Medicaid is a major source of health insurance coverage for people with low incomes and disabilities. The program also pays for much of the mental health and substance use care provided in the United States. Changes in policy that reduce access to Medicaid, restrict eligibility, or cut funding could undermine people’s ability to get the mental health and substance use care they need.
How many people with mental health or substance use disorders are covered by Medicaid?
In 2023, 5.64 million youth ages 12 to 17 experienced major depressive episodes or substance use disorder (SUD) over the previous 12 months. These conditions touched 23 percent of all youth and 23 percent of youth on Medicaid. Medicaid covered 43 percent of youth with major depressive episodes or SUD (2.41 million youth), of which 60 percent experienced only major depressive episodes, 26 percent experienced only SUD, and 14 percent experienced both.
In 2023, 84.7 million adults experienced any mental illness or SUD over the previous 12 months. These conditions touched 33 percent of all adults and 44 percent of adults on Medicaid. Medicaid covered 26 percent of adults with any mental illness or SUD (22 million adults), of which 46 percent experienced only mental illness, 25 percent experienced only SUD, and 29 percent experienced both.
What is the work status of Medicaid enrollees with mental health or substance use disorders?
Nearly half of the adult population with any mental illness or SUD who are enrolled in Medicaid have a job and work or are retired from their job (see exhibit). Almost 20 percent are unable to work due to disability; the remaining are caregivers, in school, actively looking for work, or unemployed for another reason.
Across this population, the median annual personal income is between $10,000 and $19,999. About half of those between ages 26 and 49 live with their minor children.
What are other characteristics of those covered by Medicaid?
Among adults with any mental illness or SUD, Medicaid covers:
- 33 percent of those who live outside urban and suburban areas
- 21 percent of those with minor children in the home
- 16 percent of those that are veterans or enlisted with reserve components of the military.
Does Medicaid get people access to effective mental health and substance use services?
Because of Medicaid, 53 percent of youth enrollees with a major depressive episode or SUD in the past year, and 53 percent of adult enrollees with any mental illness or SUD, received needed treatment in the past 12 months. Adult Medicaid enrollees had greater access than those without insurance (only 30 percent), commercial insurance (45 percent), or Medicare (47 percent). Among Medicaid-enrolled youth and adults with major depressive episodes or any mental illness, 73 percent reported that the mental health care they received was helpful to them.
Only about 2 percent of Medicaid-enrolled adults with mental health and SUD conditions reported unmet needs because of lack of coverage.
How important is Medicaid financing for mental health and substance use care?
Medicaid is the primary payer for mental health or substance use care. Using the most recent publicly available data from 2019, Medicaid spent more than $58 billion on mental health care and $17 billion on substance use care. Much of this went toward services for depression, anxiety, schizophrenia, opioid use disorder, and alcohol use disorder. Almost 43 percent of Medicaid spending on mental health care was for those younger than 20 years of age. Mental health and substance use disorders also can drive health care spending in other areas, such as diabetes care, because unmet needs can exacerbate other health conditions and make them more costly to treat.
Of the $43.2 billion spent in the United States on inpatient care for mental health and substance use (excluding autism and intellectual and developmental disabilities), nearly half came from Medicaid — $19.3 billion, while $16.2 billion came from commercial insurance, $6.8 billion from Medicare, and $880 million from out-of-pocket spending by individuals (see exhibit).
What would happen if people lost access to Medicaid?
Without Medicaid, many of the children, youth, and adults facing mental health challenges and substance use disorder would not be able to access care. Most Medicaid enrollees do not have access to other affordable health insurance options and cannot pay for care out of pocket, despite many working full time. Medicaid is critical for meeting the mental health and substance use needs of Americans and preventing suicide, overdose, and disability.
