What Comes Next for Mental Health and Medicaid Featuring Jennifer Snow and Hannah Wesolowski

In this follow-up conversation about Medicaid and mental health advocacy, NAMI’s Chief Advocacy Officer Hannah Wesolowski discusses Medicaid cuts and advocacy opportunities with Jennifer Snow, NAMI's National Director of Government Relations and Policy. Listeners will hear their expert opinions on how Medicaid cuts just passed by Congress will impact people with mental health conditions and their families, policies NAMI will be monitoring, how supporters can stay involved, and more. Plus, hear from Hannah and Jen about the third anniversary of the 988 Suicide and Crisis Lifeline and NAMI’s recent public opinion polling about 988.

You can find additional episodes of this NAMI podcast and others at nami.org/podcast.

"Hope Starts With Us" is a podcast by NAMI, the National Alliance on Mental Illness. It is hosted by NAMI CEO Daniel H. Gillison, Jr. 

Co-executive produced by Traci Coulter and Connor Larsen.

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The health care system is huge and complex. If your rural hospital struggles to stay open and now has a flood of uncompensated care because people lose access to health insurance, if that hospital chooses to close or close certain departments, they close for everybody, not just for people with Medicaid or marketplace coverage. So this bill has huge effects on the U.S. health care system. I think they're going to be ripples that we might not even anticipate. Welcome to Hope Starts With Us, a podcast by NAMI, the National Alliance on Mental Illness. I'm your guest host Hannah Wesolowski, NAMI's Chief Advocacy Officer. NAMI started this podcast because we believe that hope starts with us. Hope starts with us talking about mental health. Hope starts with us making information accessible. Hope starts with us providing resources and practical advice. Hope starts with us sharing our stories. Hope starts with us breaking the stigma. If you or a loved one is struggling with a mental health condition and you have been looking for support, we made this podcast for you. Hope starts with all of us. Hope is a collective. We hope that each episode with each conversation brings you into that collective so you know you are not alone. So today we're talking about mental health advocacy and some Medicaid updates. And I'm so pleased to welcome our guest today, my dear colleague, Jen Snow. Jen's our National Director of Government Relations and Policy here at NAMI. And she works alongside me on our government relations policy and advocacy team. We have a lot to break down today. Jen, thank you for joining us. Oh, delighted to be here. So, Jen, a few months ago, I was joined by another colleague of ours, Anita Burgos and Sue Abderholden our Executive Director of NAMI Minnesota. And that was in April. And a lot has changed since then. We were talking about Medicaid and why it's important for mental health. Earlier this month, Congress passed legislation. Some call it budget reconciliation, some call it HR1, and others are referring to it as the "One Big Beautiful Bill Act." This passed both chambers of Congress. It was signed into law by the president. It's not great for Medicaid, is it? Unfortunately, it is not great for Medicaid. And can you tell us a little bit about takeaways from that bill and just broadly, why are these changes to Medicaid bad for mental health care? Yeah. Thanks, Hannah. So as you said, the changes enacted in this bill are really devastating for Medicaid. And we'll talk more about that really over the next, the rest of this podcast episode. But stepping back just a minute, putting the bill in context. The bill is not solely related to health care. The bill does a lot of other things. Primarily, it makes some of the tax credits that were enacted during the first Trump administration permanent. That was a big campaign promise. And certainly one of the president's priorities coming into office. It also rolls back some of the clean energy initiatives that were of the previous administration. It makes some major changes to domestic policy related to immigration. So more money for immigration enforcement. So the bill does a lot of things for a lot of issues that impact Americans. But when it comes to the big picture for Medicaid and for the health care system, the enacted bill, the estimates are that it would remove roughly$1 trillion in Medicaid funding over the course of the decade. So $1 trillion in cuts. You know, I honestly struggle to even think exactly how many zeros is that, is a trillion dollars. An enormous amount of money. More important is that the Congressional Budget Office so kind of the independent scorekeepers for Congress, they came out with new estimates, just a few days ago that show that they think about 10 million people will become uninsured over the next decade due to what is in the bill. So, you know, a huge change in the uninsured numbers. There's also an additional 5 million people that are estimated to lose health care coverage. It has to do with what's not in the bill. And we can talk about that more a little bit later. But exactly what the number is, no one knows for sure. But, you know, we're talking 10 to 15 million people not having access to health insurance. The bill also makes some changes to what's known as a SNAP, the Supplemental Nutrition Assistance Program. Some people might know it more commonly as food stamps. It, the bill, cuts funding for SNAP by $186 billion. So real big cut to food assistance programs that are also so critical to folks who struggle with, you know, having food on their plates and in their houses. Interestingly, the of the estimate is that the overall bill actually increases the federal deficit by about $3.4 trillion. So it's one of these unfortunate situations that it's a lot of cuts to programs that we care about and an increase to the federal deficit. Thanks for taking us through that. What a lot of people don't always understand is that even though not every person with a mental health condition has Medicaid, Medicaid is a huge component of our country's mental health system. 1 in 4 dollars spent on mental health and substance use care comes from Medicaid. A lot of rural hospitals and other facilities operate largely on Medicaid dollars. And 1 in 3 people with a mental illness is covered by the Medicaid program. So it's a huge, huge component.$1 trillion sounds like a lot. Is this the worst case scenario of what we, you know, could be anticipating with Medicaid? You know, great question. No, I am an eternal optimist and I will say definitively that this bill, as devastating as it will be, this is not as bad as we thought it might be back in January. So I know when your last podcast-- when you talked with Sue and Anita, you know, I can't remember exactly where we were in negotiations in April, but I think we still were fearing, a worse situation when the president came into office, there was a lot of conversation about changing the fundamental nature of the Medicaid program. You know, turning it into a block granted program. Getting rid of the individual entitlement to that benefit or, you know, just massive structural changes to the Medicaid program. And while we-- a trillion dollars in cuts to Medicaid is enormous, it is not as bad as we anticipated it might have been come January. And I really like to think that a lot of-- where the final bill ended up, I'd like to think, was in part because of the advocacy from NAMI advocates, from other health care advocates who really told their members of Congress how important this program is to them and how, you know, significant cuts would have a devastating impact on their lives. And, you know, as I said, I am an eternal optimist, but it is the truth that this bill could have been much worse. Yeah. I can vouch for Jen being an eternal optimist. But we need that right now. And NAMI's advocacy was a pretty big component of the push back on this bill. We launched that Protect Medicaid, Protect Mental Health campaign earlier this year. NAMI advocates took over 170,000 actions. And contacting Congress and raising their voices, you know, and our NAMI alliance really came together because I think everyone saw the threat for mental health care and what this means. You know, something that really touched me was that over 1500 people shared their stories with us, trusted us with their stories so that we could use that in our advocacy to push back on these cuts. And while it's not ideal what happened, as Jen mentioned, definitely could have been even worse. We live to fight another day, essentially. The Medicaid infrastructure is intact and we're going to keep advocating to try to minimize the impact of these changes on our community. So, far from ideal, but, you know, I want any advocate out there who's listening to know that their voice truly made a huge difference in this effort. Beautifully said. So let's dig into it because I'm sure people want to know what does this mean for them? What does it mean for mental health care? A huge part of this bill that affects the NAMI community is something called work requirements. In the bill, it's phrased as "community engagement." Can you describe for us what that looks like? And then we'll talk about who it applies to. Yes, absolutely. This is really, in some ways, I think, the most significant change to the Medicaid program, because for the first time, someone's eligibility for Medicaid will be tied to their employment or their community engagement activities. It really is a fundamental shift in the way we look at Medicaid eligibility. It is also the provision that is estimated to result in the most people losing coverage as a result of these new requirements. So basically, what is now going to be required is for states who have expanded Medicaid, so that is 40 states within the country, the District of Columbia, and also, Wisconsin, kind of in a little interesting twist. They cover individuals who are often referred to as "able-bodied adults." So these are individuals who did not qualify for Medicaid based on, let's say, a disability status or a pregnancy status or being a child. These are people who historically had not been in the Medicaid system before the Affordable Care Act. So in the vast majority of states, the states are going to have to set up a new system to verify whether those able-bodied adults are able to do 80 hours of work, work or another qualifying activity, per month. So it's 80 hours of work per--work or other community engagement activities a month. As a result of that, depending on how states set up the systems, people are likely going to have to do something to either to show that they are working for that 80 hours a month, or they're doing some sort of community engagement, or that they qualify for an exemption. And I should be clear. We're saying work or community engagement. There are a few things that count towards that 80 hours. The most straightforward ones are work and community service. But if you're participating in a work program for 80 hours a month, that would also count, as well as people who are enrolled in an educational program for at least half time. Or you can have some combination of those four things. As long as it adds up to 80 hours a month. That's kind of the new threshold for whether or not you will be eligible. There's also two other ways you can qualify instead of on the number of hours worked on how much income you made. It's a little squirrely, but, you know, basically 80 hours a month is the big new assessment point that will be made for individuals if they are deemed, you know, worthy of receiving Medicaid benefits. So, you know, during the debate around this bill, there's a lot of conversation of like, well, people who are on Medicaid who can work, should work, and, you know, I think it's important that we reiterate, we agree. In fact, most people on Medicaid do work. 92% are working in school, volunteering, a full time caregiver. And so, you know, it's actually really small population that this is going to be something different. I think where the challenge comes in, not a lot of people realize is that, people who are complying with these requirements are going to miss the paperwork or not report it correctly, or their time spent working is not going to be captured accurately, and people are going to fall through the cracks, not because they're not meeting the requirement, but because they haven't reported it correctly. And, you know, so again, a lot of people are already doing this who are part of that able-bodied population. But it's not easy to navigate online computer systems and know the deadline and know the right site and know the process and do all of those things. And that's where a lot of people will fall through the cracks. You're exactly right. And in states that experimented with the work reporting requirements, that's exactly what the evaluations found, that people were dropped from coverage, not because they were ineligible for the benefit. It was they just they either weren't aware of it or they didn't submit the right paperwork at the right time in the right order. I mean, I know just from my own personal self when I have to fill out paperwork, you know, it's a hassle, it can be annoying. And, you know, there are times that you, you know, drop something, you forget something that's, you know, sitting on the counter that you maybe meant to do but didn't get a chance to do. I'd like to think that's not just me, that that's a common occurrence for many people. And it's devastating. The impact that it will have for someone who is trying to live their lives and not necessarily, you know, spending as much time figuring out the paperwork. Yeah. And a lot of people have questions about this. And I want to make clear that we still don't know a lot. A lot of what's in the bill has to be further defined by the Department of Health and Human Services. They have until next June to do that. And then states have to figure out a system because this doesn't go into effect until January 1st, 2027. So folks who are listening who may be on Medicaid or have a loved one on Medicaid, this list is not going to affect right away. Although states may apply to have this start sooner. And it'll be up to the Department of Health and Human Services whether to allow that. But the bill does not require this to go into effect until 2027. That's a really important clarification. And I wish that there was some way that we could have an answer that would apply nationwide to everyone that potentially could be listening to this that might be worried or wondering about it, because to your point, the effective date is 2027, but there's the ability of states to do it earlier and we've yet to be seen whether any state might try to do that. But we know that a number of states, before this bill passed, were waiting in line, trying to be able to add work reporting requirements to their programs. So I don't think it's outside the realm of possibility that we might see some states implement this sooner than the effective date in the legislation. Yeah. And that's really important. And, you know, I think the--so there's the downside of there's still a lot to be figured out. And we're going to talk about who's exempted from this next. And that's part of what needs to be figured out. And then once that's figured out, states then need to figure out their part of how they manage this process. The upside of all that is, it gives us time to continue to advocate which NAMI will do to try to limit the impact of this bill on our community. So our advocacy is not over just because the bill passed, our advocacy is going to continue to try to minimize the impacts, on people with mental health conditions. But let's talk about people with mental health conditions outside of the actual work requirement. So you have to work, but some people are exempted from that. What population is exempted from these work requirements? Yeah. Thanks, Hannah. This is a really important part of the bill. And when the members of Congress were debating it, you heard a number of people point to these exemptions to say, no, no, no, people aren't going to be hurt. We have exemptions in here. So we are happy that there are exemptions in place. But it's a lot of question about how they will be implemented and if they really will protect the populations intended. So there is a laundry list of people who are exempt. Just for example, people who are under age 19, thankfully, they're not expecting five-year-olds to work, so that is a good thing. People enrolled in Medicare are also exempt. Also parents, caretakers for children aged 13 and under, are exempt. So once a child hits 14, you're not exempt. You've got to prove that you're working for parents of younger children, you are exempt. Veterans with, disability, a total disability rating are exempt. Pregnant women are exempt. When it comes to mental health specific issues, there is an exemption for people who are, quote unquote, medically frail or otherwise have special medical needs. And then within that medically frail bucket, it includes people specifically with a substance use disorder and people with a quote unquote,"disabling mental disorder." So what does "disabling mental disorder" mean? That's the million dollar question. What in the world does that mean? What if you're someone with a mental health condition where it is disabling at different points in time? Is it-- are they going to look at it when you apply whether your condition is disabled at that moment, is it going to be based on a certain period of time? Is it going to be based on what a doctor says? It's going to be based on the condition? I'm just throwing out some of the questions that I have in my mind. I don't have any clue how they're going to operationalize this definition, and I think it is probably the most critical piece in the context of this conversation, because for people with mental health conditions, if they are able to qualify for an exemption under this, they would be able to continue their health care. But if not, it's really an open question of whether they would then be able to continue to have access to the health care coverage that hopefully is keeping them healthy and engaged in the community. So there's still just, this I think is, again, a huge question. And over the next few weeks continue to-- weeks and months, honestly--try to think through what are going to be our recommendations for the Secretary as he and his department look to define this. Secretary of HHS to be clear. The Federal Department, and the Department of Health and Human Services is who is in charge of implementing this. And the current secretary is Robert F. Kennedy Jr. Much of the Medicaid program is implemented through the centers for Medicare and Medicaid Services. So they will work to put out, as you mentioned, regulations implementing these requirements. So that'll be a huge focus of conversations going forward. Because this this has the potential to be able to protect some of our population. And I think an important clarification for folks who are listening and especially in the NAMI world, just to give an example, you know, you have your primary care physician and you have specialists you go to, not just psychiatric care, but your dermatologist, your cardiologist, and a lot of times their health records don't talk to each other. So your state Medicaid program, if it's based on, say, a condition or symptoms, it's not a given that the state Medicaid program knows that people will have to prove that they meet whatever that exemption criteria is. So a person has to know that they're on Medicaid, which is often confusing because Medicaid programs are called many different things across the country. Will have to know that this exemption exists. Will have to know they qualify for this exemption, and will have to know how to report it and be able to report in the right way to get the exemption. So it's not like you wave a magic wand and anyone who's exempt is exempt. And everyone knows and we're all set. There's a lot of steps to go through to prove you qualify for the exemption. And somebody has to be able to complete that process. So I think that's an important clarification too, and something that NAMI's going to be really focused on educating our community about, once we have more clarity on what this looks like, and what people need to be on the lookout for. Yeah, that's beautifully said. There's so many questions and that's why, in part, why we're so worried about this. Because, you know, people who are not going to realize and not going to have all of the facts at hand of what you just went through, and what is that going to mean for them, their ability to stay healthy. And I recognize a lot of people listening are scared and worrying about what their care is going to look like or their loved ones care. And again, there's still a lot to be determined and nothing happens right away. So I want to keep reiterating that point that we have some time and we're going to do our best to get answers for folks once those answers are available. But right now, no one really knows the answer, because a lot has to be decided. And that's where our advocates' voices are going to continue to be really important. So work requirements is a big bucket. That's the big one. But there's other things in the bill, that we care about, like some things around Medicaid. So can you talk about kind of eligibility verification, cost sharing, and some of the other things that our listeners might be curious about? Sure. Yeah. I think a theme of the bill, at least when it was when it was being debated on the Hill, on Capitol Hill, a number of policymakers were framing the changes they were making to address fraud, waste, and abuse. And in part, you know, I guess trying to make an argument that people are receiving Medicaid benefits who should not be receiving them because they're actually not eligible. So one of the ways that they made a change in this law is to require more frequent eligibility verifications. These are sometimes referred to as redetermination. Typically individuals only have to go in and have their eligibility predetermined once a year for the expansion population. The change now, starting in 2027, states are going to have to conduct those eligibility determinations twice a year. So basically the number of times you have to fill out the paperwork will be doubled. Which, you know, definitely, you know, there's some concerns that will address fraud, waste, and abuse. I think objectively, people like us are concerned that that's creating another hoop for people to jump through. People move, they change their phone numbers. They change their emails, their addresses. They don't necessarily--the first thing on top of their mind is I've gotta update my state Medicaid agency on how to contact me. So they--it's very likely that people will miss, if they have to provide information, will miss those notices, right? I think that's absolutely legitimate. I think there's also a population of people who maybe have absolutely no change. They're still living in the same place. They're their the situation hasn't changed in terms of their income. It's just whether or not, even they will be able to do the paperwork in the right way, in the right order and submit the right things in the right time. So it's yes, it impacts the population of people who, you know, might be moving, might not think to, you know, the first thing when you're moving, you might be thinking to contact your state Medicaid agency. But I think even for people who, you know, might be in the same old house doing the same old thing, it just means they have to remember to do the paperwork twice as often as they did before. And, you know, just what potential is that going to have for people to be, you know, to fall through the cracks because they didn't fill out that paperwork? Yeah. So again, it's this pattern: fraud, waste and abuse. But what is really happening is people who are eligible for Medicaid are falling through the cracks because of these additional burdens and hoops they have to jump through. These are people that should be getting this coverage. And our fear is that they're going to lose their mental health care. And so again, we're going to work to educate the NAMI community. But it's something that's going to be incumbent on all of us to share that information with our peers and loved ones to make sure folks understand what they should be looking for, what they should be doing. So we can try to limit the impact of these changes. Yeah, Hannah. No, I that's exactly right. And it does make me think too, if someone, you know, listening to this, maybe there's someone listening to this who says, wait a minute. No, I think there's a lot of fraud in this Medicaid program. And there are a number of really good podcasts out there that talk about what the data tells us about fraud and who is committing fraud within the Medicaid program. So certainly encourage folks who are interested in that to, you know, to do some looking and learning, because the vast majority of research is that, you know, fraud is not committed by individuals trying to game the system. There are fraudsters. I'm not here to say that there's no fraud within the program, but it is typically not committed by beneficiaries. Right. But it's the beneficiaries who are going to pay the price and lose the coverage, which is just tragic and really sad state of affairs for our community. I would agree. So I know there's lots of other Medicaid components. And I will urge folks we are adding updates to NAMI.org/medicaid. So that's always going to be a hub to find out more information. But I want to also touch on some other pieces of this really, really large and complex bill that are outside of Medicaid. So the Affordable Care Act did a lot of things for mental health care. There are pieces of this bill that impact the marketplace, the Affordable Care Act. But there's some other things happening outside of this bill that are changing the marketplace for the Affordable Care, where a lot of people buy their health insurance. Can you speak to some of those changes, both within and outside of the bill that are going to create this more complex environment? Yeah, yeah, absolutely. And, I think if it's helpful, I'm just going to say, a sentence or two, just to make sure folks are operating on this on the same page. So the Affordable Care Act, sometimes called Obamacare, basically, it had the idea, why don't you expand health care coverage to more people. And the primary we did that was expanding Medicaid, which we've been talking about so far. It also created the health insurance marketplace, which is basically for people who were not low enough income to qualify for Medicaid, but they were individuals who were unable to get health care insurance. Sometimes it was because their job didn't offer health insurance, or maybe it wasn't affordable. Maybe they were in the gig economy and we're looking to purchase health insurance for themselves because they were not part of a larger organization. So this health insurance marketplace is a robust place for people to be able to buy health insurance. And there are advance premium tax credits that help people afford the coverage on those health insurance marketplaces. So we've got the health insurance marketplace. It's been operating wonderfully for the past over ten years. And there are some significant changes that the bill makes as well as the administration did some changes through regulation as well. And again, this theme of fraud, waste, and abuse comes up. These changes were all kind of talked about in the context of really wanting to address fraud within the health insurance marketplace. But I would say that instead of going after the documented fraud in the program, it does things that impact beneficiaries. It makes it harder for beneficiaries to get care. So just to run through some quick things, it's going to shorten the open enrollment period and eliminate special enrollment periods for folks. So this is the way that people, you know, at the end of the year, you have an open enrollment period where you can enroll in health care coverage that you're not able to the rest of the year. And there have been efforts to make that longer so that more people would be able to enroll and be aware that open enrollment exists. But I think the thought is that, well, fraud happens if that open enrollment period is too long. It's going to be shortened. People are going to have less opportunity to enroll outside of the open enrollment period by eliminating some of these special enrollment periods that got at people who, for whatever reason, might not have been overall during the open enrollment period and then had a change in circumstance. It's also going to end auto re-enrollment. The marketplace was set up to basically try to make it easier on consumers that, you know, automatically read enroll them in a plan if they didn't opt for a different plan, getting rid of that because they know about potential that somehow is fraudulent. And even imposing a penalty on people until they reapply. So again, a lot of changes that are going to impact the beneficiary, but really phrased in the context of, addressing fraud, waste, and abuse. But one thing you had said, Hannah, that I think is really important for folks to realize is, so this is what's been in the bill and in the regulations, but there's something that's not in the bill that is estimated to have a huge impact on these marketplaces. And that's-- while the law extended a lot of tax credits, there was one tax credit that it did not extend, and that was the tax credit for people to buy health insurance coverage on the marketplaces. It's kind of the wonky name. It's Advanced Premium Tax Credits. And they were what helped people afford the coverage that they were able to buy. And they expire this year. They expire at the end of this year. And unfortunately, the bill did nothing to extend them. Right. And it's unlikely that we are going to see any other big package get through this really partisan environment to extend these tax credits. I think that's certainly the betting odds would say that. I mean, there is always the chance that that policy makers will realize the impact of this and act before the end of this year. But we had a huge bill pass that was focused on tax credits and health care and these tax credits weren't included in that package. If Congress was going to act, this would have been the logical place for them to act. They chose not to. And the Congressional Budget Office, again, that kind of objective, nonpartisan scorekeeper thinks that about 5 million people are going to become uninsured because of the lack of extension of those tax credits, because some estimates show that your premium could increase by about 75% on average for those people who had tax credits and now will not have them for planned year 2026. So, you know, I mean some people see-- double of your premium. I mean, that's a significant chunk of change out of your monthly budget. You know, and you see people who might say, you know, I just I can't afford it. I can't afford to have this health insurance. And, you know, 5 million people losing coverage is quite significant. Again, the we think about 10 million losing it, because of the Medicaid changes and about 5 million losing it because of the premium tax credits not being expired. Yeah. So this is, I mean, this is going to cause a huge ripple effect throughout the mental health system. I think it's important for folks to know that those changes to the marketplace are going to hit sooner than the changes to Medicaid because those tax credits expire at the end of this year. So that's actually going to create more of an immediate impact that states are already trying to figure out what to do with. Because when people don't have coverage, their health needs don't go away. We could face a lot more demands on hospitals and emergency rooms where hospitals are already facing the burden of losing a lot of their Medicaid revenue. And so it's just kind of this perfect storm of challenges that are going to put strain throughout the health care system. Yeah. And it's exactly right. And I think that's why we have been trying in our advocacy, and I hope that listeners, you know, will hear this and probably many already are aware of it, that while many of the changes impact people on Medicaid and people on the marketplace and, you know, there might be some people out there who think, well, I don't have Medicaid or my loved one doesn't have Medicaid. So I'm not worried about this. But unfortunately, the health care system is huge and complex and so many interconnections. You know, if your rural hospital struggles to stay open and now has a flood of uncompensated care because people lose access to health insurance, if that hospital chooses to close or close certain departments, they close for everybody, not just for people with Medicaid or marketplace coverage. So this bill has huge effects on the U.S. health care system that I don't think we even fully understand all of the ripples we know. We certainly know some of them, but I think they're going to be ripples that, that that we might not even anticipate as a result of such a drastic change in such a negative way. Yeah. And it's also important that people understand--so Medicaid's a shared program that the federal government pays a share, at least 50% and the state pays a share because of a lot of these changes, states are going to be getting less revenue, either from how they pay for Medicaid or because some of the changes and they can't make up the gap. And so they're going to have to make tough decisions. So outside of the things Jen just talked about, they're going to have to decide, are they taking revenue from other places to put in the Medicaid program, so that means cutting other services. Are they cutting eligibility or benefits for their Medicaid program to cut costs? You know, what are the challenges and things that they are going to have to do to have a balanced budget, which most states are required to have? It's really going to put enormous strain on states that are going to impact other services whether it's within Medicaid program or cutting other services to make up for some of these gaps that states have to fill in. Yeah. You and you're so right. And that just underscores how this is going to be so complicated because it is going to be a state--every state is going to look different. The decisions that states make to fill in those budget shortfalls are going to vary. And so we're going to have to stay very diligent not only to try to mitigate some of those negative impacts, but then also help people know once the decisions are made, what does that mean for them and their coverage. So this is again a Herculean task that's ahead of us to try to do what we can to help our folks. Yeah. And again, I know a lot of folks listening are scared or concerned. You know, please know that NAMI will continue to be in this conversation and in this fight. Again, our advocacy isn't over, but we also will be doing everything we can to explain what's happening to you all and providing whatever information we can. Jen, is there any good news we can share? Anything positive happening in the mental health, policy space that, we can switch to? Yes. Let's talk about some good news here, Hannah. And I think one of the most clear good news was this July, we celebrated the third anniversary of nationwide availability of 988. I imagine that many listeners of this podcast are very familiar with 988. But I'm wondering, you've done so much work on it-- Can you tell folks what is 988? Yeah, so that's a good thing to bring up. So 988 is the National Suicide and Crisis Lifeline. It's something that is available 24/7, something NAMI has advocated for many, many years from before its inception to making sure it had the resources to be successful. It's a confidential, support line for anyone in a mental health substance use or suicide crisis, or experiencing emotional distress to call and talk to a trained crisis counselor. We know too many people who are in a mental health crisis have traditionally been met with a law enforcement response. And 988 is part of our effort to reimagine crisis response and make sure that when people are in crisis, they have someone to talk to. And for a lot of people, that's enough. But NAMI's also been working to make sure communities have additional crisis services that are focused on providing mental health care. So it's health care in a health care crisis, mental health care in a mental health crisis, just like we treat other health care emergencies. And so just this month, we celebrated the third anniversary of 998 being available nationwide. And more than 16.5 million people in the last three years have used this resource. So, you know, NAMI is really proud of our advocacy around making 988 available. We know there's a lot more work to do. This is never a short term effort to build out this crisis system. And we know that 998 provides what is needed for a lot of people. And yet some people still have challenging experiences, so we won't rest until everyone has all of the care and support they need in their crisis. But we have come so far in the last three years. And, you know, it was really exciting to celebrate that. And actually, NAMI released new polling. We've been tracking what people know about 988 and more than three quarters of Americans are least, aware of 988. So they've heard about it. A lot less actually know what it is, so we have some work to do. And I encourage everyone that's listening to share 988 with at least, you know, five people in your life. Make sure that they know about it. I know it's always gratifying for me when I meet somebody new and can tell them about 988 but that is something positive going on that 988 is available and it's helping people and continues to grow and provide more and more resources. If there is one positive thing for us to focus on this month, it is absolutely that. It is such an amazing accomplishment and something that has helped so many people. Well, you know, we always wrap up every episode asking the question, what gives you hope? You know, this is really about making a place that people can find hope and hold on to that hope. So, Jen, I've worked with you a long time. But I'm curious, you know, what helps you hold on to hope? Gosh, that is a great question, because there-- I'll be honest, there have been times over the past few weeks where it's been hard to hold on to hope, you know, to be quite honest, you know, to see this legislation passed that many knew we're going to hurt lots of people. But undeniably, what makes me hold on to hope is the NAMI community and how much the NAMI community rallied to tell their policymakers that this was a bad idea. And as we talked about at the beginning, that the cuts were not as bad as we anticipated they might be, it's not to say they're not going to be really damaging, but they are not-- this is not as bad as it could have been. And that's because 172,000 people took actions to call their member of Congress, to write a letter, to click through our alerts, and to have that outpouring of support from individuals. It is impossible not to have hope hearing those numbers and hearing the impact that we were able to have. I couldn't agree more. What a beautiful way to end. Our NAMI advocates are the best. And thank you, Jen, for joining us today. You know, it is an honor for me to work with Jen. She is truly a policy expert and a relentless advocate for the NAMI community. So I'm so glad that she could be on the podcast with us today. This has been Hope Starts With Us, a podcast by NAMI, the National Alliance on Mental Illness. If you're looking for mental health resources, you are not alone. To connect with the NAMI helpline and find local resources, visit NAMI.org/help, text "helpline" to 62640 or dial 800-950-NAMI. That's 800-950-6264. Okay, if you're in experiencing an immediate suicide, substance use, or mental health crisis, we just talked about 988, so please call or text 988. You can also chat on 988lifeline.org. You'll speak to a trained crisis specialist who can help you and provide you the support you need. I'm Hannah Wesolowski your guest host today. Thanks for listening. And be well.