For local clinics that rely on Medicaid patients — Certified Community Behavioral Health Clinics (CCBHCs), Community Mental Health Centers (CMHCs), Federally Qualified Health Centers (FQHCs), and Rural Health Clinics (RHCs) — these are not abstract projections. RAND projects that work requirements alone will drive enrollment reductions exceeding 20 percent in some expansion states by 2034. These individuals often populate community behavioral health clinics as uninsured patients, and OBBBA does nothing to close that gap. Rural behavioral health clinics are recruiting from an already constrained talent pool. Many community behavioral health clinics lack the ability to access these metrics quickly.