The Affordable Care Act (ACA) has extended health insurance coverage to nearly seventeen million people, the majority of which has come through the expansion of Medicaid for low-income individuals. Consequently, this has increased the demand for primary care visits and psychiatry appointments nationally. Despite the projected increase, the distribution of that demand will not be uniform across states, as only 31 states and the District of Columbia have decided to expand Medicaid coverage. The potential strain on behavioral health providers, delivery systems, and public programs will differ based on whether a state chose to expand Medicaid.

This project helps to inform our understanding of how workforce capacity differs between states that have expanded Medicaid and those that have not. We proposed the following questions:

  1. What barriers and challenges have organizations in expansion states faced as they face increased utilization?
  2. What lessons can be drawn from successful organizations?
  3. Are successful organizations employing innovative, team-based care models
  4. What have state policymakers done to encourage organizations to achieve workforce capacity, including changes to telehealth and scope of practice requirements?


The Affordable Care Act’s expansion of Medicaid eligibility among participating states increased the number of per-capita behavioral health providers more significantly than increases in states that did not expand Medicaid eligibility. Further examination of the relationship between Medicaid and behavioral health workforce was necessary given the important role that Medicaid played in financing behavioral health services across our nation.

Study findings have supported the National Health Service Corps Loan Repayment Program as an effective incentive to increase rates of behavioral health providers in underserved and high-need areas. However, this program could be made more effective with increased funding, improved behavioral health recruitment and retention strategies, and expanded participant eligibility for substance use disorder treatment facilities and providers.