NAMI Report—State Medicaid Expansions Will Strengthen Mental Health Care, Gain Billions in Federal Dollars
Texas, Ohio, Tennessee Are Biggest Losers If Expansion is Rejected
May 30 2013
ARLINGTON, Va., May 30, 2013 -- Up to 30 percent of currently uninsured adults who would receive health care coverage through state Medicaid expansions are individuals living with mental illness, the National Alliance on Mental Illness (NAMI) reported today.
See report: www.nami.org/medicaidexpansion.
"Today more than ever before, Americans recognize that the mental health care system is in crisis," said NAMI Executive Director Michael Fitzpatrick .
"Unfortunately, despite increased public concern for greater mental health care, 14 states have shut the door this year to helping this vulnerable population by rejecting Medicaid expansion under the Affordable Care Act."
"Besides abandoning people in need, states that reject Medicaid expansion lose an opportunity for federal funds that would help strengthen the overall mental health care system. States that are still considering expansion need to carefully focus on mental health implications for everyone."
"When mental illness isn't treated, major costs get shifted elsewhere -- to emergency rooms, police, jails and broken families," Fitzpatrick said.
Nationwide, 2.7 million currently uninsured individuals living with mental illness would become eligible for health care under Medicaid expansion.
In the report Medicaid Expansion and Mental Health Care, NAMI lists 21 states in which the proportion of uninsured persons who would benefit from Medicaid expansion and are living with mental illness totals 20 to 30 percent.
Of those 21 states, seven have approved Medicaid expansion: Arkansas, Delaware, Iowa, Kentucky, Minnesota, Rhode Island and Vermont. Five have rejected it: Alabama, Nebraska, Oklahoma, South Dakota and Wisconsin.
In both Minnesota and Nebraska, 30 percent of currently uninsured persons live with mental illness and would benefit from Medicaid expansion. Minnesota has adopted expansion, but Nebraska has rejected it.
Within the 20 percent range, states in which Medicaid expansion is still -- at least technically -- an open question:
- Ohio -- 24 percent*
- Indiana -- 23 percent
- Virginia -- 22 percent
- West Virginia -- 22 percent
- Maine -- 21 percent
- South Carolina -- 21 percent
- Tennessee -- 20 percent
- Utah -- 20 percent
- Michigan -- 20 percent
Of the remaining 29 states and the District of Columbia, the proportion ranges from 10 to 19 percent, with the exception of Maryland (8 percent) and Massachusetts (6 percent). In that range, 15 states have approved Medicaid expansion. Eight have rejected it.
Five states in the lower tier have the following proportions of currently uninsured adults living with mental illness who would benefit from expansion:
- Montana -- 17 percent
- New Hampshire -- 15 percent
- Kansas -- 13 percent
- Arizona -- 12 percent*
- Texas -- 11 percent
Over 10 years from 2013 through 2022, states in which Medicaid expansion is still pending stand to lose a total of $255 billion in federal funds if they reject it. Texas, Ohio and Tennessee stand to lose the most.
- Texas -- $66 billion
- Ohio -- $53 billion
- Tennessee -- $23 billion
- Michigan -- $18 billion
- Indiana -- $17 billion
- South Carolina -- $16 billion
- Virginia -- $15 billion
- Arizona -- $10 billion
- West Virginia -- $9 billion
- Kansas -- $5 billion
- Utah -- $5 billion
- Maine -- $3 billion
- Montana -- $2 billion
- New Hampshire -- $2 billion
*As NAMI prepared to release the report on May 30, 2013, legislative votes on Medicaid expansion were considered imminent in Arizona and Ohio. Because of publication deadlines, late developments may not be reflected in the report. For example, Iowa is listed as "pending" in Appendix V of the report, but has since adopted expansion.
NAMI is the nation's largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. NAMI advocates for access to services, treatment, supports and research and is steadfast in its commitment to raising awareness and building a community of hope.