Check your phone bill — a tax for the new 988 suicide hotline may be coming soon

Calls and texts have been pouring in to the nation’s suicide prevention hotline since last summer after the government simplified the number to 988.

While calls and texts come in at record rates from those seeking help with drug addiction or suicidal thoughts, the cost of maintaining the 988 Suicide & Crisis Lifeline is rising.

The Biden administration has been picking up the tab, but federal law makes state and local governments responsible for expanding more than 200 call centers that route contacts to mental health counselors.

Taxpayers and consumers are beginning to pay those costs as state legislatures pass bills to add fees to phone bills or add budget funding for the call centers.

California, Colorado, Nevada, Virginia and Washington have created phone taxes to fund the call centers by adding 12 to 50 cents to monthly bills for phone lines.

Another six — Minnesota, New Jersey, Oregon, Rhode Island, Texas and Vermont — are considering similar fees.

Congress designated the 988 dialing code during a pandemic relief spending spree in 2020 and authorized state governments to levy telecommunications fees to cover the costs.

President Trump signed the National Suicide Hotline Designation Act into law that October, and the Biden administration has since deposited nearly $1 billion of startup money into 988 operations.

“Significant investments in capacity at the federal, state and local levels have helped ensure that the 988 Lifeline has been able to respond to many more people in crisis,” Monica Johnson, director of the 988 & Behavioral Health Crisis Coordinating Office, told The Washington Times. “Data following the transition to 988 in July 2022 continues to show an increase in overall calls, texts and chats from the year prior, all while answer rates are significantly improving.”

Virginia was the first state to enact a phone tax funding 988 operations under Gov. Ralph Northam, a Democrat who signed it into law in March 2021. The service fee adds 12 cents a month to the cellphone bills of Virginians with subscription wireless plans. Those with prepaid wireless services pay 8 cents per retail transaction.

Conservative policy analysts are skeptical about adding a “suicide tax” to residents’ monthly phone bills.

“This is an unfunded mandate, pure and simple, and the federal government needs to rethink their funding mechanism,” said Raven Harrison, a Texas-based Republican political strategist. “We also need to be looking at utilizing churches and other charitable organizations to help shoulder the load because rarely does the government do anything better or more effectively than the private sector.”

According to the nonprofit National Alliance on Mental Illness, at least 20 other states have approved or are debating 988-related legislation that does not involve a phone tax.

The Democratic-dominated Maryland General Assembly has approved a bill that would route money directly from state budgets to 988 call centers or mobile crisis services. Legislation in other states would create task forces to study potential funding alternatives.

“The way Congress set this up is reasonable,” said Ed Haislmaier, senior research fellow in health policy at the conservative Heritage Foundation. “The federal government can’t do something and tell states to pay for it, but it can facilitate a program in a way that removes obstacles to states doing things.”

The situation recalls the Obama administration’s 2009 push to expand Medicaid benefits through the Affordable Care Act, said James Carville, a Democratic Party political strategist. He pointed out that many Republican-led states, especially in the Deep South, have refused to pay for that expansion.

“Frankly, I think cruelty is part of the appeal when you don’t want to pay for something that benefits people who aren’t like you,” Mr. Carville said. “The idea is that you don’t need a suicide hotline or [psychiatric] drugs and counseling if you get depressed — you can just suck it up and soldier on.”

According to the federal Substance Abuse and Mental Health Services Administration, the 988 hotline answered 404,194 calls, chats and texts in February. That was an increase of 161,678 contacts from the same month last year, before the change.

Call volume in February increased year over year by 48%. The number of online chats rose by 247%, and the number of text messages shot up a staggering 1,599%.

The crisis centers absorbing this spike “are fundamentally operated at the local level” and need state funding mechanisms to expand services as demand keeps growing, said Dani Bennett, a spokesperson for the Substance Abuse and Mental Health Services Administration, which is part of the Department of Health and Human Services.

“States are taking a range of approaches, including assignment of coalitions and commissions, leveraging state Medicaid funding and passing legislation that allocates specific funding to 988 response,” Ms. Bennett said.

Through the substance abuse and mental health agency, HHS funds Vibrant Emotional Health — the 988 line’s nonprofit administrator — to support telephone networking, data collection, quality assurance, operator training and call routing.

Federal money also funds a small network of national crisis call centers and text and chat services that back up the local centers during overflow.

The Democratic-led Congress and White House included $501.6 million for the 988 Suicide & Crisis Lifeline in the fiscal year 2023 omnibus spending package. That followed a $432 million investment from the Biden administration.

Ms. Bennett said the federal grants do not cover mobile crisis response, community behavioral health clinics or dedicated crisis care-related funds, so states must find ways to pick up the tab in those areas.

“The federal investments have been used to scale up crisis center capacity, national backup center capacity and to provide special services, including a subnetwork for Spanish language speakers, to ensure all Americans have access to help during mental health crises,” Ms. Bennett said. “Prior to this investment, the lifeline, which has existed since 2005, had been long unfunded and under-resourced.”

The Department of Veterans Affairs, HHS and the Federal Communications Commission developed the suicide lifeline, which also links to the Veterans Crisis Line. The original number functions alongside the 988 code.

The number of people contacting the old hotline spiked during pandemic lockdowns and stayed elevated during remote work arrangements, mental health counselors say. Call centers reported an uptick in suicidal adults with work-from-home jobs who felt unable to get out of bed or were abusing opioids to numb their loneliness.

State and local call centers received 3.6 million calls, chats and texts on the hotline in 2021, the FCC reported last year. The FCC expects that number to double in the first full year of the 988 number.

According to the Centers for Disease Control and Prevention, suicide was the second leading cause of death in 2020 for people ages 10-14 and 25-34. From April 2020 to 2021, the CDC found that more than 100,000 people died from drug overdoses, up significantly from pre-pandemic levels.

To fund the 988 expansion, Democratic-leaning states have led the way in adding fees to monthly telephone bills. That method also funds 911 call centers in many parts of the country.

In 2021, Washington state enacted a law imposing a monthly 40-cent tax per phone line to fund 988 operations.

That fee will bring in an estimated $11 million each year. A separate bill pending in the Legislature would develop informational materials, launch a social media campaign, fund mobile rapid response crisis teams and report hotline usage data.

In neighboring Oregon, lawmakers are considering a monthly tax of 50 cents per phone line. Minnesota Democrats have introduced bills in the House and Senate that would impose a monthly phone fee of 12 to 25 cents.

Other states have sought ways to fund the 988 expansion without a phone tax.

The Maryland measure will set aside $12 million in 2025 for 988 operations.

An Ohio spending bill would provide roughly $21 million in fiscal year 2024 and about $26 million in fiscal 2025 “to support statewide operations and related activities” of 988.

In Wyoming, lawmakers rejected a proposed $46 million allocation to the 988 hotline. It opted in February to create a 988 trust fund and reserve account — both of which remain empty — that can receive private donations and state budget allocations until 2028.