Behavioral Health
Medicaid is the single largest payer for behavioral health services, including mental health and substance use services. All state Medicaid programs must cover certain behavioral health services for adults, including medically necessary inpatient and outpatient hospital services, rural health clinic services, nursing facility services, home health services, and physician services. For adults, many other services used for the treatment of mental health and substance use disorder are optional.
Children and youth under age 21 are entitled to medically necessary behavioral health and other services under Medicaid’s mandatory early and periodic screening, diagnostic, and treatment (EPSDT) benefit. Behavioral health services are a required benefit in separate State Children’s Health Insurance Programs (CHIP).
States can provide behavioral health services under state plans, waivers, demonstrations, and other authorities.
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Behavioral health benefits
Substance use disorder
Featured Publications
Introduction to Work on Residential Services for Youth with Behavioral Health Needs
Access in Brief: Children and Youth with Special Health Care Needs
School-Based Behavioral Health Services for Students Enrolled in Medicaid
Access in Brief: Behavioral Health and Beneficiary Satisfaction by Race and Ethnicity
Access to Medicaid Coverage and Care for Adults Leaving Incarceration
Access to Mental Health Services for Adults Covered by Medicaid
Access to Behavioral Health Services for Children and Adolescents Covered by Medicaid and
CHIP
State Coverage Policies of Mental Health Services for Adults
Encouraging Health Information Technology Adoption in Behavioral Health: Recommendations
for Action
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Featured Publications
Introduction to Work on Residential Services for Youth with Behavioral Health Needs
September 19, 2024
Medicaid supports a wide range of behavioral health services for children including residential treatment programs. In response to the Commission’s continued interest in services for Medicaid-enrolled children and youth, MACPAC has initiated work to examine how Medicaid ensures that children and youth with serious behavioral health conditions appropriately access intensive services in residential settings following […]
Access in Brief: Children and Youth with Special Health Care Needs
August 8, 2024
Children and youth with special health care needs (CYSHCN) have a wide range of health care needs, including physical, mental and behavioral health conditions, and levels of limitations that require health and related services beyond that required by children generally. It is important that this population has timely access to care because they can experience […]
Access in Brief: Behavioral Health and Beneficiary Satisfaction by Race and Ethnicity
January 16, 2024
Racial and ethnic health disparities persist throughout the U.S. health care system. Measuring differences in access and use of services, as well as experience and satisfaction of behavioral and mental health care, can help to better understand the underlying causes of disparities. This issue brief highlights data from the 2016 Association of American Medical Colleges […]
