NAMI HelpLine

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 health insurance coverage is essential for people with mental illness to access mental health care and successfully manage their condition. Medicaid is a lifeline for tens of millions of Americans as the nation’s largest payer of mental health condition and substance use disorder (MH/SUD) services, and nearly 40% of nonelderly adults covered by Medicaid have a MH/SUD. Through Medicaid coverage, people with mental health conditions can access critical services like psychotherapy, inpatient treatment, prescription medications, and crisis care.

Before the Affordable Care Act (ACA), many people with mental health conditions did not qualify for Medicaid unless they were pregnant, elderly, or qualified for disability benefits. To increase access to health insurance, the ACA expanded Medicaid eligibility to adults with incomes up to 138% of the federal poverty level, a population group that includes many people 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 expansion of Medicaid eligibility has enrolled an estimated 21 million people, and nearly 30% of this expanded eligibility population are individuals with a mental health condition and/or a substance use disorder.

Medicaid expansion has improved health outcomes for people with mental health conditions. Medicaid expansion has led to more people with serious mental illness using mental health services and fewer people delaying or skipping necessary care. Medicaid expansion states have seen improvements in access to medications and services for MH/SUD, as well as decreased suicide mortality. Medicaid expansion has helped people receive the mental health services they need to thrive in their communities.

To incentivize states to accept Medicaid expansion, the ACA provided a 90% match rate on the group of people covered — a higher rate than states’ regular Medicaid match rate for most other populations. This means that states only have to pay for 10% of the expansion program’s costs. The increased federal support to cover the expansion population allows states to increase health insurance coverage in a cost-effective manner.

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, over 75% of states have elected to expand Medicaid. However, in a few expansion states, continued coverage of this population is contingent on the ACA’s enhanced federal match rate. Some states have so-called “trigger laws” that would immediately end Medicaid expansion or require reevaluation if the enhanced match rate was eliminated or reduced, putting coverage at risk for millions of Americans. NAMI remains committed to Medicaid expansion and urges policymakers to continue to build on its gains in health care coverage for people with mental health conditions.

How We Talk About It

  • About one in five people in the United States has a mental health condition, but only about half get needed treatment each year.
  • Access to health care coverage and mental health care is essential for people with mental illness to successfully manage their condition.
  • Medicaid pays for vital services that people with mental health conditions rely on, such as medications, psychotherapy, intensive and inpatient treatment, peer support, and crisis care.
  • 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.
  • Medicaid expansion covers an estimated 21 million people, and nearly 30% of people covered by Medicaid expansion have a mental health condition and/or a substance use disorder.
  • Medicaid expansion improves health outcomes for people with mental health conditions. 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 — all 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.
  • Proposals that seek to reduce the federal matching rate for or eliminate Medicaid expansion would cause people with mental health conditions to lose critical health care coverage, pushing people with mental illness into costly emergency rooms, hospitals, and jails.
  • NAMI urges policymakers to protect Medicaid expansion and continue to support this successful policy and encourages all states to expand their Medicaid program so people can access the treatment they need and deserve.

What We’ve Done

  • NAMI-led coalition letter to Congress on protecting Medicaid for people with mental health conditions and substance use disorders
  • NAMI coalition letter to Congress on protecting Medicaid for people with serious, acute, and chronic health conditions

NAMI HelpLine is available M-F, 10 a.m. – 10 p.m. ET. Call 800-950-6264,
text “helpline” to 62640, or chat online. In a crisis, call or text 988 (24/7).