A patchwork workforce: state variation in behavioral health paraprofessional regulation.

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 (ie, 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.