A Shifting Policy Landscape: The ACA at Risk and What It Means for Mental Health Providers

As the new federal administration signals efforts to scale back or revise key elements of the Affordable Care Act (ACA), mental health organizations and other healthcare providers are preparing for potential disruptions in coverage and reimbursement.

Coverage is a key determinant of access to behavioral health services nationwide. Recent analyses suggest that marketplace policy changes and the expiration of enhanced affordability could result in substantial coverage losses over time, with disproportionate effects on people who rely on ongoing mental health treatment.

For not-for-profit providers already operating on tight margins, coverage volatility tends to become more evident quickly, resulting in fewer insured visits, interrupted treatment plans, increased administrative burden, and higher uncompensated care. When individuals become uninsured or underinsured, providers often experience a shift from preventive and routine care toward crisis-driven utilization, raising both clinical intensity and cost per encounter.

How ACA Disruptions Cascade into Challenges for Mental Health and Healthcare Providers

The effects of ACA disruption extend beyond the marketplaces. Because behavioral health and community providers rely heavily on stable coverage and Medicaid dynamics, policy volatility can strain access, finances, and operations:

• Access and continuity: Coverage losses and churn increase delayed care, missed appointments, and medication interruptions—undermining clinical outcomes and increasing downstream emergency and inpatient utilization.
• Higher acuity: Medicaid eligibility reviews and coverage transitions can lead patients to re-enter care later and sicker, elevating complexity and staffing demands.
• Network and cash-flow instability: Premium pressure and shifts in insurer participation can narrow networks and disrupt contracted reimbursement pathways, leading to increased denials, authorization workload, and cash-flow unpredictability.
• Compounding policy and budget uncertainty: Broader federal policy shifts affecting Medicaid and behavioral health oversight can add operational risk, particularly for organizations serving high-need and low-income populations.

Taken together, these forces underscore why financial resilience is crucial: strong systems and proactive planning enable organizations to maintain services through coverage churn, reimbursement variability, and shifts in external funding conditions.

Grant-Ready and Resilient: Financial Strategies for Mental Health Organizations

As mental health awareness and care become a growing priority across the country, organizations are committed to enhancing community well-being while facing new challenges and opportunities. With growing demand, decreased funding availability, and shifting models of care, a strong financial foundation has never been more critical.

Mental health-focused organizations often operate under significant pressure with rising service demand, limited funding, and staff burnout and face challenges that are frequently exacerbated by inconsistent financial systems or unclear budgeting strategies. Robust financial planning delivers measurable benefits by supporting consistent programming, enabling stable compensation to aid recruitment and retention, reducing administrative stress through clear workflows and reporting, and creating flexibility to address urgent or unexpected needs.

Grant and Donation Opportunities

As demand for mental health services grows, so does the availability of public and private funding sources. However, competition for these funds is intensifying. Organizations must be grant-ready and equipped with reliable accounting systems and clearly defined “use-of-funds” plans to stand out from the crowd. Being grant-ready improves the chances of securing funding and supports stronger stewardship once awards are received.

“Grant-Ready” Considerations

• Develop a restricted funds strategy: Allocate grant funds to allowable program expenses (e.g., staffing, telehealth infrastructure, outreach) and ensure proper categorization in financial reporting to maintain compliance.
• Build a compelling budget narrative: Align each dollar with mission outcomes, explaining how funds address a gap or create sustainable change.
• Strengthen financial infrastructure: Upgrade accounting systems, conduct periodic internal reviews, and meet regularly with advisors to support compliance and long-term planning.

While many local and federal programs offer meaningful opportunities, they also demand financial accountability and long-term planning to be fully leveraged. Building trust in an organization’s stability and transparency can make a lasting difference.

Strengthening Financial Processes

Establishing clear financial processes and grant-readiness practices enables organizations to present their financial position, understand their funding capacity, and comply with their reporting responsibilities. These efforts or often enhanced when organizations consult with outsourced accounting advisors who support budgeting, tracking restricted-funds, and consistent financial reporting. Over time, strong practices enable better planning, closer alignment of resources with program goals, and greater stability as organizations respond to evolving community needs.

The Demand for Mental Health Care

With nearly one in four U.S. adults experiencing a mental illness in the past year, demand for mental health services continues to rise. Organizations can bolster resilience by developing multi-year budgets aligned with growth projections, building reserves to cushion disruptions, and diversifying funding streams to reduce dependency on any single source.

Looking Ahead

As the ACA policy environment remains unpredictable, mental health organizations face an increasingly complex intersection of rising demand, unstable coverage, and intensified financial pressure. While policy outcomes may be uncertain, preparation is not. Organizations that invest in strong financial systems, grant readiness, and long‑range planning are better positioned to withstand coverage disruptions without compromising access to care. In this moment, financial resilience is more than an operational safeguard as it is a cornerstone of continuity, equity, and the ability to meet communities where they are, even as the policy landscape continues to shift.

For more information, please contact Brian Sackstein, Partner and Leader of Anchin’s Not-For-Profit and Healthcare Groups, Anthony Carrella, Partner and Leader of Anchin’s Client Accounting Advisory Group, or your Anchin Relationship Partner.