Time is running out for Congress and behavioral health advocates to accomplish meaningful legislative reforms before the end of the year. Experts from the recent Behavioral Health and Well-Being Congress emphasized that the calendar itself has become a primary enemy to advancing federal behavioral health reform.
November brings more than just the final weeks of the congressional session—it also ushers in another round of federal elections. The ensuing lame-duck period introduces uncertainty that could disrupt ongoing efforts and potentially change the composition of the House and Senate.
“It’s an election year and so what will happen will be anybody’s guess in a toss-up,” said Maeghan Gilmore, vice president of government affairs for the Association for Behavioral Health and Wellness (ABHW). “As we look at the next three months and the elections that are coming, we know that the calendar is not in our favor — as we have been saying for months.”
The combination of electoral uncertainty and the fast-approaching end of the congressional session creates a compressed window for policy action. Advocates are now facing a high-stakes scenario where every week counts in moving federal behavioral health reform forward.
Bipartisan Bills Offer a Glimmer of Hope
Despite these challenges, panelists at the congress highlighted reasons for optimism. Many of the mental health-related bills currently active in Congress are bipartisan and bicameral, meaning they have support across both parties and in both chambers. This increases their chances of passing before the session ends, a key step for advancing federal behavioral health reform.
“These are all bipartisan, bicameral bills in both chambers of Congress,” said Laurel Stine, executive vice president and chief policy officer for the American Foundation for Suicide Prevention.
One prominent example is the Bipartisan Safer Communities Act. While frequently described as a gun-control measure, the bulk of the funding is directed toward behavioral health initiatives, particularly youth mental health programs, school-based services, and the expansion of the Certified Community Behavioral Health Clinic (CCBHC) model. This act demonstrates that even legislation framed around other priorities can significantly advance federal behavioral health reform.
Another potential game-changer is the Restoring Hope for Mental Health and Well-Being Act, sponsored by Rep. Frank Pallone Jr. (D-N.J.). This legislation merges multiple behavioral health regulations and focuses on expanding access to treatment. Among its provisions are the removal of the one-year opioid addiction requirement for Opioid Treatment Program (OTP) admission and the elimination of the X waiver for prescribing buprenorphine to treat Opioid Use Disorder (OUD). These steps are critical milestones in moving federal behavioral health reform forward.
The urgency of these reforms is underscored by a new congressional report estimating that the opioid crisis alone cost the nation over $1.5 trillion in 2020, highlighting the massive human and economic toll of inaction.
“Congress and the administration are paying such close attention to our issues,” said Pamala Greenberg, CEO and president of ABHW. “They are really taking a deeper dive into the things that we’ve been working on, some of us for decades, and are finally getting the attention that we deserve.”
Where Advocates Should Focus Their Efforts
Panelists at the congress outlined several priority areas where advocates can focus their energy in the coming months to ensure federal behavioral health reform stays on track.
Modernizing Medicare Behavioral Health Coverage
Expanding behavioral health coverage under Medicare can produce substantial benefits for patients and the healthcare system. Kelly Corredor, chief advocacy officer for the American Society of Addiction Medicine, referenced a Legal Action Center report showing that broadening Medicare Substance Use Disorder (SUD) coverage would cost roughly $1.9 billion annually but could result in $1.6 billion in savings due to reduced hospitalizations and other medical expenses.
Corredor emphasized the importance of clarifying that individuals with primary SUDs, even without a co-occurring mental health diagnosis, are included in these expansions. Doing so ensures that all eligible patients can access critical care and that facilities providing these services are supported, which is essential for advancing federal behavioral health reform.
Addressing Workforce Shortages
The shortage of mental health and substance use providers has only worsened since the pandemic. Reyna Taylor, vice president of public policy and advocacy for the National Council for Mental Wellbeing, reported that 97% of organizations are struggling to retain their current workforce, creating a dire situation for service delivery.
Recent Senate Finance Committee discussion draft legislation could provide immediate relief. It proposes Medicare reimbursement for services provided by licensed marriage and family therapists (LMFTs) and licensed professional counselors. These provisions, drawn from the Mental Health Access Improvement Act of 2021, aim to increase access to care and alleviate some pressure on the workforce. These workforce initiatives are another cornerstone of federal behavioral health reform.
Promoting Equity and Justice System Integration
Behavioral health policy must also address equity and the intersection with the justice system. Caren Howard, director of policy and advocacy for Mental Health America, highlighted two key bills:
- PEERS Act of 2021: Establishes a federal definition of peer support specialists and integrates them into behavioral health models covered under Medicare.
- Pursuing Equity in Mental Health Act: Provides federal funding for cultural competency programs, minority youth mental health outreach, and grants for inter-professional behavioral health teams in diverse communities.
These measures could help reduce disparities in care and ensure behavioral health services reach underserved populations, furthering the goals of federal behavioral health reform.
Navigating Uncertainty Amid the Lame-Duck Session
Even with promising legislation on the table, the combination of a midterm election and the end-of-session timeline introduces high uncertainty. Advocates must act decisively and strategically to ensure that key reforms pass before Congress adjourns.
“What we hope to see and what we will see — I don’t know if they match up,” Stine observed, emphasizing the delicate balance between advocacy efforts and political realities.
The stakes could not be higher. Federal behavioral health reform has the potential to impact millions of Americans, from improving access to youth mental health services to expanding opioid treatment programs and addressing workforce shortages. The clock is ticking, and advocates must leverage every opportunity in these final months to push forward critical legislation.
Conclusion
As 2025 draws to a close, the federal behavioral health policy landscape faces a unique combination of urgency and uncertainty. The calendar may be working against reform, but bipartisan efforts, strategic advocacy, and an informed, committed coalition of stakeholders provide reason for cautious optimism.
The next few months will be critical for ensuring that the progress made over the last several years does not stall. With focused advocacy on Medicare expansions, workforce development, equity, and justice-system integration, meaningful reforms can still cross the finish line—and make a tangible difference for those who need care most.
