While the future of Medicaid continues to be debated in Washington, D.C., it’s important to highlight just how critical a program it is, especially when it comes to mental health services.
Medicaid is the nation’s largest public health insurance program, playing a pivotal role in ensuring that Americans can access critical mental health care that might otherwise be out of reach. Indeed, one in five Americans – nearly 80 million adults and children – are covered by Medicaid, and it is the single largest payer for mental health services in the U.S.
More than half of all young people with severe mental health conditions receive coverage through Medicaid or CHIP – the Children’s Health Insurance Program, which covers children and teens up to age 19. In Medicaid expansion states, which include 41 states, the District of Columbia, and Puerto Rico, people living at or below 138% of the federal poverty level qualify for Medicaid coverage, including mental health services. Additionally, people qualifying for Supplemental Security Income (SSI) due to mental disabilities automatically receive Medicaid in most states.
For much of the last 20 years, Medicaid has repeatedly evolved and expanded to provide increased coverage for mental health services. The Mental Health Parity and Addiction Equity Act, passed by Congress in 2008 and signed into law by then-President George W. Bush, requires Medicaid to cover mental health services on par with physical health services. That includes outpatient therapy and counseling, inpatient psychiatric care, prescription medications, rehabilitation services, and screening and prevention services.
In addition
Several Medicaid initiatives have emerged from states to address gaps in mental health care for various populations, including:
Certified Community Behavioral Health Clinics (CCBHCs)
“One-stop shops” providing comprehensive mental health and substance use treatment regardless of ability to pay. Data show that CCBHCs have reduced emergency department visits by 60% among participants.
Home and Community-Based Services
These waivers allow states to provide support services that help people with serious mental illness remain in their communities rather than in institutions.
Telehealth expansion
During the COVID-19 pandemic, Medicaid telehealth usage for mental health services increased by 2,500%, with many states having since made these flexibilities permanent.
Youth Mental Health and Medicaid Coverage
As concerns continue to grow over the mental health of our nation’s young people, numerous health organizations have identified Medicaid expansion and enhancements to the program as key components in addressing this critical challenge. Specifically, Medicaid and CHIP play a crucial role in supporting youth mental health in the United States. Together, the programs provide health coverage to more than 40 million young people, including nearly half of all children and young people in the country.
The Early and Periodic Screening, Diagnostic, and Treatment program, a comprehensive benefit for children and young people under age 21, is mandatory for all state Medicaid programs. It requires states to provide regular screenings for physical and mental health conditions and ensure treatment for any identified conditions, even if these services aren’t covered for adults in the state’s Medicaid plan.
Medicaid also reimburses schools for certain mental health services provided to eligible students, including assessments, therapy, and counseling. Approximately 70% of school-based health centers provide mental health services that can be billed to Medicaid. Many states have also expanded youth mental health services through Medicaid, including mobile crisis response teams that can intervene during mental health emergencies without law enforcement involvement.
While states design and administer their own Medicaid programs within federal guidelines, Medicaid operates as a state-federal partnership. Through the Federal Medical Assistance Percentage (FMAP), the federal government pays, on average, between 50% and 78% of Medicaid costs, with less-resourced states receiving higher reimbursement rates. For mental health services in some expansion states, for example, the federal match has been as high as 90%.
States can also apply for block grants and waivers to test innovative approaches to mental health service delivery, including value-based payment models that incentivize improved outcomes.
Looking Ahead
Clearly, Medicaid is an immensely important program for the health and well-being of Americans, including young people who are struggling with their mental health at increasing rates. Is it a perfect program? Of course not. There are geographic disparities, especially in rural areas, where there are shortages of providers who accept Medicaid. And non-expansion states have notable gaps in coverage. But there is no question as to Medicaid’s life-changing and often life-saving impact on nearly 80 million people.
As mental health needs continue to rise across the country, Medicaid’s role becomes increasingly vital. Recent federal initiatives, including increased funding through the American Rescue Plan Act, have strengthened Medicaid’s mental health infrastructure. However, improving the well-being of adults and young people requires sustained investment, continued expansion of telehealth, and improved integration of physical and mental health services.
For millions of Americans living with mental health conditions, Medicaid is more than just an insurance program—it is a pathway to recovery, stability, and health that might otherwise remain inaccessible.
