Medicaid Expansion

Where We Stand 

NAMI urges all states to expand Medicaid, as indicated in the Affordable Care Act, to ensure more people with mental illness have access to essential health care services and supports.

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 the 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 of adults with a serious mental illness. Through Medicaid coverage, people with mental health conditions can access critical services like therapy, inpatient treatment, and prescription medications.
 
Before the Affordable Care Act (ACA), there was no standard pathway to Medicaid coverage for adults with mental illness unless they were pregnant, elderly, or had been determined to have a disability. To ensure all lower income Americans had access to health insurance, the ACA expanded Medicaid eligibility to adults with incomes up to 138% of the federal poverty level (FPL), 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 additional people with mental illness, helping 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 half of states have elected to expand Medicaid. In states that have not chosen to expand their Medicaid programs, millions of Americans with mental illness are left without any affordable option for health insurance.

How We Talk About It

  • 1 in 5 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 1 in 4 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 mental health services when they need them.   
  • In states that have already expanded Medicaid, people are less likely to skip medications due to cost, more likely to seek regular care for their ongoing health conditions, and report improvements in their overall health.
  • Medicaid expansion has led to more people with serious mental illness using mental health services and fewer people in delaying or skipping necessary care.
  • Mental illness and substance use disorders (SUDs) are often co-occurring, and in states that have expanded Medicaid, adults covered by the 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.
  • And when adults gain access to health coverage, it also benefits entire families. Children of low-income families are more likely to get coverage and receive annual well-child visits, which include mental health screenings, when their parents have Medicaid coverage.
  • 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.

What We’ve Done

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