Behavioral health, which encompasses mental health care and substance use disorder treatment, plays a critical role in the overall health of Medicaid beneficiaries. With Medicaid being the largest source of health coverage in the United States, it is a key player in financing mental health and substance use disorder services. Addressing the behavioral health needs of this population is necessary to improve the long-term sustainability of healthcare in the United States.
Medicaid covers a disproportionate number of individuals with behavioral health conditions. Nearly 40% of the nonelderly adult Medicaid population, or 13.9 million enrollees, had a mental health or substance use disorder in 2020. These beneficiaries often have co-occurring physical health conditions, and their expenditures are approximately double compared to those with physical health conditions alone. Addressing these behavioral health needs is not only important for personal well-being but also for helping vulnerable populations overcome barriers to care.
To improve quality of life and ensure long-term recovery, behavioral health services in Medicaid have become integrated with physical care. Coordinating mental and physical care not only improves health outcomes but reduces costly hospitalizations and emergency room visits.
Addressing Behavioral Health in North Carolina
Medicaid expansion under the Affordable Care Act significantly increased access to behavioral health care by closing care gaps. This has allowed more individuals to access the care they need without a financial burden, particularly in rural and underserved communities.
North Carolina Managed Medicaid provides comprehensive behavioral health services through various programs aimed at addressing mental health, substance use disorders, and intellectual/developmental disabilities (I/DD). Covered services include:
- Outpatient Services: Individual and group therapy, family therapy, psychological testing, medication management for all beneficiaries, including pediatrics and adults
- Inpatient Services: Hospital treatment for acute psychiatric or substance use problems, including inpatient psychiatric hospitalization and medically managed intensive inpatient services
- Assertive Community Treatment: A community-based service for adults with severe mental illness, including daily medication delivery and help finding housing
- Other Services: Crisis services, Community Support Team, Multi-Systemic Therapy, intensive in-home services, psych rehab, and peer support
In addition, North Carolina recently introduced Tailored Plans, which provide a more personalized approach for beneficiaries with severe mental health needs, substance use disorders, I/DD, and traumatic brain injuries. These plans give beneficiaries autonomy in how they choose to receive care, allowing them to have a designated care manager who works with their broader care team, further integrating behavioral health into their physical care to promote the best outcomes for every beneficiary.
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