The Trump Administration’s new guidance inviting states to apply for federal waivers to convert their Medicaid programs for adults into block grants — with capped federal funding and new authority to cut coverage and benefits — would put coverage and access to treatment and recovery services at risk for millions of people with behavioral health conditions, including mental health and substance use disorders (SUDs).
States could seek waivers that would affect adults under age 65, other than those whom federal law requires them to cover, including the 17 million people covered by the Affordable Care Act’s (ACA) Medicaid expansion.
Before the expansion, many low-income, non-elderly adults with behavioral health conditions weren’t eligible for Medicaid and were largely left uninsured. The Medicaid expansion has enabled millions of people with mental health conditions and SUDs to get coverage. For example, 32 percent of Michigan’s expansion enrollees have a mental health condition, and nearly 10 percent of Ohio’s expansion enrollees have a SUD diagnosis. The share of mental-health-related and opioid-related hospitalizations in which the patient was uninsured each fell dramatically in expansion states, which provides further evidence of large coverage gains for these groups.
These coverage gains have improved access to care, including medications and services to treat behavioral health conditions. Following the expansion, the number of Medicaid-funded prescriptions for mental health conditions rose by 19 percent more in expansion states than in non-expansion states. The expansion also boosted admissions to facilities providing medication-assisted treatment — the gold-standard treatment for opioid use disorders — by about 50 percent.
Block-grant waivers would jeopardize these gains by:
Block-grant waivers would roll back the progress under the Medicaid expansion in helping people get needed care for both behavioral and physical health conditions. That’s why groups like the National Alliance on Mental Illness and American Psychiatric Association, as well as many physician, hospital, and patient advocacy organizations, have opposed them forcefully.