Behavioral Health
Medicaid is the single largest payer for behavioral health services, including mental health and substance use services. All state Medicaid programs must cover certain behavioral health services for adults, including medically necessary inpatient and outpatient hospital services, rural health clinic services, nursing facility services, home health services, and physician services. For adults, many other services used for the treatment of mental health and substance use disorder are optional.
Children and youth under age 21 are entitled to medically necessary behavioral health and other services under Medicaid’s mandatory early and periodic screening, diagnostic, and treatment (EPSDT) benefit. Behavioral health services are a required benefit in separate State Children’s Health Insurance Programs (CHIP).
States can provide behavioral health services under state plans, waivers, demonstrations, and other authorities.
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Behavioral health benefits
Substance use disorder
Featured Publications
Introduction to Work on Residential Services for Youth with Behavioral Health Needs
Access in Brief: Children and Youth with Special Health Care Needs
School-Based Behavioral Health Services for Students Enrolled in Medicaid
Access in Brief: Behavioral Health and Beneficiary Satisfaction by Race and Ethnicity
Access to Medicaid Coverage and Care for Adults Leaving Incarceration
Access to Mental Health Services for Adults Covered by Medicaid
Access to Behavioral Health Services for Children and Adolescents Covered by Medicaid and
CHIP
State Coverage Policies of Mental Health Services for Adults
Encouraging Health Information Technology Adoption in Behavioral Health: Recommendations
for Action
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Featured Publications
June 2025 Report to Congress on Medicaid and CHIP
June 10, 2025
MACPAC’s June 2025 Report to Congress on Medicaid and CHIP contains five chapters of interest to Congress:
Chapter 1 makes recommendations on transitions from pediatric to adult care for Medicaid-covered children and youth with special health care needs (CYSHCN).
Chapter 2 focuses on appropriate access to residential behavioral health treatment services for children.
Chapter 3 describes findings from the Commission’s […]
Appropriate Access to Residential Behavioral Health Treatment for Children in Medicaid
June 10, 2025
Chapter 2 focuses on appropriate access to residential behavioral health treatment services for children. Medicaid supports a wide range of behavioral health services for children, including residential treatment programs, which are considered a last resort. States are required to provide treatment for individuals with disabilities, including serious mental illness and serious emotional disturbance, in community-based […]
School-based Health Centers and Behavioral Health Care for Students Enrolled in Medicaid
March 27, 2025
Schools are a convenient point of access for children and adolescents with Medicaid coverage to receive health services. School-based health centers (SBHCs) are an important source of primary care and behavioral health care for students, particularly as communities seek to address an increase in behavioral health challenges among young people. This issue brief examines how […]