Top 15 State Medicaid Programs for Mental Health Care

The Role of Medicaid in Mental Health Care Across the United States

Medicaid is the largest single payer for mental health services in the United States, playing a crucial role in ensuring access to care for millions of adults with mental illness and substance use disorders. According to national health data, an estimated 58.7 million U.S. adults—nearly one in four—live with a mental illness. Among this population, individuals enrolled in Medicaid are more likely to experience mental illness than those with private insurance, highlighting the program’s essential role in addressing the nation's mental health crisis.

While Medicaid is federally funded, it is administered by individual states, which have significant discretion over how they structure, finance, and deliver services. As a result, the availability and quality of behavioral health services can vary significantly from state to state. These differences are especially critical now, as many states face financial pressures and potential budget cuts that could make it harder for people to access the care they need.

A recent analysis evaluated how effectively state Medicaid programs serve adult patients with mental health and substance use needs. This evaluation used data from the Centers for Medicare and Medicaid Services (CMS) Medicaid and CHIP Scorecard – Core Set Year 2023. Based on this data, Addiction-Rep developed a composite score called the Behavioral Health Performance Index, which averages scores across four key categories: initiation and engagement, evidence-based medication use, care continuity and follow-up, and patient experience.

Here are the top-performing state Medicaid programs based on their performance in these areas:

Top State Medicaid Programs for Mental Health Support

1. New Hampshire
2. Behavioral Health Performance Index: 74.73
3. Initiation and Engagement: 82.25
4. Evidence-Based Medication Use: 89.68
5. Care Continuity and Follow-Up: 92.83

6. Patient Experience: 34.17

7. Massachusetts

8. Behavioral Health Performance Index: 74.69
9. Initiation and Engagement: 64.45
10. Evidence-Based Medication Use: 85.28
11. Care Continuity and Follow-Up: 87.27

12. Patient Experience: 61.77

13. Vermont

14. Behavioral Health Performance Index: 73.40
15. Initiation and Engagement: 74.45
16. Evidence-Based Medication Use: 99.45
17. Care Continuity and Follow-Up: 92.87

18. Patient Experience: 26.83

19. West Virginia

20. Behavioral Health Performance Index: 71.93
21. Initiation and Engagement: 90.00
22. Evidence-Based Medication Use: 76.33
23. Care Continuity and Follow-Up: 37.67

24. Patient Experience: 83.73

25. Pennsylvania

26. Behavioral Health Performance Index: 70.87
27. Initiation and Engagement: 67.80
28. Evidence-Based Medication Use: 76.95
29. Care Continuity and Follow-Up: 60.70

30. Patient Experience: 78.03

31. Rhode Island

32. Behavioral Health Performance Index: 69.73
33. Initiation and Engagement: 35.55
34. Evidence-Based Medication Use: 82.10
35. Care Continuity and Follow-Up: 84.00

36. Patient Experience: 77.27

37. Kentucky

38. Behavioral Health Performance Index: 66.02
39. Initiation and Engagement: 92.20
40. Evidence-Based Medication Use: 61.80
41. Care Continuity and Follow-Up: 40.97

42. Patient Experience: 69.10

43. Connecticut

44. Behavioral Health Performance Index: 65.29
45. Initiation and Engagement: 64.45
46. Evidence-Based Medication Use: 76.20
47. Care Continuity and Follow-Up: 73.33

48. Patient Experience: 47.17

49. Ohio

50. Behavioral Health Performance Index: 62.53
51. Initiation and Engagement: 95.60
52. Evidence-Based Medication Use: 22.93
53. Care Continuity and Follow-Up: 64.10

54. Patient Experience: 67.50

55. Wisconsin

    • Behavioral Health Performance Index: 56.81
    • Initiation and Engagement: 51.10
    • Evidence-Based Medication Use: 68.93
    • Care Continuity and Follow-Up: 60.87
    • Patient Experience: 46.33

56. Maryland

    • Behavioral Health Performance Index: 55.81
    • Initiation and Engagement: 72.25
    • Evidence-Based Medication Use: 51.25
    • Care Continuity and Follow-Up: 65.57
    • Patient Experience: 34.17

57. Tennessee

    • Behavioral Health Performance Index: 55.69
    • Initiation and Engagement: 74.45
    • Evidence-Based Medication Use: 49.63
    • Care Continuity and Follow-Up: 31.17
    • Patient Experience: 67.50

58. Delaware

    • Behavioral Health Performance Index: 55.20
    • Initiation and Engagement: 90.00
    • Evidence-Based Medication Use: 45.23
    • Care Continuity and Follow-Up: 23.80
    • Patient Experience: 61.77

59. New Mexico

    • Behavioral Health Performance Index: 53.55
    • Initiation and Engagement: 74.45
    • Evidence-Based Medication Use: 41.60
    • Care Continuity and Follow-Up: 46.07
    • Patient Experience: 52.07

60. Arizona

    • Behavioral Health Performance Index: 53.46
    • Initiation and Engagement: 64.45
    • Evidence-Based Medication Use: 15.58
    • Care Continuity and Follow-Up: 81.77
    • Patient Experience: 52.03

Understanding the Metrics

The Behavioral Health Performance Index evaluates several key metrics, including:

• Initiation and Engagement: Measures how quickly patients begin treatment and remain engaged in care.
• Evidence-Based Medication Use: Assesses the use of medications that have been proven effective for specific conditions.
• Care Continuity and Follow-Up: Evaluates how well patients receive ongoing care after initial treatment.
• Patient Experience: Gauges overall satisfaction with the care received.

Each category includes multiple metrics, most of which focus on adult behavioral health patients aged 18 to 64. However, patient experience measures apply to all adult Medicaid enrollees, as condition-specific experience data is not available.

Only states with sufficient data across all four categories were included in the final rankings. However, states with partial data are still shown in visualizations and detailed tables for the metrics where data is available.

This analysis provides valuable insights into how different states are performing in supporting mental health and substance use care through their Medicaid programs. It underscores the importance of continued investment and improvement in these critical services.