Which States Have the Most Behavioral Health Medicaid Benefits

The bulk of state Medicaid programs cover services to treat substance use disorders (SUDs) and outpatient services, but few cover crisis care services.

That’s according to a new report by the Kaiser Family Foundation (KFF), which included survey responses from 45 states about their health benefits. In the survey, KFF provided state Medicaid officials with a list of 55 behavioral health benefits potentially covered in their fee-for-service (FFS) Medicaid programs, and officials then checked off which services were provided.

All but two states covered more than 50% of SUD services, and 37 states covered more than 75% of SUD services.

“Within this category, nearly all states cover outpatient SUD treatment, while states were least likely to cover clinically managed high intensity residential services,” researchers wrote in the report. “As services grow in intensity, the number of states placing limits on the service also increases. Also within this service category, all or nearly all states reported coverage of medications for SUD treatment, including buprenorphine, naltrexone, and methadone.”

Outpatient mental health was also an area of high coverage.

All states queried reported that their FFS Medicaid program covered at least 50% or more of the outpatient behavioral health services. Another 26 states covered more than 75% of outpatient programs included in the survey.

“While all or nearly all states cover evaluation and testing services as well as individual, family, and group therapy, there is more variation in coverage of ADL/Skills training, case management, and day treatment services,” the report states. “Within this category, states were most likely to report limits for case management and copays for therapy (individual, family, or group).”

Meanwhile, just over half (24 states) covered 50% or more of crisis care services. Still, Arizona, New Mexico, New York and Tennessee reported covering every crisis service asked about in the survey.

“States were less likely to cover crisis services compared to other categories: for most states, crisis services was the category for which the state reported the lowest coverage rate, including several states that reported covering none of the crisis services queried,” the report said.

State-by-state disparity 

Researchers found that the median number of behavioral health services covered across states was 44 out of 55. Specifically, 11 states covered more than 48 services, 13 states covered between 44 and 47 services, 11 states covered 41 and 43 services, and 10 states covered less than 41.

South Carolina covered 27 behavioral health services, making it the state with the fewest behavioral health services covered in the survey. Meanwhile, Arizona, Oregon and New York tied for the top spot, covering 53 of the 55 services.

“These high rates of coverage reflect state trends in recent years to expand Medicaid services across the behavioral health care continuum,” researchers wrote. “However, coverage of services may not translate into access to care, particularly given workforce shortages that make accessibility a challenge for Medicaid enrollees (as well as people with private insurance).”