Policy shifts are impacting psychologists’ ability to deliver care

[This article is part of the 2026 Trends Report]

In 2026, the U.S. health policy landscape looks markedly different from a year ago. In July 2025, H.R. 1—also known as the One Big Beautiful Bill Act—was signed into law, ushering in sweeping changes to Medicaid that may push millions of people off the program. At the same time, the Make America Healthy Again (MAHA) framework, led by Health and Human Services Secretary Robert F. Kennedy Jr., is advancing. The initiative emphasizes reducing exposure to toxins and food additives, promoting healthier nutrition and physical activity, and investigating the root causes of chronic conditions. Federal leaders are also signaling enthusiasm for leveraging technology to modernize and improve health care.

However, psychologists are facing mounting challenges as sweeping policy changes disrupt access to care across multiple domains—including providing supportive counseling for reproductive health, chronic condition management, and gender-affirming care. Some federal officials have also amplified unscientific claims about autism and have promoted vaccine skepticism. While legal restrictions, funding cuts, and health misinformation are limiting care and worsening outcomes for many, clinicians are striving to continue providing ethical and evidence-based care to those who need it most.

H.R. 1, as enacted, will implement the largest cuts to Medicaid and the Children’s Health Insurance Program (CHIP) in U.S. history—$1 trillion or 15% over the next decade. The law also established new work and reporting requirements for Medicaid enrollees and ended enhanced premium tax credits in 2025, limiting access to affordable insurance for millions of lower-income Americans.

The consequences for behavioral health are stark. Medicaid accounts for roughly 25% of all spending on mental health and substance use treatment, making it the nation’s single largest payer for these services. Cuts at this scale are likely to widen health disparities, especially for children, families, and rural residents. The Congressional Budget Office has projected that nearly 12 million more Americans will be uninsured by 2034 as a result.

Research suggests that the mental health consequences of losing coverage will be significant. A recent study based on census data found that adults who lost Medicaid because of administrative barriers were significantly more likely to experience anxiety, frequent worrying, depression, food insecurity, and functional health challenges compared with those who maintained coverage (Soni, A., & Blackburn, J., JAMA Health Forum, Vol. 6, No. 3, 2025opens in new window).

Robert Frank, PhD, a professor emeritus and past director of the University of New Mexico’s Center for Health Policy, called the cuts a dramatic reversal. “They risk reversing major gains, leaving millions without access to essential medical and behavioral health services. That impacts every stage of life, not just those with public insurance; the strain reverberates throughout our health system,” he said.

Frank also pointed to Medicaid’s role in psychology training. Many psychologists complete practicum or internship work in hospital systems, academic medical centers, or federally qualified health centers—settings heavily dependent on Medicaid billing. “Whether [psychologists] directly care for Medicaid patients or not, Medicaid has a role in supporting the infrastructure of our profession,” he said.

The financial strain will ripple across hospitals and communities. Even as hospitals remain obligated to treat patients, reduced hospital reimbursement will make it harder to pay staff, maintain equipment, and deliver essential care. “It really is quite shocking just how very little [Medicaid reimbursement] the hospital receives for the services they provide,” said William Tsang, PsyD, a clinical neuropsychologist at Hackensack Meridian Health in New Jersey. The result, he added, is an overwhelming administrative burden that leaves “less time for things like treatment planning, which is crucial for good patient care.”

Patients feel the impact directly, with increased difficulty scheduling services, understanding insurance, or accessing needed therapies. Tsang has witnessed the effects when he needs to refer patients to other services, such as occupational, physical, and speech therapy. “With these cuts, different specialties cannot even work together because [patients] are not going to be seen. It makes it very hard for individuals to even be able to access multiple types of therapies that they likely need in their recovery process.”

The risks are especially acute in rural America. The National Rural Health Association estimated that Medicaid reimbursement for rural hospitals will drop by 21%opens in new window under H.R. 1. An additional analysis by the Cecil G. Sheps Center for Health Services Research estimated 338 rural hospitalsopens in new window are at risk of closure. “It’s hard to be an effective psychologist when a patient who needs hospital services can’t get them,” Frank noted.

Lynnea Lindsey, PhD, MCSP, former deputy director of the Oregon Health Authority, warned that underfunding hospitals will push patients and systems to the brink. “If people can’t access care, it will blow up emergency departments. People will languish there,” she said. Preventive and early intervention programs will be sidelined in favor of costly acute care, eroding community health.

Maryam Jernigan-Noesi, PhD, a health disparities expert and organizational consultant to community behavioral health agencies, described the funding losses as “a jagged pill to swallow.” She warned that cuts will disproportionately harm “Black and Brown communities, people with disabilities, the elderly, and other groups,” while accelerating the trend of psychologists opting out of Medicaid. “You’ve got folks who are vulnerable, who need services, who are unable to identify and access providers,” she said. “For me, that is an ethical issue.”

For Lindsey, the forthcoming cuts are “morally, ethically, professionally, and personally distressing.” Oregon has long pursued a vision of health care as a human right, and the cuts are likely to push vulnerable populations even further to the margins. And although the Centers for Medicare and Medicaid Services (CMS) is allocating $50 billion through the Rural Health Transformation Program, the funding falls far short of what’s needed to sustain rural health care systems.

Preventive programs are also at risk. Jernigan-Noesi noted that behavioral health integration efforts—such as embedding mental health services in maternal health care—are often “the first to be eliminated” when budgets tighten.

“Most states won’t get more than $100 million. Overall, it sounds like a big amount, but it’s spread across 50 states over 5 years,” Lindsey said. “Hospitals will be precarious in their ability to deliver whole-person care. We are already seeing it impact us in Oregon. Maternal medicine services are being closed on our coast and in our inland rural hospitals.”

As the MAHA movement grows in national prominence, experts are also taking stock of its implications for public health. In September 2025, the MAHA Commission released its Make Our Children Healthy Again Strategyopens in new window, a blueprint to overhaul U.S. food, health, and regulatory systems with the ambitious goal to “end childhood chronic disease.” Proposals include removing harmful additives and artificial food dyes, launching school-based nutrition and fitness campaigns, and reforming dietary guidelines. The strategy also calls out what it labels the “overmedicalization” of children.

Education Secretary Linda McMahon and Kennedy have also come out against annual school-based mental health screeningsopens in new window, claiming without evidence that such assessments stigmatize the normal challenges of growing up. APA respondedopens in new window, stating such screenings are essential to detecting emotional and behavioral challenges early.

While MAHA promotes broadly appealing health messages, it focuses narrowly on personal choice rather than social drivers of health—factors like housing, education, clean water, and safe neighborhoods that also deeply influence health outcomes.

Experts see potential in aligning MAHA’s wellness messaging with an evidence-based strategy that addresses deeper systemic barriers to health. Certain messages, such as the role of physical activity in pain management or the stress-reducing benefits of nature, align with well-established science. Lindsey suggests reframing the conversation around improving access to community resources—such as gardens, safe recreation spaces, and nutritious foods—to bridge the gap.

“Prevention is important, but we cannot will ourselves into good health or out of poor health. We know that things like poverty, racism, and housing insecurity also influence those outcomes,” Jernigan-Noesi said. What does help is blending behavioral health with chronic disease management, particularly in collaborative medical settings. This could help bridge gaps left unaddressed by the MAHA emphasis on personal responsibility. Whether assisting with diabetes care, substance use, or managing chronic pain, psychologists working hand-in-glove with their medical counterparts in integrated health systems can contribute to more equitable and effective outcomes.

Jernigan-Noesi added that psychologists are well-positioned to leverage the MAHA message by advocating for a holistic model of health care. “If this is the goal, let’s continue down the road of integrative health care. Let’s advance the integration of mental and behavioral health providers, including psychologists, into settings where individuals are already receiving medical care. That’s where we can make a significant impact.”