A patchwork workforce: State variation in behavioral health paraprofessional regulation

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ID: 324378
2026
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Abstract
Abstract Introduction Increasing availability and wide geographic distribution of a skilled behavioral health/substance use (BH/SU) workforce is key to ensuring access to treatment for millions of individuals with BH/SU disorders. In many other healthcare sectors, there are state-regulated paraprofessional roles (i.e., roles that require a bachelor’s degree or less). Yet, the BH/SU field has historically lacked state-regulated paraprofessional roles, limiting workforce entry pathways. Methods The purpose of this study was to examine policy provisions that states have adopted to formalize BH/SU paraprofessional roles using a formal legal mapping methodology. Results As of September 2025, we identified a total of 94 BH/SU paraprofessional roles regulated by 36 states. Certification was the dominant level of regulation, and a majority of the BH/SUs certificates had a nondegree training pathway. From a financing perspective, explicit reimbursement references were common, with certification showing the clearest billing pathway. Conclusion As the first systematic national legal mapping of state-regulated BH/SU paraprofessional roles, these insights can assist states considering the adoption or expansion of BH/SU paraprofessional roles.
Reference Key
openalex_W7201983408 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Hannah Maxey, Mykayla Moore, Ashlyn Burns, Steven Stead
Journal Health Affairs Scholar
Year 2026
DOI
10.1093/haschl/qxag207
URL
https://doi.org/10.1093/haschl/qxag207
Keywords Keywords not found

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