Behavioral Health Feasibility Study in Maryland

Many practices, very small loans

Behavioral health in Maryland combines high frequency with low dollars. The 2.40x location quotient says clinics and treatment programs weigh in at more than twice their national share of Maryland approvals, the state ranks 8 of 52 for the class, and yet behavioral health sits 15 of 39 among Maryland asset types. A $100,000 median loan comes to only 0.33x the national median, and the loans in the middle of the range run from $50,000 to $280,000. There are 45 approvals totaling $20.6 million over FY2017 to FY2026. Median size is the standout. Maryland's practices borrow a third of what the class does nationally, so many deals look like small outpatient practices.

Recent growth and concentrated lending

Annual counts show a late surge. After 3 loans in FY2017, a year with none in FY2019 and 2 in FY2023, approvals rose to 9 in FY2024 and 15 in FY2025, with $6.0 million that year, and FY2020 shows $5.8 million from only 3 loans. Manufacturers and Traders Trust Company dominates the lender list with 22 loans totaling $4.0 million. The 7(a) program supplied 44 loans against 1 for 504, and franchising is 6.7% of loans. Baltimore County holds 16 loans, Baltimore City 11, Howard County 7 and Harford County 3.

Maryland behavioral health carries neither a cancellation figure nor a charge-off figure on this page. Each rests on a cohort under 30 loans, because so much of the approval volume is recent and has not yet had time to be cancelled or funded. A withheld rate is not a zero. Anyone using these loans as a signal of performance should wait for the cohorts to mature.

The industry codes cover behavioral health and addiction treatment together, so a mental health counseling office and a residential treatment program share a line. The two cannot be split, and a study must say which one is meant, since licensing, staffing and reimbursement are very different.

What a Maryland study has to settle

The study should begin with licensure and payers. Outpatient counseling, intensive outpatient programs and residential care each carry different state approvals, clinician ratios and reimbursement, and the plan should show which payers will pay what for the services offered. Referral sources, such as courts, hospitals and employers, and the number of clinicians already in the catchment around Baltimore, should be measured. On cost, a loan near $100,000 suggests an office fit-out, while a residential program needs property and is a different undertaking. Coverage of the loan payment should be shown with slow credentialing and a delayed first payment cycle, and the appraiser will lean on collections, so the study should document billing.