Physical and mental well-being are closely intertwined, and both are essential for people to lead their healthiest and most productive lives. The Rural Health Transformation Program, created under OBBA and administered by CMS, presents an important opportunity for Governors and states to strengthen rural health, including by addressing mental health and substance use disorder, through the identification of innovative and effective strategies.
Addressing behavioral health is a named priority in the Rural Health Transformation Program, specifically around investing in opportunities to expand access to treatment for substance use disorders and mental health treatment. This funding opportunity aligns with commitments from Governors to improve outcomes related to these two issues, which remain a consistent bipartisan priority.
About one-in-five individuals living in rural areas have a mental illness, a similar percentage to those living in urban areas. However, those in rural areas may have more severe behavioral health outcomes. For instance, suicide rates are higher in rural areas compared to urban areas, with rates nearly doubling in rural areas between 2000 and 2020.
Improving behavioral health in rural communities can also be hindered by the stigma around mental health and substance use disorders, limited provider capacity and other social drivers of poorer health such as higher rates of unemployment, transportation barriers and lower incomes.
Through strategic investments in behavioral health infrastructure, Governors can strengthen rural communities. Below are a few policy areas Governors and states can consider as they work to address these challenges.
Bolstering the Behavioral Health Workforce
Over 25 million rural Americans live in areas that are considered Mental Health Professional Shortage Areas, meaning demand for treatment services exceeds provider capacity. Governors can support strengthening the behavioral health workforce through:
Promoting Interstate Licensure Compacts
Governors and states can join behavioral health interstate licensing compacts, which allows licensed professionals to practice across state lines with other states that have signed onto the compact. Three examples of behavioral health licensure compacts include the Counseling Compact, the Psychology Interjurisdictional Compact (PSYPACT) and the Social Work Licensure Compact.
Promoting telehealth for behavioral health services to expand access:
People living in rural areas travel farther to access healthcare, and telehealth has expanded access for individuals in need of mental health and substance use services. Telehealth can be especially important for older Americans who have additional barriers to accessing care. To improve access to telehealth, states can support investments in broadband access, review and adapt streamlined licensing requirements for providers offering telehealth services, ensure parity in reimbursement for telehealth services and invest in Health Information Technology (HIT) infrastructure.
Resources: Telehealth for Behavioral Health Care
Expand Capacity to Treat Behavioral Health Conditions
As part of the Rural Health Transformation Program, Governors can identify opportunities to expand access to treatment through more coordinated systems of care and within existing healthcare access points.
Investing in Certified Community Behavioral Health Clinics
Certified Community Behavioral Health Clinics (CCBHCs) provide comprehensive mental health and substance use disorder services in a coordinated manner. CCBHCs require nine services:
- 1. Crisis Care
- 2. Outpatient Mental Health and Substance Use Services
- 3. Person-and Family-Centered Treatment Planning
- 4. Community-Based Mental Health Care for Veterans
- 5. Peer Family Support and Counselor Services
- 6. Targeted Care Management
- 7. Outpatient Primary Care Screening and Monitoring
- 8. Psychiatric Rehabilitation Services
- 9. Screening, Diagnosis and Risk Assessment
Evaluations of this model have shown that people who receive care through these clinics experience reductions in hospitalizations, homelessness and spend less time in jails.
CCBHCs can also help people access medications for opioid use disorder (MOUD). A recent evaluation showed that nearly 90% of CCBHCs offer one or more forms of MOUD, compared to 64% of substance use disorder treatment centers nationwide.
Integrated Behavioral Health Care into Primary Care
Integrating behavioral health care into primary care settings can expand access, improve outcomes, reduce stigma, and be cost-effective for treating mental health and substance use disorders. Depending on the model, integrated behavioral health care ranges from primary care physicians screening and referring for behavioral health conditions to co-locating coordinated primary care and behavioral health services using a team-based approach to provide whole-person care.
While federal actions can make it easier to integrate primary and behavioral health care, Governors can encourage this approach through managed care contracting, prioritizing value-based payments, investing in provider training and enforcing network adequacy standards.
Resources: Aligning Systems to Advance Care- State Behavioral Health Integration Approaches
Leverage Emergency Medical Services (EMS) Systems
EMS systems are critical for providing lifesaving healthcare and are sometimes the only guaranteed access point for medical care in rural areas. EMS can be leveraged in non-emergency settings through Community Paramedicine or Mobile Integrated Healthcare. This model enables EMS providers to support patients, in their home, with chronic and behavioral health disease management.
In some areas, EMS providers have been equipped with resources to address the ongoing overdose crisis by providing naloxone following an overdose scene, as well as initiating buprenorphine treatment.
Next Steps
States are continuing to prioritize rural health needs through the Rural Health Transformation Program application process as they submit their applications by November 5, 2025. While the health needs in rural areas are broad, states can leverage these resources to reimagine the way they respond to these issues and implement evidence- based interventions that strengthen behavioral health systems for years to come.
For more information on how Governors can strengthen behavioral health through the Rural Health Transformation Program, contact Marianne Gibson: mgibson@nga.org.
