million compared to FY 2021)
Interagency Task Force for Trauma-Informed Care: $1 million
“The Committee includes $1,000,000 for the Interagency Task Force for Trauma-Informed Care, as authorized by the SUPPORT Act, to develop best practices to identify, prevent, and mitigate the effects of trauma on infants, children, youth, and their families.”
Substance Abuse Prevention and Treatment (SAPT) Block Grant: $2.8 billion (+$1 billion compared to FY 2021)
“The Committee establishes a ten percent set-aside within total SABG funding for the provision of evidence-informed SUD non-clinical recovery supports and services.”
State Opioid Response (SOR) Grants: $2 billion (+$500 million compared to FY 2021)
Pregnant and Parenting Women: $49.4 million (+$16.5 million compared to FY 2021)
“The Committee includes an increase of $16,466,000 for the Pregnant and Postpartum Women program and recognizes SAMSHA for its work managing this program, which utilizes a family-centered approach to provide comprehensive residential SUD treatment services for pregnant and postpartum women, their minor children and other family members. A provision in the Comprehensive Addiction and Recovery Act (CARA) authorizes SAMSHA to allocate a portion of these resources for a pilot program to State alcohol and drug agencies to support outpatient, intensive outpatient and related services in a family centered approach. The Committee again encourages SAMHSA to fund an additional cohort of States above and beyond those pilots already funded.”
Children and Families within SAMHSA’s Center for Substance Abuse Treatment (CSAT): $30.2 million (+$592 thousand compared to FY 2021)
“The Committee includes an increase of $592,000 for the Children and Families program, which makes appropriate treatment available to youth and their families or caregivers to reduce the impact of SUD and/or co-occurring mental and substance use disorders on communities in the U.S.”
Health Resources and Services Administration (HRSA):
Maternal and Child Health Block Grant: $869 million (+$156 million compared to FY 2021)
“The Committee recommends $868,700,000 for the MCH Block Grant, $156,000,000 above the fiscal year 2021 enacted level and $46,000,000 above the fiscal year 2022 budget request. States use the MCH Block Grant to improve access to care for mothers, children, and their families; reduce infant mortality; provide pre- and post-natal care; support screening and health assessments for children; and provide systems of care for children with special health care needs.”
Alliance for Maternal Health Safety Bundles: $14 million (+$5 million compared to FY 2021)
“The Committee includes $14,300,000, an increase of $5,300,000 above the fiscal year 2021 enacted level and the same as the fiscal year 2022 budget request, to support continued implementation of the Alliance for Innovation on Maternal Health Program’s maternal safety bundles to all U.S. States, the District of Columbia, and U.S. territories, as well as tribal entities. Maternal safety bundles are a set of targeted and evidence-based best practices that, when implemented, improve patient outcomes and reduce maternal mortality and severe maternal morbidity.”
State Maternal Health Innovation Grants: $53 million (+$30 million above the FY 2021)
“The Committee includes $53,000,000, $30,000,000 above the fiscal year 2021 enacted level and the same as the fiscal year 2022 budget request, for State Maternal Health Innovation Grants to establish demonstrations to implement evidence-based interventions to address critical gaps in maternity care service delivery and reduce maternal mortality. The demonstrations should be representative of the demographic and geographic composition of communities most affected by maternal mortality.”
Maternal Mental Health Hotline: $5 million (+$2 million above the FY 2021)
“The Committee includes $5,000,000, an increase of $2,000,000 above the fiscal year 2021 level and $1,000,000 above the fiscal year 2022 budget request, to support a maternal mental health hotline. The COVID–19 pandemic has exacerbated maternal mental health conditions, with pregnant and new mothers experiencing anxiety and depression at a three to four times higher rate than prior to the pandemic. The hotline shall provide 24 hours a day voice and text support that is culturally and linguistically appropriate. Funds provided shall also be used to raise public awareness about maternal mental health issues and the hotline.”
Pregnancy Medical Home Demonstration: $25 million ($25 million compared to FY 2021)
“The Committee includes $25,000,000, an increase of $25,000,000 above the fiscal year 2021 level and the same as the fiscal year 2022 budget request, to support a demonstration providing incentives to maternal health care providers to provide integral health care services to pregnant women and new mothers, with the goal of reducing adverse maternal health outcomes and maternal deaths.”
Screening and Treatment for Maternal Depression and Related Disorders: $10 million (+$5 million compared to FY 2021)
“The Committee provides $10,000,000 for the Screening and Treatment of Maternal Depression and Related Behavioral Disorders Program (MDRBD), an increase of $5,000,000 above the fiscal year 2021 enacted level and the same as the fiscal year 2022 budget request. Maternal mental health (MMH) conditions are the most common pregnancy and postpartum complication; however, 75 percent of mothers go untreated. The COVID–19 pandemic has exacerbated maternal mental health conditions, with pregnant and new mothers experiencing anxiety and depression at a three to four times higher rate than prior to the pandemic. MDRBD trains health care providers to screen, assess, and treat for MMH conditions and provide specialized psychiatric consultation to assist the providers. The Committee directs HRSA to make grants to establish new State programs, and improve or maintain existing State programs. Grants shall include culturally competent approaches to assist in the reduction of maternal health inequities. The Committee recognizes the high need amongst States and directs MDRBD to provide technical assistance to non-grantee States.”
Rural Maternity and Obstetrics Management Strategies (RMOMS): $10 million (+$5 million compared to FY 2021)
“The Committee recommendation includes $10,400,000 for RMOMS, an increase of $5,400,000 above the fiscal year 2021 enacted level and the same as the fiscal year 2022 budget request. RMOMS supports grants to improve access to and continuity of maternal and obstetrics care in rural communities by increasing the delivery of and access to preconception, pregnancy, labor and delivery, and postpartum services, as well as developing sustainable financing models for the provision of maternal and obstetrics care.”
Administration for Children and Families (ACF):
Child Care and Development Block Grant: $7.4 billion (+$1.5 billion compared to FY 2021)
“Child care is one of the most critical needs of families with young children—it is essential—and yet CCDBG currently reaches only 15 percent of children who are eligible to receive child care services. The increase included in this bill will provide CCDBG-funded child care for approximately 200,000 additional children, which will also enable more parents in low-income families to remain in the workforce. Women, particularly women of color, are disproportionately impacted by the child care crisis in this country, and the investment in this bill builds on the $52,500,000,000 in supplemental funding that Congress provided for child care during the coronavirus pandemic…”
Child Abuse Prevention and Treatment Act (CAPTA): $257 million (+$71 million compared to FY 2021)
Family Violence and Prevention Services Act (FVPSA): $463 million (+$281 million compared to FY 2021)
Domestic Violence Hotline: $26 million (+$13 million compared to FY 2021)
National Institutes of Health (NIH):
National Institute of Mental Health (NIMH): $2.223 billion (+$119 million)
National Institute on Drug Abuse (NIDA): $1.86 billion (+$380 million)
National Institute on Alcohol Abuse and Alcoholism (NIAAA): $582 million (+$27.5 million)
“The Committee includes an increase of $30,000,000 for the Implementing a Maternal Health and Pregnancy Outcomes Vision for Everyone (IMPROVE) Initiative, as requested in the fiscal year 2022 budget. Maternal mortality in the U.S. is higher than in other industrialized nations, and there are disparities in maternal outcomes across the country. For example, Black women experience maternal mortality at nearly four times the rate of White women. The IMPROVE Initiative advances research to reduce preventable causes of maternal deaths and improve health for pregnant and postpartum individuals before, during, and after delivery. The initiative uses an integrated approach to understand biological, behavioral, sociocultural, and structural factors that affect severe maternal mortality and maternal mortality (SMM/MM) by building an evidence base for improved care and outcomes in specific regions of the country. IMPROVE will target health disparities associated with SMM/MM by (1) implementing and evaluating community-based interventions for disproportionately affected women (e.g., African American, American Indian/Alaska Native, advanced maternal age, low socioeconomic status, and rural populations), and (2) identifying risk factors and the underlying biological mechanisms associated with leading causes of SMM/MM, including cardiovascular disease, infection and immunity, and mental health.”
Office of Research on Women’s Health: $61 million (+$18 million compared to FY 2021)
Office of the Secretary of Health and Human Services (HHS):
Office of Minority Health: $76 million (+$14 million compared to FY 2021)
Office on Women’s Health: $42 million (+$7 million compared to FY 2021)
Centers for Disease Control and Prevention (CDC):
Safe Motherhood/Infant Health: $119 million (+$56 million)
“The Committee includes a total increase of $56,000,000 for this portfolio of programs to improve the health of pregnant and postpartum individuals and their babies, including to reduce disparities in maternal and infant health outcomes. Building on the commitment made in FY 2021, the total funding allows for the expansion of Maternal Mortality Review Committees (MMRCs) and Perinatal Quality Collaboratives (PQCs) to all States and territories and for increased support to current States and territories, as well as increased support for other programs including Sudden Unexplained Infant Death (SUID). The Committee encourages CDC to help MMRCs build stronger data systems and improve data collection at the State level to create consistency in data collection, analysis, and reporting across State MMRCs. This investment is necessary to provide accurate national statistics on U.S. maternal mortality rates and will inform data-driven actions to prevent these deaths. The Committee requests a report within 90 days of enactment of this Act on barriers to effective and consistent data collection and opportunities to improve coordination among State MMRCs. PQCs improve maternal and neonatal outcomes using known prevention strategies such as reducing severe pregnancy complications associated with high blood pressure and hemorrhage. PQCs help to address the high incidence of maternal mortality, particularly among women of color, maternal opioid use disorder and neonatal abstinence syndrome as a result of the opioid crisis, which has been exacerbated by the COVID–19 pandemic. The Committee requests an update on the PQC program and challenges faced, including those created by the COVID–19 pandemic, within 90 days of enactment of this Act. Furthermore, little is known about the tragic, sudden, and unexpected deaths of young children because of variations in investigations and the way deaths are certified. The Committee urges CDC to facilitate data and analysis, including the expansion of the SUID and Sudden Death in the Young Case Registry, to improve SUID prevention strategies.”
Surveillance for Emerging Threats to Mothers and Babies: $15 million (+$5 million)
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