As Congress heads into the final days of the 2022 legislative session, behavioral health reform could be one of the major policy areas to see action. Experts from the law firm Polsinelli note that several “must-move” bills remain on the table, and bipartisan interest in behavioral health reform could create a favorable environment for key provisions to pass. With the combination of legislative urgency and political alignment, the lame-duck session presents a unique opportunity for meaningful change in the U.S. behavioral health system.
The centerpiece of these efforts is the Restoring Hope for Mental Health and Well-Being Act of 2022 (H.R. 7666), sponsored by Rep. Frank Pallone Jr. (D-N.J.). The bill, which the U.S. House of Representatives passed on June 22, is designed to expand and strengthen the nation’s collective behavioral health system. Among its provisions, the legislation reauthorizes and expands several funding grants, adjusts non-monetary regulatory requirements, eliminates the X waiver for certain opioid use disorder medications, and removes behavioral health parity opt-outs for non-federal health plans. The Congressional Budget Office estimates that the bill would increase behavioral health-related spending by $1.65 billion over the next decade, signaling a significant federal commitment to addressing the nation’s behavioral health needs.
Sylvia Kornegay, a policy advisor with Polsinelli, highlighted the rare level of bipartisan agreement on these issues. “On these types of policy issues, there really isn’t a tremendous amount of daylight between Democrats and Republicans in principle,” she said during a recent webinar. However, she noted that lawmakers are carefully weighing which bills they are most familiar with, which proposals carry the least cost, and which have strong stakeholder support—factors that provide political cover for a “yes” vote.
Bipartisan Momentum in 2022
Congress has already shown signs of bipartisan support for behavioral health reform earlier this year. The Restoring Hope Act passed the House with overwhelming support—402-20—with all opposition coming from Republican members. In addition, the Bipartisan Safer Communities Act, which linked mental health provisions to gun control measures, saw 14 Republicans vote in favor during its final 220-193 passage. Tim Perrin, a Polsinelli policy advisor, emphasized that this pairing of behavioral health reform with other high-profile issues is a first in U.S. legislative history, showing that mental health is increasingly recognized as a critical component of broader policy discussions, even in politically sensitive areas like gun legislation.
The Senate Finance Committee has also been active, releasing multiple bipartisan discussion bills throughout the year. Their most recent proposal, released on November 10, explores ways to accelerate behavioral health reform through integration within Medicare and Medicaid programs. These efforts demonstrate the committee’s recognition of the urgent need for systemic reform and provide potential pathways for legislative success in the coming weeks.
Opportunities Amid Must-Pass Legislation
Experts note that large, must-pass bills could provide strategic opportunities for including behavioral health reform initiatives. Perrin explained that measures such as the National Defense Authorization Act and the omnibus government funding bill could offer legislative cover for behavioral health reform provisions. Because these bills are so large in scope and funding, adding initiatives that carry minimal cost is often easier to accomplish. “You just never know what goes into how these big packages come together,” Perrin said. “But when the number’s really big, sometimes it’s easy to glom on something that doesn’t cost a whole lot to the federal government because it doesn’t impact that huge number.”
Dozens of House members are publicly pressuring leaders to prioritize the Restoring Hope Act. The Bipartisan Addiction and Mental Health Task Force, composed primarily of Democrats, sent an open letter urging action, reflecting growing advocacy efforts from both lawmakers and stakeholders. For Democrats, the lame-duck session is particularly critical because control of the House will shift in 2023, with Republicans holding a narrow majority. The Senate will also face narrow margins, with Vice President Kamala Harris serving as the tie-breaking vote and a Georgia Senate run-off scheduled for December 6. This political reality creates a pressing incentive for Democrats to advance as many priorities as possible before losing the House majority.
Medicaid Coverage and the End of the Public Health Emergency
A major unresolved question for behavioral health reform is how Medicaid coverage will be affected after the end of the public health emergency (PHE). During the pandemic, the federal government made it easier for people to qualify for Medicaid and provided states with extra funding to avoid disenrolling participants. Following the end of the PHE, states will resume closer scrutiny of Medicaid eligibility, which could put as many as 15 million Americans, including 6.7 million children, at risk of losing coverage.
Medicaid expansion under the Affordable Care Act has been instrumental in increasing behavioral health access, with 39 states and the District of Columbia currently offering expanded coverage. Jennifer Evans, an attorney with Polsinelli’s Behavioral Health Law Group, emphasized the importance of retaining coverage. “You’ve got a lot of people who have access to parity through the Medicaid program who never have before in their life—who are learning about behavioral health, who are learning about how to get this treatment,” she said. “Now we need providers who can go in and serve them while they still have that coverage.”
The combination of Medicaid expansion, potential legislative momentum, and the strategic opportunities presented by must-pass bills positions behavioral health reform at a pivotal moment. With millions of Americans dependent on Medicaid coverage and systemic gaps still present in the U.S. behavioral health system, the actions taken during this lame-duck session could have long-lasting impacts on access to care, funding, and regulatory policies.
Looking Ahead
As Congress navigates the final weeks of its session, the fate of behavioral health reform will likely depend on bipartisan cooperation, strategic legislative timing, and the urgency of addressing pressing public health concerns. The Restoring Hope Act, along with other initiatives focused on integrating behavioral health into Medicare, Medicaid, and broader public policy, represents a rare opportunity to make meaningful improvements in mental health and substance use treatment across the country.
For providers, advocates, and patients alike, the outcome of this legislative session will be closely watched. A successful passage could not only strengthen the behavioral health infrastructure in the U.S. but also serve as a blueprint for addressing systemic gaps in access, parity, and quality of care for millions of Americans who rely on these critical services.
