For too long, behavioral health has stood in the shadows of the broader healthcare conversation. Despite rising rates of mental health disorders, addiction, and suicide across the U.S., access to quality behavioral health services has remained limited — hampered by underfunding, insufficient reimbursement, and systemic barriers to care. But the tides may finally be turning.
In 2020, signs of progress emerged in Washington, D.C., with new legislative initiatives, expanded grant funding, and policy shifts indicating that behavioral health is finally receiving the national attention it deserves. The Centers for Medicare and Medicaid Services (CMS) has opened new doors for behavioral health reimbursement. The Substance Abuse and Mental Health Services Administration (SAMHSA) is increasing grant opportunities, and a growing number of state governments are working to enforce parity laws.
Yet, while encouraging, these advancements are just the beginning. According to Chuck Ingoglia, president and CEO of the National Council for Behavioral Health, much work remains to be done.
A New Era of Attention — and Action
The National Council represents more than 3,300 behavioral health providers nationwide, many of which are safety net organizations serving the under- and uninsured. Ingoglia and his team have long advocated for policy reform to strengthen behavioral health access. In 2020, their priorities focus on expanding programs, protecting Medicaid, and keeping behavioral health in the spotlight as a major national issue.
At the heart of their efforts is the Certified Community Behavioral Health Clinic (CCBHC) Demonstration Program. Initially launched as a pilot project, CCBHCs offer comprehensive behavioral health services — including 24/7 crisis care, medication-assisted treatment (MAT), and integrated care for co-occurring conditions — all under a payment model designed to cover the real cost of care.
“The CCBHC model raises the bar for what behavioral health care should look like,” Ingoglia explains. “It’s not just about access, it’s about timely, high-quality, coordinated care.”
In recent months, SAMHSA made CCBHC expansion grants available nationwide, a move Ingoglia views as a critical step forward. However, he emphasizes that true success will require more than grant dollars — it will require structural support through Medicaid and sustainable funding mechanisms.
The Threat to Medicaid Coverage
One of the biggest obstacles to behavioral health access is the continued uncertainty surrounding Medicaid — especially efforts at the federal level to restrict access through work requirements, block grants, and potential eligibility changes.
“These kinds of policies disproportionately affect the people who rely on Medicaid the most — individuals with complex behavioral health needs,” Ingoglia warns. “If it becomes harder for people to access coverage, it becomes harder for providers to deliver care.”
Additionally, ongoing legal challenges to the Affordable Care Act (ACA) pose a looming threat to Medicaid expansion. While the final ruling on the ACA’s constitutionality may not arrive until after the 2020 election, the very uncertainty it brings adds stress to providers and patients alike.
Despite the instability, Ingoglia urges providers to stay focused. “The ACA is the law of the land,” he says. “Until something changes, we need to keep doing what we do best — providing care and advocating for those who need it.”
Elevating Behavioral Health on the National Stage
With the 2020 presidential election looming, the National Council is working hard to ensure behavioral health is part of the national conversation. Through public polling, educational town halls, and voter engagement efforts, they’re shining a spotlight on the urgent need for expanded mental health and addiction services.
“The American public is concerned — they want more access to mental health and addiction care,” Ingoglia says. “Our job is to make sure policymakers are hearing that.”
He draws parallels to the opioid crisis, which gained significant federal attention only after constituents began voicing concerns directly to their representatives. That kind of grassroots pressure, he believes, is key to elevating mental health as a national priority.
Medicare Expansion for Opioid Treatment: A Welcome Shift
Among the most significant developments in 2020 is the decision by CMS to allow Medicare to reimburse opioid treatment programs (OTPs), including coverage for methadone — a long-overdue win for addiction care.
Even more promising is the bundled payment model CMS is using, which pays providers for a range of services instead of reimbursing each 15-minute increment. “This is a game-changer,” says Ingoglia. “It gives providers the flexibility to focus on what’s best for the client, not just what fits into a billing code.”
Bundled payments reduce administrative burden and enable more holistic, person-centered care — a potential breakthrough not just for addiction treatment, but for all of behavioral health if the model is adopted more broadly.
Broadening the Focus Beyond Opioids
While the national response to the opioid epidemic has been vital, some in the behavioral health community worry that other issues may be neglected. Ingoglia shares that concern but sees signs of progress.
Recent legislation has expanded funding beyond opioid use disorder to include stimulant abuse — a growing concern as methamphetamine and cocaine use rise. There’s also more awareness of the devastating toll of alcohol, which still causes more deaths annually than opioids.
“Addiction is not one-size-fits-all,” Ingoglia notes. “We need to give states the flexibility to respond to their unique needs — whether it’s opioids, stimulants, alcohol, or something else.”
Addressing the Workforce Crisis
No conversation about behavioral health reform is complete without discussing the workforce shortage. Across the country, providers are struggling to recruit and retain qualified staff. The issue is especially severe in rural areas and low-income communities.
“It’s a question of reimbursement,” Ingoglia says plainly. “If people can make the same salary at a fast food restaurant — with less stress — we’re not going to be able to keep them in this field.”
To combat this, the National Council is advocating for higher reimbursement rates, expanded loan repayment programs, and increased support for education in fields like social work, counseling, and psychiatric care. They’re also pushing Medicare to recognize more types of licensed professionals, including marriage and family therapists and licensed professional counselors.
“If we want a strong behavioral health system, we have to invest in the people who provide the care,” he says.
Looking Ahead
The renewed attention to behavioral health in Washington, D.C., is both promising and overdue. With new funding streams, expanded Medicare coverage, and growing public support, the foundation for meaningful reform is finally being laid.
But progress will depend on continued advocacy, especially at the state and local level. Whether it’s ensuring Medicaid remains accessible, expanding CCBHCs, or fighting for parity laws, the work is far from over.
“We’re at a turning point,” Ingoglia says. “Now is the time to build the kind of behavioral health system that truly meets the needs of every American — no matter who they are or where they live.”
As the conversation continues in Congress and on the campaign trail, one thing is clear: Behavioral health is no longer on the sidelines. It’s finally at the table — and with continued commitment, it may soon become a central pillar of the U.S. healthcare system.
