State Innovations in Behavioral Healthcare: Challenges and Opportunities
November 19, 2025 · Guest Contributor
Kristine Toppe, Vice President of State Affairs, NCQA Behavioral healthcare in the U.S. faces many barriers to improved access and quality, including financial, structural and long-standing policies. But some states are exploring ways to increase access and measure improvement. NCQA has been convening with stakeholders—innovation hubs—to identify ways to drive improvement in behavioral healthcare access and outcomes.
We held state roundtable discussions on three trending topics in behavioral health—network adequacy and access; crisis care; funding and sustainability—and convened with state leaders at conferences like NatCon and the National Association of State Mental Health Program Directors Annual Meeting.
States’ Challenges
There are no easy answers to the behavioral health crisis, but standardization and measurement can help create a framework for improvement. NCQA wants to adapt our standards and measures to reflect states’ needs and priorities. Top challenges we heard include:
Surging demand. Multiple factors are intensifying the demand for care: reduced stigma, increased screening, social disconnection, the rise in gambling and other addictions.
Provider shortages. Demand is exacerbated by a shortage of behavioral health providers, especially in rural areas. Approximately 122 million people in the U.S. live in areas with mental health provider shortages.1
Digitization of data. Behavioral health lags behind in the move to interoperable systems (primarily due to lack of funding), which complicates data sharing and coordinating with physical health care systems.
Adherence to measures. Reporting on quality measures is challenging and time-consuming, especially for rural providers. States are looking for ways to make it easier to collect data for value-based care initiatives. “If we introduce new measures, let’s make sure they work for both physical health and behavioral health,” said one roundtable participant.
Social needs screening. Many behavioral health systems are not set up to capture or receive data from other care delivery systems—data that are essential for care coordination and measurement.
Opportunities for Improvement
Despite policy and budget challenges, states are developing innovative solutions to expand behavioral health programs, support interoperability and measure quality and outcomes.
- Louisiana expanded mental health professionals eligible for Medicaid reimbursement to include provisionally licensed professional counselors, provisionally licensed marriage and family therapists and licensed master social workers as rendering providers.
- Washington State implemented community-based behavioral health enhancement funding to ensure adequate staffing for local community-based behavioral health providers.
- Some states have permanently expanded the use of telehealth for behavioral health services, which had been available on a limited basis during the pandemic.
- States are developing expanded crisis care services, including mobile crisis response and crisis care walk-in centers like Connections Emergency Behavioral Health Crisis Walk-In Center in Pennsylvania.
- Integration between physical health and behavioral health is another priority focus, with states exploring value-based care models that reward collaboration.
- Interoperability and data sharing continues to be an area of innovation. Washington State is implementing the Health Care Management and Coordination System across multiple state agencies and care settings. The system will include shared governance, data, resources and common workflows to maximize impact and efficiency.
States have many levers they can use to improve behavioral healthcare. For example, even with limited funding, states can require accreditation to help ensure that health plans and care delivery organizations meet certain standards.
How NCQA Can Help States
NCQA supports improvement in quality and access to behavioral health services in many ways:
We accredit behavioral healthcare organizations and certified community behavioral health clinics.
Our Distinction in Behavioral Health Integration recognizes primary care organizations that excel at integrating behavioral health into their practices. NCQA recently received funding from the Health Resources and Services Administration to support Federally Qualified Health Centers and Look-Alike Health Centers that want to achieve this Distinction.
We incorporated behavioral health measures into HEDIS® to measure and report the quality of behavioral healthcare. We updated our care continuity measures to include peer support, and we’re developing measures for network adequacy.
We engage in publicly and privately funded research on behavioral healthcare quality and access.
NCQA is creating standard, repeatable frameworks and developing outcomes measures that limit states’ administrative burden.
To learn more about NCQA’s work in behavioral health—or to join the conversation—email us at publicpolicy@ncqa.org.
Additional Resources
- Listen to our Quality Matters podcast, How To Make Behavioral Healthcare Better.
- Read our white paper, Improving Accountability for Behavioral Healthcare Access.
- Visit our Behavioral Health Resource Center.
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