Medicaid Backgrounder

January 18, 2018

  • Across the country, more than 10 million people with mental illness rely on Medicaid, including many who live with severe conditions.
  • Medicaid helps address the nation’s mental health care crisis by paying for services that people need, such as medications, case management, therapy, peer supports and crisis and hospital care.
  • In most states, if a person is approved for federal SSI (Supplemental Security Income) due to their psychiatric disability, they are eligible for Medicaid coverage.
  • People who have been working and then become disabled due to a mental illness may be eligible for SSDI (Social Security Disability Insurance), which is different than SSI.
  • People on SSDI are not automatically eligible for Medicaid in most states. Instead, they become eligible for Medicare after 2 years, and may also become eligible at that time for Medicaid if their income is low enough (dual-eligibles).
  • However, many adults with mental illness fall through the cracks, including:
  • Young adults with first symptoms of a serious mental illness who are not ill enough to be eligible for Medicaid, but need intensive services;
  • People whose mental health symptoms are so severe they cannot navigate the federal disability system to become eligible for Medicaid; and
  • People with serious mental illness whose symptoms have stabilized with hospitalization and don’t meet criteria for Medicaid at discharge (but need treatment to stay stable).
  • 33 states, including D.C., have adopted Medicaid expansion, which allows adults to be eligible for Medicaid based on income, which helps people with mental illness who do not have federal disability status.
  • In states that have expanded eligibility, nearly 1 in 3 people have a mental health or substance use condition.
  • Medicaid coverage should be improved, not made worse. Medicaid helps people with mental illness get the treatment they need instead of shifting costs to emergency rooms, hospitals and jails.

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