Senate ARPA bill includes $400m investment in mental health
Features new loan repayment program for clinicians
LEADERS IN THE Massachusetts Senate will unveil a plan on Wednesday to spend $400 million improving the mental health system, part of a larger proposal for how to spend federal funds from the American Rescue Plan Act.
The centerpiece of the plan will be $122 million to repay the loans of nearly 2,000 mental health clinicians – an effort aimed at recruiting and retaining workers in the field.
The Senate also plans to release a separate bill related to mental health policy in the coming weeks.
Sen. Julian Cyr, a Truro Democrat who co-chairs the Joint Committee on Mental Health, Substance Use and Recovery, said the Senate’s goal is “nothing less than a transformation of mental health.” “We’re going to keep at it until we get this right and until we can truly realize a mental health care system that truly gets people the services and care they need and they deserve,” Cyr said.
The House, in its ARPA bill, proposed spending $250 million on behavioral health programs, with $100 million carved out for workforce initiatives – things like student loan assistance, tuition reimbursement, and training.
The Senate proposal goes further. The hallmark of the Senate plan will be an immediate focus on expanding existing loan repayment and grant programs to mental health clinicians at all levels – psychiatrists, social workers, nurse practitioners, and others.
The $122 million fund would offer between $30,000 and $300,000 to each individual, depending on the level of their training. This would help at least 70 psychiatrists, who would be eligible for the maximum reimbursement, and more than 1,300 bachelor’s and master’s level mental health clinicians, who could apply for $30,000 or $50,000 apiece. The program would also aim to recruit 40 new psychiatric mental health nurse practitioners to work in community health centers.
Recipients of the money would have to commit to working in a Massachusetts community health center, community mental health center, or in-patient psychiatric hospital for at least four years.
The bill would dedicate $500,000 to a public awareness campaign to boost knowledge of the program.
Sen. Cindy Friedman, an Arlington Democrat who chairs the Joint Committee on Health Care Financing, said many of these workforce programs already exist, but on a smaller scale, and ARPA will provide money to expand them. “What we’ve realized is that not only are there people in the system that aren’t making enough and can’t afford to stay, there are many people that aren’t doing the work they’ve been licensed for for the same reason,” Friedman said. “They can’t afford to take the work because the rates so low, and their debt is so high.”
Cyr said expanding the workforce will help address the crisis of mental health patients waiting in the emergency department for days until a bed opens up. “There are available psychiatric inpatient beds in Massachusetts, but they do not have the staff,” Cyr said.
Mauch said an expanded loan repayment program could help people with lower incomes enter the field. It could also incentivize clinicians who do not take insurance because of low reimbursement rates to begin accepting insurance. “It creates the opportunity for more people to enter the field who might not consider it, then it creates the opportunity for those who left insurance panels…to come back into that workforce,” Mauch said.
The Senate bill would also make additional investments in mental health programs.
Senators seek to create a portal clinicians can use to find available beds for patients who are waiting in an emergency department. There would be $10 million to expand a program that offers intensive community-based psychiatric services, some of it earmarked for children. There would be $15 million for initiatives that embed mental health clinicians with the police, so people in crisis are diverted out of the criminal justice system. Another $5 million would go toward a public awareness campaign in multiple languages to promote the awareness of mental health services.
The senators also plan to put $240 million into a trust fund, which would be governed by an advisory board of mental health experts. This could be used, for example, to improve the reimbursement rates the state and insurers pay clinicians for providing mental health services, or to pay for scholarships to create a pipeline of workers.
The Senate bill would also create a $55 million program aimed at retaining and recruiting frontline human service workers – those who work in home health care, for community-based organizations, and in group homes under state contracts – through loan repayment and other efforts.Cyr said more policy changes will be incorporated in a separate bill that will be released soon. That bill is expected to address rates, parity between mental and physical health services, and access issues. Many of the proposals could be similar to those the Senate took up in February 2020, in a bill that was derailed by the pandemic and never made it into law.
The House already voted on its version of a spending plan, which called for spending $3.82 billion in a mix of ARPA money and surplus left over from last year. The Senate plan will be released this week and voted on next week. It will have to be reconciled with the House bill before it goes to Gov. Charlie Baker for his signature.