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MACPAC Examines Medicaid’s Role in Providing Behavioral Health Services

June report finds high use of medical and mental health services among people diagnosed with behavioral health conditions

June 15, 2015—The Medicaid and CHIP Payment and Access Commission (MACPAC) today released its June 2015 Report to Congress on Medicaid and CHIP, focusing on Medicaid’s role in providing behavioral health services. The report—the second of two reports to Congress MACPAC issues annually—takes a first look at the use of Medicaid services by beneficiaries with behavioral health conditions while also considering two related issues: the program’s role in covering care for neglected and abused children and the extent to which program beneficiaries are being prescribed psychotropic medications.

“Medicaid plays a critical role for people with behavioral health diagnoses including children under the supervision of child welfare authorities, adults with serious mental illness, and frail elders with dementia,” said MACPAC chair Diane Rowland. According to the June 2015 report, one in five Medicaid beneficiaries has a diagnosis of a behavioral health condition and these individuals’ care accounted for almost half of total Medicaid expenditures.

“The analyses in the June report represent MACPAC’s first step in an extended inquiry into how to better manage and improve care for an especially at risk group of Medicaid beneficiaries,” said Rowland.

The June report points to low-income children under the protection of child welfare authorities as one group with high levels of unmet need for mental health care. According to the report, more than 40 percent of children in foster care had mental health diagnoses compared to 11 percent of other children with Medicaid. Nearly one-quarter of children enrolled in Medicaid based on child welfare assistance used a psychotropic medication, almost five times the share of other non-disabled children.

The MACPAC report also examines Medicaid coverage of dental services for low-income adults, who are more than three times as likely to have untreated cavities as adults with higher incomes. While state Medicaid programs must cover dental benefits for children, adult dental coverage is a state option. MACPAC’s analysis shows that state Medicaid programs vary considerably in the dental services they offer adults, and that access to regular dental care is challenging in many areas of the country.

As part of its ongoing role to examine payment policy, the report’s opening chapter provides an overview of new Delivery System Reform Incentive Payment (DSRIP) demonstration projects now underway in California, Massachusetts, New Jersey, New York, Ohio, and Texas. DSRIP programs are testing whether new uses for Medicaid supplemental payment can improve health care delivery if tied to achievement of specific milestones.

The June 2015 Report to Congress on Medicaid and CHIP, and each of its chapters, Using Medicaid Supplemental Payments to Drive Delivery System Reform; Medicaid Coverage of Dental Benefits for Adults; The Intersection of Medicaid and Child Welfare; Behavioral Health in the Medicaid Program—People, Use, and Expenditures; and Use of Psychotropic Medications among Medicaid Beneficiaries are available at


ABOUT MACPAC: The Medicaid and CHIP Payment and Access Commission (MACPAC) is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide array of issues affecting Medicaid and the State Children’s Health Insurance Program (CHIP). For more information, please visit