Legislative engagement and advocacy will help determine whether behavioral health access expands or contracts in the years ahead, four executives speaking on a panel during Becker’s Spring 2026 Behavioral Health Summit said.
“Behavioral health isn’t on the brink because leaders lack passion. It’s on the brink because the handoffs are held together with duct tape and heroism, and heroism doesn’t scale,” Jim Serratt, CEO of Tulsa, Okla.-based Parkside Psychiatric Hospital and Clinic, said.
That strain is playing out alongside heightened scrutiny of Medicaid spending. In December 2024, an audit found Indiana’s Medicaid program made at least $56 million in improper payments for autism treatment. Separately in January, an audit found Colorado’s fee-for-service Medicaid payments for ABA therapy did not fully comply with federal and state requirements, resulting in $77.8 million in improper payments.
“There’s just a lot of chaos right now; I think that’s an understatement,” Stuart Archer, CEO of Oceans Healthcare in Plano, Texas, said. “We’ve got the fraud, waste and abuse crowd where I’m afraid those pitchforks get lit and the mob starts going after things that are, despite evidence, labeled fraud whether it’s there or not.”
At the same time, uncertainty around mental health parity enforcement is raising concerns among providers.
Earlier in April, HHS, the Treasury Department and the Labor Department said it plans to issue new proposed rules and revisit requirements tied to the Mental Health Parity and Addiction Equity Act, and it will not defend the current rule. Behavioral healthcare leaders warn that weakening mental health parity enforcement will reduce access to care, increase system strain and widen gaps between behavioral and physical health coverage.
Federal funding decisions also put behavioral health access in limbo. H.R. 1 may decrease Medicaid spending by nearly $1 trillion, with the number of uninsured individuals growing to 11.8 million more by 2034, while allocating $50 billion over five years to support rural health systems.
Glenn Simpson, COO of ECU Health Behavioral Health Hospital in Greenville, N.C., said Medicaid expansion has historically improved access.
“Over the last 10 years, many states were able to expand Medicaid; North Carolina just did that a couple of years ago,” he said. “In North Carolina alone, we added about 650,000 people to the Medicaid rolls. In our behavioral health settings, we actually saw a dip in self-pay — meaning uninsured — because those folks had access to Medicaid.”
Even for insured patients, affordability remains a barrier. Mr. Archer said it’s a “huge issue” when patients enter the hospital with a $10,000 deductible.
At the same time, reimbursement models are struggling to keep pace with the push toward integrated care.
CMS recently launched the ACCESS model, tying payment to outcomes in aims to expand access to technology-supported care for Medicaid beneficiaries with chronic disease such as behavioral health conditions. The model focuses heavily on medical and behavioral health integration.
“I think one of the biggest shifts we’re seeing is this movement toward whole health and truly integrated care models,” Anh Le Kremer, chief strategy and development officer of New Bringhton, Minn.-based Sagent Behavioral Health, said. “Unfortunately, when the actual reimbursement codes came out [for the ACCESS model], I was disappointed. The economics just don’t work.”
Still, some see progress at the state level. Oklahoma, for example, passed legislation this year to fund the 988 Suicide and Crisis Lifeline.
Between the July 2022 launch of 988 and December 2024, 35,529 suicides were observed in the U.S. compared to 39,901 expected — an 11% reduction. The 10 states with the greatest increases in answered calls reported a 146.2% rise in monthly calls (from 32,635 to 80,338) and an 18.2% reduction in suicide mortality.
“I’m going to urge you to focus on your states,” Mr. Serratt said. “Your governors and your legislatures are going to be the next group of people that make a difference in behavioral health.”
That shift toward state-level action is already taking shape, with leaders emphasizing coordination at the local level.
“What we’ve found to be extremely helpful is joining with other behavioral health stakeholders within the state and approaching policy issues in a unified way,” Ms. Kremer said. “When we approach the Capitol with that unified voice, it really helps keep our issues at the forefront.”
Ultimately, executives say alignment — both internally and across the industry — will be critical.
“Education internally within our systems, with our C-suite colleagues, is just as important as external advocacy,” said Mr. Simpson.
At the Becker's Fall Behavioral Health Summit, taking place November 4–5 in Chicago, behavioral health leaders and executives will explore strategies for expanding access to care, integrating services, addressing workforce challenges and leveraging innovation to improve outcomes across the behavioral health continuum. Apply for complimentary registration now.
