On the Issues: Mental Health and Medicaid Expansion

Mental Health and CTG One-pager FINAL• Every dollar that Florida would invest to increase the eligibility for Medicaid Medical Assistance would return $13.41 in matched and enhanced federal funds1.

• Health insurance coverage is crucial for individuals who have mental illnesses to access consistent, quality mental health services that promote recovery.

• Access to behavioral health treatment — services and prescription drugs to address behavioral health conditions — is important because of the harmful consequences of untreated conditions, which may result in worsening health, increased medical costs, negative effects on employment and workplace performance, strain on personal and social relationships, and possible incarceration2.

• The consequences of mental health disorders extend well beyond the affected individuals: to their families, to the development of children, and to the welfare of the wider community.

• More than half of the people incarcerated in our jails and prisons live with mental illnesses3. Many of these individuals would not have come into contact with criminal justice systems had they received timely and effective treatment.

• Serious mental illness[a] is association with poverty. People serious mental illnesses are frequently uninsured and must access services through state and locally funded community mental health centers. Most community mental health center patients have income below the federal poverty line, placing them in the coverage gap4.

• Florida state and county governments contribute to the expenses of providing community-based services to uninsured people living with mental illnesses. Much of these expenses could be paid though health plan reimbursement rather than state and local tax dollars if Florida closed the gap and provided coverage to low-income[b] adults.

• Florida currently covers a 74.4 percent of the cost of mental health services from state taxpayer supported general revenue, but the amount of funding is limited and many people are left without access to services3. Accepting federally allocated funds to provide coverage for low-income Floridians would shift the much of the cost of services away from state taxpayers and assure access to services for all working low-income Floridians.

• Florida ranks 50th[c] in per capita spending for mental health services5, largely contributing to the poor level of access to mental health services in the state. If the low-income adult who are currently uninsured had coverage to pay for services, the funding levels in the state would increase — along with access to care.

• Community health centers in Florida lose $32 million in annual revenue for behavioral health services due to Florida not covering low-income people4.

• Closing the coverage gap would bring a stable source of consistent health care to Floridians with mental illnesses and reduce reliance on expensive tax-payer funded traumatizing crisis and inpatient care. Services covered through health plan reimbursements would facilitate the transition to community-based models of care that are built on evidence-based practices6.

• There were 66,723 uninsured adults (18-64 years) in Florida with serious mental illness denied access to mental health care in 2014. These individuals would have accessed care if Florida had covered low-income uninsured people in 20146.

• Despite Florida ranking as a state with a low prevalence of serious mental illness, Florida ranks 44 out of 50 states and the District of Columbia for access to mental health services, largely due to the extremely high rate of uninsured adults in the state7.

• Of the 1.4 million Floridians who would be eligible for coverage if Florida covers low-income uninsured people, 15.7 percent (228,840) have a serious mental health and/or a substance use condition that would benefit from treatment and services2.

• 68,000 fewer Floridians would have experienced major depression in 2014 had Florida closed the coverage gap6.

• Mental health conditions are a major cause of disability in the U.S., and can be responsible for the inability to work or reduced work performance. The vast majority of Floridians with mental illnesses who stand to gain access to services if Florida closes the coverage gap have the education required for quality employment (high school graduates, 40 percent, College, 37 percent)6.

• There are 41,200 uninsured veterans in Florida’s coverage gap; one-third of them have (13,596) have mental illnesses and currently lack access to consistent quality mental health care6

• About two-thirds (62 percent) of Floridians with mental illnesses in the coverage gap in 2014 were white adults6.



  1. Dorn S, McGrath M, Holahan J. What is the result of states not expanding Medicaid? 2014; 413192.
  2. Government Accounting Office (GAO). Behaviorial health: Options for low-income adults to receive treatment in selected states. 2015; 15-449.
  3. Mental health and the role of the states. 2015.
  4. Jones E, Zur J, Rosenbaum S, Ku L. Opting Out of Medicaid Expansion: Impact on Encounters With Behavioral Health Specialty Staff in Community Health Centers. PS 2015; 66(12):1277-1282.
  5. Kaiser Family Foundation. State Health Facts: State Mental Health Agency (SMHA) Per Capita Mental Health Services Expenditures. . 2015. Available at: http://kff.org/other/state-indicator/smha-expenditures-per-capita/.
  6. Miller JE, Finley JK, Meyerhoeffer W, Gibson R. Access denied: Non-Medicaid expansion states blocked uninsured people with serious mental illness from receiving affordable, needed treatments. 2015.
  7. Ranking the states. . 2015. Available at: http://www.mentalhealthamerica.net/issues/ranking-states#Adult.

[a] The Substance Abuse and Mental Health Services Administration defines serious mental illness (SMI) among adults as a mental disorder (excluding developmental and substance use disorders) that results in serious functional impairment that substantially interferes with or limits one or more major life activities.

[b] Low-income refers to individuals who are at or below 138 percent of the FPL, which reflects those who may be newly eligible for Health coverage under PPACA.

[c] Out of 50 states, Puerto Rico, and the District of Columbia.