Behavioral health advocates have ambitious priorities for the 2026 General Assembly that include improving the major shortage of behavioral health professionals, advocating for affordable housing options and protecting funds that support the behavioral health network.
But pushing those priorities may be a challenge as legislators grapple with a projected $1.6 billion budget deficit, with higher-than-anticipated use of behavioral health services under Medicaid considered a key driver in the shortfall, according to state analysts.
Adrienne Breidenstine, vice president of policy and communications for Behavioral Health System Baltimore, advocating during the 2025 legislative session for restoring proposed cuts to behavioral health programs. The budget is expected to be a challenge for behavioral health advocates again this year. Credit: Daniuelle J. Brown / Maryland Matters
“That will be key during session, and central to any policy considerations, especially as we’re thinking about asking for increases. Especially as we’re looking at new initiatives,” Adrienne Breidenstine with the Behavioral Health System Baltimore said during a virtual discussion Wednesday.
“This budget gap means that were going to have to be navigating that,” she said.
In November, state analysts told lawmakers that the fiscal outlook for the upcoming fiscal 2027 fiscal year was “quite a bit worse” than what was predicted at the end of the previous legislative session. That’s partially because of funding changes from the Trump administration and the budget reconciliation bill HR 1, known as the “One Big Beautiful Bill Act.”
But another reason is that the state has spent about $778 million more than analysts forecast over the current fiscal year, with Medicaid behavioral health services contributing $217 million of that overspending.
In November, Department of Legislative Services Budget Analyst David Romans highlighted Medicaid spending on behavioral health as one of the “big items” contributing to higher-than-anticipated spending over fiscal 2026.
“We’ve seen over the last couple of years a fairly dramatic jump in utilization of behavioral health services by adults enrolled in Medicaid,” he said during a virtual Joint Spending Affordability Committee hearing in November. “I don’t know if we have a complete answer as to why that is.”
But Breidenstine stressed that overspending is “not necessarily a bad thing,” since it means that people who need behavioral health resources are getting them.
“There was a larger than anticipated services utilization of Medicaid services,” she said Wednesday. “Not necessarily a bad thing — it shows that people need care and they’re getting access. It just means that the state didn’t anticipate all of that need.”
In the 2025 session, Gov. Wes Moore (D) proposed cutting around $116 million from various behavioral health programs as the state worked to close a $3 billion budget shortfall it faced then. Advocates like Breidenstine mobilized against those cuts, and lawmakers were able to restore most of that funding.
But solving the upcoming budget deficit will be a key challenge for the 2026 General Assembly session that starts next week, aggravated by the fact that it’s an election year and there is little appetite for raising taxes. Several officials have said the budget may require tightening spending on state programs.
Meanwhile, advocates still want to push other initiatives during the upcoming session that they say are crucial in helping people get behavioral health services they need, which could require additional state funds to accomplish.
Dan Rabbitt of Behavioral Health System Baltimore said one of the organization’s newest priorities is to push for affordable housing options, especially as the Trump administration pulls federal funding to support what’s called permanent supportive housing.
“We’ve also seen a lot of threats coming in from the federal government around permanent supportive housing,” he said. “The current federal administration doesn’t seem to believe in that model. And so, increasing and protecting affordable housing is going to be a priority of ours in the next two years.”
People facing chronic homelessness often struggle with mental health needs and drug addiction. Advocates say that permanent housing programs may address those challenges by pairing housing assistance with connections to mental health services and other resources.
Rabbitt also said that advocates will be pushing lawmakers to help solve the 34,000 behavioral health professional shortage in the state, which is forecasted to only get worse if no action is taken, according to a 2023 report. Ideally, that would involve improving reimbursement rates for providers of mental and behavioral health services, which would require additional state funds.
But advocates are not deterred by those challenges, and hope to work with lawmakers to boost behavioral health services during the 2026 session.
“We advocates have been here before, we know what’s ahead of us to work together to address these issues,” Breidenstine said.