Taking care of our mental health is important for our overall well-being. Medicaid helps those with limited incomes get the mental health care they need. In this article, we talk about how Medicaid covers mental health care, the rules that protect people's rights, how states can offer more services, and how Medicaid helps people with mental health and substance use challenges.
Behavioral health refers to how behaviors affect overall physical, mental, and emotional well-being. This field covers the treatment and management of mental health conditions, substance use disorders (SUD), and other behaviors that impact our health.
Behavioral health services include counseling, psychiatric care, therapy, and treatments aimed at helping individuals cope with mental illness, addiction, and emotional distress:
Federal law requires Medicaid to cover necessary behavioral health services. The Mental Health Parity and Addiction Equity Act (MHPAEA) requires that mental illness and substance use services are covered the same way as medical and surgical benefits. While federal law sets the basic requirements, individual states can decide which services to cover and which providers to include in their Medicaid networks.
The Mental Health Parity and Addiction Equity Act (MHPAEA) is an important piece of legislation that ensures people with mental health and substance use disorders get the same quality of care as those with medical or surgical conditions. MHPAEA stops unfair practices that historically limited coverage for behavioral health services.
Under the MHPAEA, coverage for mental health conditions and substance use disorders must be no more restrictive than the coverage for medical/surgical conditions, including:
Starting March 29, 2016, a final rule from the Centers for Medicare & Medicaid Services makes sure that Medicaid and CHIP programs follow the same rules as private insurance. This means that Medicaid and CHIP beneficiaries have the same rights as those with private insurance for equal access to necessary mental health and SUD treatment services.
Medicaid waivers, such as 1915(b) and 1115 waivers, allow states to create programs that target specific needs, populations, or care models not generally covered under traditional Medicaid plans. States can use waivers to prioritize behavioral health services, making sure that people in need get complete care.
1915(b) waivers allow states to implement managed care models that make it easier to get behavioral health services by coordinating care across providers. These models coordinate care among providers to make sure people get the support they need without having to deal with lots of different providers or systems.
1115 waivers give states more freedom to try new ways of providing care for behavioral health conditions. These waivers often focus on specific groups, such as people with serious mental illnesses or substance use disorders, by expanding community-based services like counseling, rehabilitation, and peer support. They also aim to combine behavioral health and primary care, making it easier for patients to get comprehensive treatment for both their physical and mental health needs.
States like New York and Texas have implemented Medicaid waivers focusing on integrated care models, ensuring that behavioral health is treated holistically alongside other medical conditions. These innovations, made possible through waivers, highlight the growing recognition of the importance of behavioral health within the broader health care system.
Medicaid covers a broad spectrum of services aimed at supporting recovery for people with substance use disorders (SUD). As one of the largest payers for SUD treatment in the United States, Medicaid ensures that millions of individuals, particularly those with limited incomes, have access to necessary care.
Medicaid coverage for SUD treatment includes a variety of services, such as:
As the opioid epidemic continues, Medicaid has helped expand access to evidence-based treatments for so many people. States have used Medicaid funding to improve the availability of MAT and other recovery services. Programs like the Medicaid Innovation Accelerator Program (IAP) have helped states improve their ability to address substance use disorder (SUD) by combining services across healthcare settings.
Eligibility is determined by factors such as income, disability status, and other criteria. Medicaid primarily serves low-income individuals and families, so eligibility often depends on meeting income thresholds set by each state.
In addition to income, individuals with disabilities, including those with serious mental illnesses or developmental disabilities, may qualify for Medicaid based on their disability status. Certain populations, like children, pregnant women, and people receiving Supplemental Security Income (SSI) qualify automatically in most states.
For those seeking behavioral health services, states have flexibility in determining which services are covered and how eligibility is assessed. We recommend you check the specific requirements for Medicaid in your state to determine eligibility and available benefits.
Enrolling in Medicaid involves completing an application and providing documentation to verify eligibility, such as a driver's license or employment records. Once enrolled, recipients use their Medicaid card to access behavioral health services from providers within the Medicaid network.
Finding a qualified provider can be challenging, mainly where there is restricted access to psychological and substance use treatment. Working with a doctor who can refer your care recipient to a specialist or help navigate the Medicaid system is often helpful.
Medicaid delivers mental health services and coordinates care with behavioral health providers, empowering them to support their family members as better members. Find the behavioral health services your loved one desperately needs. Help them live their best lives.
