Report: Almost 4 million with mental illness won’t be covered in states that don’t expand Medicaid

February 27, 2014

Source: American Mental Health Counselors Association

States that decide not to expand Medicaid under the Affordable Care Act will leave more than 3.7 million Americans with mental illness without health-care coverage, according to a new report from an organization that represents mental health professionals.

Almost one in five Americans between the ages of 18-34 who live without health insurance and make less than 138 percent of the federal poverty level suffer from serious psychological distress, the report by the American Mental Health Counselors Association says. In states that opt to expand Medicaid under the ACA, those people would be eligible for coverage that includes mental health treatment.

But 25 states have not expanded Medicaid yet, meaning those residents with mental illness won’t be eligible for coverage. The problem is most acute in Florida and Texas, both home to more than half a million uninsured adults with serious mental health and substance use conditions.

The 11 southern states that are not moving toward Medicaid expansion are home to 2.7 million people with mental illness. Virginia, North Carolina, Tennessee, South Carolina, Oklahoma, Louisiana, Missouri and Mississippi each have between 100,000 and 200,000 such uninsured adults. Georgia has 233,000 residents who suffer from mental illness, according to data compiled through the Substance Abuse and Mental Health Services Administration.

Several Mountain West states have yet to move toward expanding Medicaid. Republican-dominated legislatures in Montana, Wyoming and Idaho have not taken up Medicaid expansion legislation. Utah, where Republicans control both legislative chambers and the governor’s mansion, will take up one of several proposals; Gov. Gary Herbert (R) has said doing nothing on Medicaid expansion is the only option he will rule out.

About 40 percent of all uninsured Americans with a mental illness are eligible for health insurance coverage under Medicaid as it stands now; under Medicaid expansion in states that have opted to accept federal money; or under state health insurance marketplaces.

Mental health care is included under what the ACA dubs the “Essential Health Benefits” package.

Nationwide, about 18 million Americans are eligible for coverage through Medicaid expansion. About 10 million live in states that have opted not to expand Medicaid. Nearly 800,000 of those residents have serious mental illness, while 1.5 million experience serious psychological distress and almost 1.4 million suffer from substance abuse disorders.

Reid Wilson covers national politics and Congress for The Washington Post. He is the author of Read In, The Post’s morning tip sheet on politics.
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