Massachusetts has long been a national leader in state-level healthcare reform. In 2006, the state enacted a landmark coverage expansion that became the model for the Affordable Care Act. It has also been a leader in broadening mental health parity laws, implementing innovative cost control measures in its Medicaid program, and developing innovative delivery system and payment reforms through its long-standing Section 1115 demonstration waiver. As a result, Massachusetts has boasted the lowest uninsured rate of any state in the nation for more than a decade and ranks highly among states on both physical and behavioral healthcare quality and access measures.

Despite these efforts, there remain critical gaps in access to needed behavioral healthcare services (including mental health and substance use disorder-related services) in the commonwealth. Consumers consistently report long waits for appointments, lack of inpatient bed availability and difficulty finding providers who take insurance, among other challenges. In 2018, 38.7 percent of adults who had sought mental health and/or substance use disorder care in Massachusetts in the previous 12 months reported unmet need for such care.