By Debbie Witchey
States have made meaningful investments in behavioral health by increasing Medicaid reimbursement rates. That progress deserves recognition. But if the goal is to improve access to care, reimbursement alone is not enough.
For years, behavioral health workforce discussions have centered on reimbursement, with the assumption that higher payment rates would substantially improve access to care. A recent analysis published in Health Affairs Forefront reinforces the need to broaden the conversation.
Improving access requires a comprehensive strategy that addresses multiple factors contributing to workforce shortages and barriers to care. The first step is to expand the behavioral health workforce pipeline through graduate medical education, loan repayment programs, scholarships, internships, and clinical training opportunities to encourage more students to pursue careers in behavioral health. As demand for services continues to grow, simply maintaining the current workforce will not be enough. Policymakers should invest in strategies that attract more individuals into the profession while supporting the education and training needed to prepare a highly qualified workforce.
States can also help qualified clinicians enter practice more quickly by eliminating unnecessary delays between graduation and independent practice. Modernizing licensing, examination, supervision, and credentialing requirements—while maintaining rigorous quality and patient safety standards—can reduce the time between completing training and treating patients. Supporting interstate licensure compacts and modernizing scope-of-practice policies can further expand access by allowing clinicians to practice across state lines and at the top of their license. These reforms improve workforce flexibility, help address geographic shortages, and make it easier for providers to serve patients where they are needed most.
Reducing unnecessary administrative burden is another important opportunity to increase access. Behavioral health professionals spend significant time on documentation, duplicative credentialing, and other administrative requirements that take time away from patient care. Streamlining documentation requirements, simplifying credentialing processes, and improving prior authorization efficiency can help clinicians devote more of their day to treating patients rather than completing paperwork. Improving access is not only about training more clinicians; it is also about enabling the existing workforce to spend more time providing care.
Access also depends on delivering care differently. Expanding integrated behavioral health in primary care and other community settings can improve the early identification and treatment of behavioral health conditions, make services more convenient, and reduce stigma for patients. At the same time, measurement-informed care allows clinicians and patients to use standardized outcome measures to monitor progress, adjust treatment plans when appropriate, and ensure that care is achieving meaningful results. When paired with value-based payment models that reward quality and outcomes rather than simply the volume of services delivered, these approaches can improve both access and the effectiveness of care.
Technology also plays an important role in expanding access. Telehealth, digital tools, remote monitoring, and other technology-enabled services can extend the reach of the existing workforce, improve continuity of care, and connect patients to services regardless of where they live. These innovations are particularly valuable in rural and underserved communities, where provider shortages are often most acute. While technology is not a substitute for in-person care, it can help ensure that patients receive timely, appropriate, and evidence-based behavioral health services when and where they need them. Together, workforce development, regulatory modernization, innovative care delivery models, and technology can create a more accessible, efficient, and sustainable behavioral health system.
The experience of states reinforces why this broader approach is necessary. As the Health Affairs Forefront analysis found, nearly every state has increased Medicaid reimbursement rates for behavioral health services, with some implementing targeted increases exceeding 100 percent. These investments reflect a strong commitment to strengthening behavioral health care. While Medicaid reimbursement often remains below Medicare and commercial insurance, the gap has narrowed in many markets.
Yet significant access challenges persist. The evidence reinforces what health plans and providers have experienced firsthand: Reimbursement is only one piece of a much larger workforce puzzle. Even with higher payment rates, behavioral health systems continue to face persistent workforce shortages, geographic maldistribution of clinicians, and demand for services that exceeds available capacity. Nationally, nearly 40 percent of Medicaid adults with a mental illness still report unmet treatment needs.
This does not diminish the importance of adequate reimbursement. Fair payment is essential to maintaining a strong provider network, supporting high-quality care, and ensuring providers can sustainably serve Medicaid beneficiaries. But payment alone is not enough to attract, retain, and distribute the workforce needed to meet growing demand.
Health plans are committed to partnering with states, providers, employers, and policymakers to advance these evidence-based solutions. The significant progress states have made in increasing Medicaid behavioral health reimbursement should be recognized and applauded. Those investments represent an important step toward strengthening the behavioral health system. The next step is pairing those investments with reforms that expand provider capacity, encourage innovation, reduce barriers to delivering care, improve integration across the healthcare system, and promote accountability for quality and patient outcomes.
The workforce challenge is real, but there is no single solution. Reimbursement is an essential foundation, but it is not the finish line. Building a behavioral health system that meets growing demand will require sustained investment in payment, workforce development, regulatory modernization, interstate collaboration, innovation, and accountability so clinicians can deliver high-quality, accessible care to every patient who needs it.
The DEA’s new final rule, released on June 9, 2026, marks a turning point in how MAT is regulated for OUD. The rule finalizes portions of the 2020 interim rule that implemented the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act of 2018 (SUPPORT Act) and incorporates changes required by the Restoring Hope for Mental Health and Well‑Being Act of 2022, which passed in the Consolidated Appropriations Act of 2023. For years, clinicians had to navigate the extra layer of the DATA‑waiver system, the “X-Waiver,” with its specialized training requirements, patient caps, and administrative hurdles.
The X-Waiver has been replaced by a one-time training requirement for all prescribers of controlled substances. Instead of singling out clinicians who treat OUD, the new approach assumes that every prescriber should have some understanding of treating substance use disorders. If practitioners apply for or renew a DEA registration for Schedules II–V, they must complete this one-time training.
The rule also updates how pharmacies can support treatment. Previously, pharmacies were allowed to deliver certain controlled substances to clinicians for administration by injection or implantation, but the medication had to be used within 14 days. That window has now expanded to 45 days. The guardrails remain in place by requiring that the medication be tied to a specific patient, that it can’t be used to build office stock, and that both the pharmacy and the practitioner keep detailed records.
These changes represent a broader shift in federal policy. The barriers that once made it difficult for clinicians to prescribe buprenorphine have been dismantled. Pharmacies have clearer pathways to support treatments. And patients benefit from a system that is less about bureaucracy and more about access. It’s a recognition that MAT saves lives.
In the bigger picture, the final rule reinforces continued efforts to curb the overdose crisis and expand access to evidence‑based treatment while maintaining appropriate safeguards. As behavioral health plans continue to close treatment gaps and improve outcomes for members with OUD, this rule provides a clearer, more reliable framework to build on.
