By Jessica Simon, Program Manager, Health Systems Transformation, Association of Maternal & Child Health Programs (AMCHP)

Introduction

The most recent Substance Abuse and Mental Health Services Administration data indicates that approximately one in three people have a behavioral health disorder and more than 16 percent of people met the criteria for a substance use disorder (SUD) as of 2021. Behavioral health challenges deeply impact the perinatal population:

• Pregnant-capable people are at the highest risk of developing a SUD during their reproductive years and are most at risk for overdose during the postpartum period.
• Up to one in five perinatal people will experience a mental health disorder, such as postpartum depression.
• The leading underlying cause of pregnancy-related deaths is behavioral health conditions, including suicide and overdose.

We know that these deaths are preventable with comprehensive, stigma-free screening and evidence-based treatment. However, stigmatization, punitive policies, workforce shortages, systemic inequities, and fragmentation of behavioral and physical health systems leave many pregnant and parenting people unsupported and without access to necessary behavioral health treatment.

Policy Highlights from the FY23 Omnibus

The Consolidated Appropriations Act of 2023 (also known as the FY23 Omnibus) was signed into law in December 2022 and included significant behavioral health policies within the Restoring Hope for Mental Health and Well-Being Act. The following policy highlights included in the legislation were designed to increase access to quality behavioral health care.

Mainstreaming Addiction Treatment (MAT) Act. The MAT Act eliminates the Drug Enforcement Administration waiver (commonly referred to as the “X Waiver”), which required physicians to apply and complete training to prescribe buprenorphine, an opioid use disorder medication. This policy will make buprenorphine more readily accessible to people seeking treatment by permitting primary care providers, including physicians, physician assistants, nurse practitioners, and others, to prescribe buprenorphine as they would any other medication.

Prescribing buprenorphine and other medication-assisted treatments is the best practice for treating pregnant and postpartum people with SUD because it reduces the risk of relapse and death and improves pregnancy outcomes. However, studies have found that buprenorphine providers are 17 percent less likely to accept pregnant people for medication-assisted treatment appointments compared to identical non-pregnant people. Therefore, the MAT Act is a significant policy success for perinatal people because it removes an outdated federal regulation that has maintained treatment gaps and harmful stigmatization of SUD and medication-assisted treatments. AMCHP is hopeful that with the removal of the X Waiver requirement, more providers will incorporate substance use screening and treatment into their practices, and perinatal people will have better access to comprehensive SUD treatment.

Into the Light for Maternal Mental Health and Substance Use Disorders Act. This bill reauthorizes and expands the Health Resources and Services Administration’s (HRSA’s) grant funding to support and expand maternal mental health screening programs and maintains the recently established HRSA maternal mental health hotline. Notably, the bill also establishes a new maternal mental health task force, initially introduced in the TRIUMPH for New Moms Act, with federal and private maternal health experts. The increasing rates of people experiencing maternal mental health challenges call for a cross-sector, coordinated approach to strengthening maternal health and behavioral health systems to ensure access to prevention, treatment, and recovery services. The newly authorized federal maternal mental health task force will accomplish this objective by developing a national strategy and state recommendations. The new task force is designed to facilitate coordination among federal agencies, nonprofit organizations, people with lived experience, medical societies, and other partners in order to raise awareness of perinatal mental health needs, better coordinate existing efforts to provide more seamless care for perinatal people with mental health concerns and identify and close gaps in the system to improve outcomes for pregnant and parenting people.

The Path Forward for Perinatal Behavioral Health

AMCHP is pleased to see other behavioral health provisions included in the FY23 Omnibus that also seek to strengthen aspects of the behavioral health care system. As a whole, the behavioral health policies passed in the FY23 Omnibus have the potential to greatly reduce the stigma associated with behavioral health conditions, increase access to the continuum of behavioral health care, and elevate the behavioral health needs of perinatal people.

At the state and local level, maternal and child health (MCH) agencies can consider opportunities to engage with maternal health providers and partners regarding MAT Act changes to prescribing buprenorphine. For example, sharing data on the rates of perinatal people with SUDs is an important tool to encourage providers to add buprenorphine prescribing to office-based practice settings. Additionally, MCH agencies should play a leadership role in assessing state policies and advocating for replacing punitive approaches to perinatal substance use with equitable screening, treatment, and recovery strategies.

Although the FY23 Omnibus demonstrates significant progress in centering the behavioral health needs of MCH populations, more must be done. AMCHP expects to see telehealth, youth mental health, the behavioral health workforce, and behavioral health care financing at the forefront of the behavioral health policy debate in the coming year. AMCHP will continue to partner to advance federal policies that address the unmet behavioral health needs of MCH populations and equitably expand access to the full continuum of services, including prevention, family-centered treatment, recovery, and harm reduction.