The Tea · Impact Award
Impact Award: Lance Johnson
LANCE JOHNSON
COO, Alaska Behavioral Health Association (ABHA)
WHY HE WON THE IMPACT AWARD
Five hundred and thirty-eight miles from the nearest road in Nome, Alaska, people were sleeping in abandoned pickup trucks through Arctic winters because there was nowhere else to go. Lance Johnson looked at that and refused to accept it. He took over a behavioral health agency serving 10,000 people across 44,000 square miles, and from there, helped secure $10 million in Medicaid rate increases after decades of zero legislative funding for behavioral health in the state. He stood up a day shelter in four months for people who had no place to go during Arctic winters. Now, as COO of ABHA, he represents 87 of Alaska’s 96 Medicaid-accepting community behavioral health providers. That’s why he won the Impact Award.
THE ORIGIN STORY
Lance Johnson’s path into behavioral health started about as far from the field as you can get. He was an English major trying to figure out what to do next, like so many English majors before him. He landed a role as a program director for a 4-H center in Northern Virginia, running environmental education and team-building programs for youth. That’s where the switch flipped. Seeing the struggles those kids carried, he realized his calling wasn’t in literature. It was in people.
In 2005, he moved to Alaska and joined a small nonprofit community center that had its fingers in everything from tobacco cessation to running the local food bank to family preservation services. He kept bumping up against the same wall: families couldn’t access behavioral health care. Workforce shortages. Process breakdowns. Capacity issues that left people waiting months for an assessment. Eventually, he crossed over to work in behavioral health directly.
Within five months of joining the behavioral health agency in Nome, 538 miles northwest of Anchorage with no roads in or out, he was named interim director. He hadn’t planned on running the show. But he kept opening his mouth, questioning the way things were done, and the next thing he knew, the job was his. As Alaskans like to say, the only way to get anywhere is by plane, boat, or birth canal—and the job meant overseeing care delivery across a region where clinicians fly into remote villages, where access is shaped by weather and daylight, and where internet connectivity isn’t assumed—if it exists at all.
"I said I would never ever work for that behavioral health services agency. But that’s silly. Be an agent of change if you can. You got to surround yourself with the right people who are there for genuine reasons. And sometimes you have to cut out those who have different agendas."
— Lance Johnson, COO, ABHA
THE WORK THAT MATTERS
The accomplishment Lance is most proud of at a statewide level is one that almost didn’t happen. Last legislative session, ABHA secured a $10 million increment to augment Medicaid rates for behavioral health providers in Alaska. To put that in perspective: behavioral health had received zero dollars from the Alaska legislature across decades. And this happened during one of the tightest economic climates the state has seen, with operating budgets tied directly to oil prices. Meanwhile, Alaska’s providers were staring down some of the most severe behavioral health acuity in the country—339 overdose deaths in 2024, fentanyl involved in 73% of them, and an overdose death rate among American Indian and Alaska Native people of 101.9 per 100,000. The state’s age-adjusted suicide rate sits at 28.2 per 100,000. That’s the clinical reality the $10 million was meant to address.
How did it happen? Lance and his small three-person team were in Juneau at a moment’s notice, doing public testimony, invited testimony, and educating legislators who had no behavioral health background. Their membership showed up too, with written letters of support that carried the real stories. On a Sunday night, legislators called to say the increment had died. On Monday morning, they called back. It passed.
On the local level, the work Lance keeps coming back to happened in Nome. People were sleeping in abandoned pickup trucks and shipping containers during the winter because they had nowhere to go. An overnight shelter existed, but it only covered nighttime hours during winter months. Lance helped stand up a full day shelter with showers, laundry, and seven-day-a-week operations, taking it from concept to open doors in four months. The new facility was built directly connected to the behavioral health treatment center, so someone could walk out of the shelter and straight into care without leaving the building.
And then there’s the systemic fight. In Alaska, medical providers follow one and a half pages of documentation regulations under clinical standards. Behavioral health providers follow 137 pages. Lance brought that disparity directly to former Senator Patrick Kennedy, who championed the 2008 federal parity bill. Kennedy’s response: "What the hell? That’s just wild." A recent cost survey confirmed what everyone in the field already knew: Alaska’s behavioral health providers are spending 42% of their time on administrative work instead of clinical care. And they’re doing it while still feeding data up through the state’s reporting infrastructure and onward to federal expectations—often from places where care is being delivered without reliable internet. Alaska’s behavioral health system was intentionally designed to be responsive to its communities. But the documentation and reporting layers stacked on top of it were not.
"If I’ve got a broken leg, I can go into the emergency room and get help right away. I’ll get my plan of care done right then and there. But if I go in and I have a broken heart, I’ve got an assessment I have to go through first, then I have to come back and get a treatment plan done. By the third week, I should have my first treatment service. But that’s only if I can get my assessment done, because there might be a backlog and a wait list of six months for some agencies."
WHAT’S AHEAD
Lance sees enthusiasm for behavioral health at both the federal and state level, but he’s clear-eyed about the gap between rhetoric and action. Decision-makers talk a good game about supporting behavioral health services, especially after COVID opened more eyes to the crisis. But the enthusiasm doesn’t match the pace of regulatory change or funding reform. Documentation standards are still built on antiquated ideas rooted in decades-old fears about fraud, waste, and abuse. Meanwhile, providers are closing their doors because the rates don’t cover the cost of delivering services.
The part that sticks: if providers had known about the level of overregulation and documentation burden required to do community behavioral health work, many of them would have gone straight to private practice. And private practices, for the most part, aren’t taking Medicaid. They aren’t serving the people who need services most. The system is pushing its best people away from the populations that need them.
THE 1 THING
"Your voice is more powerful than you think. You’re not just providing direct service to individuals. You’re providing direct service for the continuum of care as a whole. Use your stories. Use your outcomes. Rise up and say enough’s enough."
— Lance Johnson
OFF THE CLOCK
If you live in Alaska and you’re bored, you’re doing something wrong. That’s Lance’s philosophy. His personal therapy during his years in Nome was playing in a band that spanned five generations, with a 70-year-old drummer who’d occasionally fall asleep behind the kit mid-gig. Lance barely played guitar when he arrived in Alaska, but the arts community in Nome encouraged everyone to get on stage at the folk festival regardless of talent. That bravery shaped him in ways he didn’t expect, building the same comfort with public platforms that now fuels his advocacy work. Music remains his go-to, and anytime he travels, he’s hunting for live concerts.
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