Medicaid Expansion

Where We Stand

NAMI believes that all people with mental health conditions deserve accessible, affordable and comprehensive health care. NAMI supports state efforts to expand Medicaid, as indicated in the Affordable Care Act (ACA), to provide important mental health services and supports to more low-income adults.

Why We Care

Access to coverage and care is essential for people with mental illness to successfully manage their condition and get on a path of recovery. Medicaid is a lifeline for much of that care as the nation’s largest payer of mental health and substance use condition services, providing health coverage to more than one in four adults with serious mental illness.

Through Medicaid coverage, people with mental health conditions can access critical services like therapy, inpatient treatment, and prescription medications. Before the ACA, many people with mental health conditions did not qualify for Medicaid unless they were pregnant, elderly, or qualified for disability benefits. To ensure all lower-income Americans can access health insurance, the ACA expanded Medicaid eligibility to adults with incomes up to 138% of the federal poverty level, including many with mental illness. By allowing people to qualify for coverage based on income, rather than a disability determination, Medicaid expansion removes barriers to coverage for many people with mental illness. This helps them receive the mental health services they need to thrive in their communities.

Medicaid expansion was originally a requirement of the law, but a Supreme Court ruling in 2012 made the Medicaid expansion optional for states. To date, more than two-thirds of states have elected to expand Medicaid. States that have not expanded their Medicaid programs have left millions of Americans with mental illness without any affordable option for health insurance.

How We Talk About It

• About one in five people in the U.S. have a mental health condition, but only half get needed treatment.
• We need more coverage and better care for people with mental health conditions.
• Medicaid is the largest payer for mental health and substance use condition services, providing health coverage to more than one in four American adults with a serious mental illness.
• When states expand Medicaid, more people with mental health conditions can get the coverage they need to access vital care.
• Medicaid expansion removes barriers for people with mental illness by allowing people to qualify based on income rather than a disability determination. This helps people get the mental health services they need, when they need them.
• In states that have expanded Medicaid, people are less likely to skip medications due to cost and more likely to seek regular care for their ongoing health conditions while reporting improvements in their overall health.
• Medicaid expansion has led to more people with serious mental illness using mental health services and fewer people delaying or skipping necessary care.
• Mental illness and substance use disorders (SUDs) are often co-occurring. Adults covered by Medicaid expansion are more likely to receive SUD treatment, including in many places most impacted by the opioid epidemic.
• Adults with mental illness also often have additional physical health conditions, including hypertension (20%), asthma (15%) and diabetes (10%). Medicaid expansion helps ensure that people can address both their physical and mental health needs.
• When parents have Medicaid coverage, their children are more likely to receive annual well-child visits and mental health screenings.
• States that have not expanded Medicaid need to make the right call for the millions of Americans with mental illness without any affordable option for health insurance. They must expand Medicaid so people can access the treatment they need in their communities.

What We’ve Done

• NAMI webinar Medicaid 101
• NAMI submits comments on individual state proposals to expand Medicaid. These comments are available by request.