The U.S. Centers for Medicare and Medicaid Services (CMS) has placed Behavioral Health Equity at the center of its strategic priorities, signaling a renewed federal focus on mental health and substance use care. With behavioral health needs rising across the country, CMS is taking steps to integrate services into community-based models, ensuring access to care for populations who have historically faced barriers. Earlier this month, the agency proposed a new ruling aimed at addressing workforce shortages, enhancing care coordination, and improving access to services. A notable aspect of this proposal is expanding medication-assisted treatment for opioid use disorder through mobile units, allowing care to reach communities that may lack traditional health care infrastructure.
Driving these initiatives is Dr. Meena Seshamani, CMS deputy administrator and director of the Center for Medicare. In a recent interview with Behavioral Health Business, Seshamani emphasized the agency’s holistic approach to Behavioral Health Equity and its connection to broader policy goals, including advancing equity, expanding access to coverage, promoting innovation in care delivery, and maintaining the sustainability of Medicare for future generations. Her insights highlight CMS’s commitment to rethinking how behavioral health services are delivered, measured, and funded.
Addressing Social Determinants of Health
At the heart of CMS’s approach is recognizing the impact of social determinants of health on behavioral health outcomes. Social determinants—including housing stability, access to nutritious food, transportation, and social support—play a critical role in shaping a person’s overall well-being. “People have a myriad of experiences that impact their health,” Seshamani explained. “We want to make sure that we are looking at the whole person.”
To promote Behavioral Health Equity, CMS now requires special needs plans to screen all enrollees for health-related social needs. Additionally, the agency has opened public comment periods on ways to stratify data to better identify disparities among populations, enabling targeted interventions to close gaps in care. These efforts reflect a shift from a purely clinical model to one that considers the broader context of a patient’s life, ensuring that behavioral health care addresses the underlying factors that influence outcomes.
Investment in Underserved and Rural Communities
One key component of CMS’s strategy is providing upfront funding to smaller providers, particularly in rural and underserved areas. These advanced investment payments allow providers to improve care infrastructure, implement holistic care models, and address health-related social needs in their communities. Funding can be used in partnership with community-based organizations to support initiatives such as food programs, housing assistance, and transportation services—critical factors in ensuring patients can access care consistently.
This strategy also aligns with CMS’s focus on accountability and outcomes. For example, the agency has solicited public comments on a health equity index in Medicare Advantage plans, which would track how plans support underserved populations, including dually eligible beneficiaries, low-income seniors, and individuals with disabilities. Similarly, a proposed health equity adjustment in the Medicare Shared Savings Program would reward Accountable Care Organizations (ACOs) that successfully care for underserved populations. These initiatives are key to advancing Behavioral Health Equity across Medicare programs.
Leveraging Community Resources and Health Centers
CMS is also focused on collaboration with Federally Qualified Health Centers (FQHCs) and rural health clinics to expand behavioral health services. By integrating these community-based providers into innovative care models, such as ACOs, CMS ensures that patients in rural or resource-limited areas have access to coordinated, high-quality care. Dr. Seshamani emphasized that CMS works closely with the Health Resources and Services Administration (HRSA), which administers FQHC grant programs, to align funding and resources that strengthen community-level care.
This approach highlights a broader trend in health care: leveraging community resources to meet patients where they are. Mobile health units, telehealth services, and partnerships with local organizations are all part of CMS’s plan to bring behavioral health care into neighborhoods, homes, and community centers, supporting Behavioral Health Equity in practical, tangible ways.
Driving Innovation While Closing Equity Gaps
Innovation is a central theme in CMS’s vision for behavioral health. The COVID-19 pandemic accelerated the adoption of telehealth and other care delivery innovations, revealing both opportunities and challenges. While telehealth allowed many patients to access care remotely, disparities in usage emerged: Black, Latinx, and rural Medicare beneficiaries were less likely to use video-based telehealth compared with their white and urban counterparts.
To address these inequities, CMS is considering a range of strategies, including expanding broadband access, improving cultural competency, and providing language support. The goal is to ensure that technology enhances care for all populations rather than widening gaps. Dr. Seshamani emphasized that innovation should serve CMS’s strategic pillars: advancing equity, promoting high-quality whole-person care, expanding access, and ensuring sustainability. This includes not only telehealth but also team-based care, integration of community health workers, and coordinated care models that connect patients with both clinical and social support services, further supporting Behavioral Health Equity.
The Importance of Behavioral Health Now
Focusing on behavioral health is particularly urgent because many Medicare populations—adults aged 65 and older, individuals with disabilities, and those with end-stage renal disease—were already vulnerable to depression, social isolation, and substance use disorders before the pandemic. These challenges have only intensified in recent years.
CMS is taking a multipronged approach to meet this growing need: expanding access to licensed marriage and family therapists and professional counselors, allowing outpatient hospital departments to provide telehealth services, integrating behavioral health with primary care, and investing in holistic models like ACOs. Mobile treatment units for opioid use disorder exemplify the agency’s commitment to bringing care directly to the community, reducing barriers to access, and improving patient outcomes. These initiatives are a clear example of Behavioral Health Equity in action.
Looking Ahead: The Future of Behavioral Health Services
The next five years are expected to bring significant changes to behavioral health delivery. Lessons learned during the pandemic—including the effectiveness of team-based care, the importance of meeting patients where they are, and the need to address social determinants of health—will continue to shape policy and practice. CMS aims to broaden its approach to health, integrating social, behavioral, and physical care into comprehensive, community-centered models.
Dr. Seshamani’s vision reflects a holistic, patient-centered future for behavioral health: one in which equity, innovation, and collaboration drive care delivery. By leveraging community resources, rewarding providers who serve underserved populations, and using data to measure outcomes, CMS is setting the stage for a system that not only treats symptoms but addresses the full context of patients’ lives, further advancing Behavioral Health Equity.
Behavioral health is no longer a secondary concern in national health policy. With CMS leading efforts to expand access, integrate care, and address social determinants, the future promises more equitable, effective, and sustainable behavioral health services—ensuring that vulnerable populations receive the care and support they need to thrive.
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