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
Adult Medicaid Enrollees with Intellectual and Developmental Disabilities: Access to Behavioral Health Services
October 29, 2026
As part of MACPAC’s ongoing work addressing behavioral health service use in Medicaid, the Commission is focusing on Medicaid enrollees with intellectual and developmental disabilities (I/DD) who may face unique barriers to accessing behavioral health care in Medicaid. MACPAC conducted a literature review and federal policy scan to understand how adults ages 19-64 with I/DD […]
Intensive Community-Based Behavioral Health Services: Findings from Stakeholder Interviews and Administrative Claims Analysis
October 29, 2026
The Commission is continuing its examination of behavioral health services for Medicaid-enrolled children and youth with behavioral and co-occurring health needs. The first phase of work examined appropriate access to residential treatment and resulted in chapters in MACPAC’s June 2025 and June 2026 reports to Congress. The second phase focuses on access to five intensive […]
Utilization Management for Medications for Opioid Use Disorder (MOUD) in Medicaid
September 24, 2026
MACPAC is continuing its work to examine access to MOUD for Medicaid enrollees. MACPAC’s work in this area explores whether utilization management strategies allow states and managed care plans to control costs and prevent misuse while maintaining appropriate and timely access to MOUD. Specifically, we focus on three utilization management strategies commonly applied to MOUD: […]