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Replacing federal pandemic relief funding critical to community programs could top Texas lawmakers’ to-do list for mental health next year as they also address understaffing of the 988 suicide hotline, mental health in schools and reviving the workforce.

Texas Comptroller Glenn Hegar projected the state will have a $20 billion surplus at the start of the 2025 session on Jan. 14. Although the state has plenty of cash, competing priorities like school vouchers, campus security and fixing Medicaid enrollment issues might diminish what’s available for mental health.

Exacerbating funding needs is the Dec. 31 expiration of federal COVID-19 relief dollars that helped pay for a wide range of efforts that included addressing health and infrastructure needs in local communities.

The $350 billion program, part of the 2021 American Rescue Plan Act, awarded the state $203.4 million in mental health grants and an additional $252.8 million in substance abuse prevention and treatment grants.

Some of the mental health programs the money paid for included telepsychiatry programs in schools and libraries, community mental health programs in churches, and peer-to-peer services where mental wellness can be practiced in the community without a degree.

These programs helped lessen the impact of the statewide mental health provider workforce shortage that has created long wait lists for services.

“There is not a formal funding option to replace the American Rescue Plan Act,” said Alison Mohr Boleware, the Hogg Foundation for Mental Health policy director. “Many stakeholders and advocates are raising the alarm on what will happen if funds are not replaced.”

As this funding ends and a new presidential administration enters, Texas lawmakers must determine how to replace it overnight, while also sustaining funding for existing initiatives such as the Texas Child Mental Health Care Consortium, a group of leaders in health-related institutions that have been tasked with improving the mental health care system for youth. The initiative was also given a hefty bump by COVID-19 relief funding

“The Texas Legislature has made historic, life-saving investments in mental health over the last decade,” said Andy Keller, president and CEO of the Meadows Mental Health Policy Institute. “The 89th legislative session presents an opportunity to build on that commitment.”

Lawmakers have already filed dozens of bills ahead of the legislative session to address mental health. Here are some to watch.

More providers in Medicaid

The federal government wholly or partly designates more than 95% of Texas’ 254 counties as mental health professional shortage areas, with a pronounced effect in rural, border, and frontier counties.

The problem is even worse for those enrolled in Medicaid, the health insurance program for low-income individuals.

SB 469 would allow social workers with master’s degrees who are still waiting on their clinical licenses to treat Medicaid patients. Social workers are often the first point of contact for many people looking for mental health help.

Social workers in Texas who have a master’s degree and are working toward their clinical license are unable to bill Medicaid until they complete two years of supervision by a licensed clinician. Removing this limit could add more than 1,500 licensed masters-level social workers to the Medicaid program quickly.

“This is really a workforce priority,” Boleware said.

HB 154 could also add more Medicaid providers to the roster by increasing Medicaid reimbursement rates for mental health and substance use services. In Texas, Medicaid pays between $60 and $122 for a 50-minute session with a therapist who can charge $180 or more for that visit. This, among other factors, has led to more Texas mental health providers no longer accepting Medicaid.

SB 176 would also allow schools to bill Medicaid for delivering behavioral health services on campus, creating another option for children in the health insurance program to access care..

988 funding

With the 988 suicide hotline saddled with a shortfall of several million of dollars, SB 188 would create a trust fund to support the program.

Dialing 988 connects callers with crisis counselors regardless of location. Since launching in 2022, the five call centers in Texas have received more than 380,000 calls, the second-highest call volume in the nation, according to the National Alliance on Mental Illness Texas. One-third of them occurred from January to June of this year.

The system’s funding demand far exceeds its available funding. In fiscal year 2024, the state allocated $14 million through grants for 988 operations. However, in 2023, the projected operational costs for the five 988 centers in Texas were $21 million.

The trust fund would be modeled after how the state helps fund 911 call centers.

Mental health in schools

Texas school districts have been struggling with high rates of chronic absenteeism since the COVID-19 pandemic.

One in five Texas students was considered chronically absent — defined as missing at least 10% of the school year — in the 2022-23 school year, according to data collected by The Associated Press.

To address the problem, several bills lawmakers have already filed for the upcoming session require school districts to work with Communities in Schools, a nonprofit that has turned into the state’s largest provider of school-based behavioral health services. The reliance on the organization has forced its leaders to ask for a $10 million increase in state funding annually, particularly to help its efforts to reduce chronic absenteeism in Texas schools.

“Chronic absenteeism is just a piece of a larger root cause, and one of those key root causes is mental health and wellness for students,” said Tasha Moore, chief executive officer for Communities In Schools of North Texas.

The spike in chronic absenteeism is linked to undiagnosed mental health issues among students and the inability to build social skills when schools closed during the pandemic, Moore said.

Communities In Schools has seen positive results from their efforts to reduce chronic absenteeism in the South Plains region. Over the past five years, an average of 83% of case-managed students who needed attendance intervention have shown improvement and are attending school on time and consistently.

Officials with the organization believe they can replicate these results statewide.

Another step that could help youth mental health is HB 1594, requiring health insurance plans to provide complete coverage to anyone younger than 26 years old who is experiencing psychosis for the first time. The plan would have to cover services such as psychotherapy, medication management, family support, and casework.

Lyssette Galvan, the National Alliance on Mental Illness Texas’ public policy director, said that to truly help young people in crisis, the state needs to ensure that commercial insurance can pay for all of those services, which currently isn’t happening.

Another youth mental health bill to watch is by Rep. Jared Patterson, R-Frisco, that would prohibit minors from creating accounts on social media sites and require age verification for new users. It is among multiple other measures to control the spread of cyberbullying, pornographic images and online exploitation among young people, particularly at school.

Substance abuse

House Rep. Erin Zwiener, D-Driftwood, has filed HB 1496, resurrecting a bill from last legislative session that would have legalized test strips that can detect fentanyl in drugs. The synthetic opioid is blamed for a rapidly growing number of overdose deaths because drug users often do not know the substances they are taking — and often illegally purchased — are laced with fentanyl.

Drug policy experts say that providing test strips to users and giving them a chance to avoid fatal overdoses opens the door to a continuum of care that could help get people off drugs.

Traditionally, many tough-on-crime Republicans have opposed efforts aimed at minimizing harm for those addicted to drugs, such as legalizing fentanyl test strips and syringe exchange services, concerned that such moves would enable drug use.

However, over the past several years, the troubling rise in opioid-related deaths have convinced more Republicans, such as Abbott, to support protections for those who continue to use drugs.

Boleware said another step to tackling substance use problems in Texas is improving the current “Good Samaritan” law so that individuals who witness someone else overdosing on drugs will not be criminally charged if they call law enforcement. As of December, no bill has been filed to address the issue.