–
Medicaid Behavioral Health Glossary: Key Terms and Concepts
Care Continuum: An integrated system of care that guides and tracks patients over time through a comprehensive array of health services spanning all levels of care.
Community-based care: Healthcare provided in the home or another community setting and that typically allows the person to stay in their home rather than moving them to a facility to receive care. Examples include home health aides, case management services, and personal care services.
Disproportionate Share Hospital (DSH) payments: Payments required by federal law from state Medicaid programs to qualifying hospitals that serve a large number of Medicaid and uninsured individuals.
Inpatient Treatment: Healthcare provided upon admission to a facility, such as a hospital. Typically treats more severe diagnoses, provides 24-hour medical and emotional support, and involves the patient staying in the facility for an extended period of time.
Institution of Mental Disease: Hospital, nursing facility, or other institution of more than 16 beds, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services.
Institutional Care: Healthcare provided in an institutional setting such as a nursing facility, mental health institution, or an intermediate care facility for individuals with intellectual disability.
Medicaid Managed Care: Delivery system for Medicaid covered services by health plans that accept a set capitated payment for these services through a contract with the state Medicaid agency.
Olmstead case: 1999 Supreme Court decision that found that the unjustified institutionalization of people with disabilities is illegal discrimination. Requires states to eliminate unnecessary segregation and ensure that persons with disabilities receive services in the most integrated setting appropriate to their needs.
Outpatient Treatment: Healthcare provided in a part-time setting that allows the patient to continue their day-to-day activities outside of treatment. Typically allows the patient to maintain a more normal daily routine and relies more heavily on social circle support.
Section 1115 Demonstration Waiver: Authority by which HHS Secretary can allow states to test new approaches in Medicaid that differ from what is required by federal statute.
Serious Emotional Disturbance: Someone under the age of 18 with a diagnosable mental, behavioral, or emotional disorder in the past year, which resulted in functional impairment that substantially interferes with or limits their role or functioning in family, school, or community activities.
Serious Mental Illness: Someone over the age of 18 with a diagnosable mental, behavior, or emotional disorder that causes serious functional impairment that substantially interferes with or limits one or more major life activities.
Substance Use Disorder: Recurring use of alcohol or drugs that causes significant clinical and functional impairment.
SUPPORT Act: Federal law partially lifting the IMD payment exclusion by allowing states to use federal Medicaid funds for nonelderly adults receiving IMD SUD services up to 30 days a year, from October 2019 through September 2023.
(Back to top)
| State |
Enrollees Receiving Only SUD Services: |
Enrollees Receiving Only Mental Health Services |
Enrollees Receiving Both SUD and Mental Health Services: |
Total Enrollees Receiving Mental Health or SUD Services |
| Total |
Only Inpatient Care |
Only Outpatient Care |
Both Inpatient and Outpatient Care |
Total |
Only Inpatient Care |
Only Outpatient Care |
Both Inpatient and Outpatient Care |
Total |
Only Inpatient Care |
Only Outpatient Care |
Both Inpatient and Outpatient Care |
|
|
|
|
|
|
|
|
|
|
|
|
| National |
989,200 |
17% |
76% |
7% |
4,687,300 |
4% |
86% |
10% |
1,134,900 |
5% |
53% |
43% |
6,839,800 |
| Alabama |
19,300 |
16% |
73% |
11% |
48,500 |
8% |
79% |
13% |
21,500 |
6% |
45% |
49% |
89,300 |
| Alaska |
3,100 |
3% |
94% |
3% |
9,300 |
2% |
92% |
5% |
2,700 |
0% |
85% |
15% |
15,000 |
| Arizona |
25,100 |
16% |
76% |
8% |
113,000 |
3% |
88% |
9% |
25,600 |
3% |
55% |
41% |
163,800 |
| Arkansas |
6,200 |
2% |
95% |
3% |
41,700 |
1% |
90% |
9% |
6,600 |
0% |
80% |
20% |
54,500 |
| California |
52,300 |
5% |
92% |
3% |
473,200 |
1% |
94% |
5% |
42,500 |
0% |
82% |
18% |
568,100 |
| Colorado |
FY2013 data not available |
| Connecticut |
16,700 |
17% |
77% |
6% |
87,600 |
3% |
86% |
11% |
21,500 |
4% |
53% |
43% |
125,700 |
| Delaware |
5,700 |
16% |
79% |
5% |
22,100 |
5% |
86% |
9% |
5,700 |
7% |
44% |
49% |
33,400 |
| District of Columbia |
9,000 |
12% |
82% |
6% |
21,100 |
2% |
90% |
8% |
6,800 |
1% |
62% |
37% |
36,900 |
| Florida |
50,000 |
22% |
69% |
9% |
203,900 |
9% |
79% |
12% |
51,900 |
10% |
39% |
51% |
305,800 |
| Georgia |
19,300 |
28% |
63% |
9% |
102,200 |
6% |
84% |
10% |
21,300 |
8% |
41% |
51% |
142,700 |
| Hawaii |
5,600 |
13% |
82% |
5% |
24,600 |
1% |
93% |
6% |
4,400 |
2% |
61% |
36% |
34,700 |
| Idaho |
3,800 |
13% |
82% |
5% |
20,900 |
5% |
85% |
10% |
6,100 |
5% |
51% |
44% |
30,900 |
| Illinois |
44,200 |
18% |
73% |
9% |
197,900 |
4% |
83% |
13% |
45,300 |
4% |
43% |
53% |
287,300 |
| Indiana |
21,100 |
18% |
73% |
9% |
100,400 |
4% |
84% |
12% |
32,600 |
4% |
52% |
45% |
154,200 |
| Iowa |
6,000 |
22% |
72% |
7% |
50,500 |
4% |
84% |
12% |
8,800 |
5% |
49% |
47% |
65,200 |
| Kansas |
1,900 |
21% |
74% |
5% |
15,300 |
5% |
90% |
6% |
1,600 |
6% |
56% |
38% |
18,900 |
| Kentucky |
28,400 |
10% |
82% |
8% |
75,600 |
5% |
86% |
9% |
34,200 |
5% |
58% |
37% |
138,200 |
| Louisiana |
17,800 |
13% |
81% |
6% |
77,600 |
3% |
84% |
13% |
16,400 |
2% |
59% |
40% |
111,800 |
| Maine |
12,000 |
4% |
91% |
5% |
51,800 |
2% |
91% |
8% |
23,000 |
1% |
70% |
28% |
86,900 |
| Maryland |
15,600 |
19% |
76% |
6% |
108,000 |
3% |
87% |
10% |
17,200 |
4% |
49% |
47% |
140,900 |
| Massachusetts |
26,100 |
13% |
80% |
7% |
217,900 |
2% |
88% |
10% |
50,400 |
2% |
51% |
47% |
294,500 |
| Michigan |
49,600 |
13% |
82% |
6% |
190,700 |
3% |
87% |
10% |
50,200 |
3% |
64% |
33% |
290,500 |
| Minnesota |
27,400 |
8% |
85% |
7% |
148,400 |
1% |
90% |
8% |
47,500 |
1% |
64% |
35% |
223,400 |
| Mississippi |
9,100 |
29% |
63% |
9% |
50,200 |
4% |
84% |
12% |
9,600 |
5% |
38% |
57% |
69,000 |
| Missouri |
18,300 |
8% |
86% |
5% |
102,200 |
2% |
88% |
10% |
24,600 |
1% |
66% |
33% |
145,200 |
| Montana |
2,000 |
15% |
75% |
10% |
12,600 |
4% |
86% |
10% |
3,400 |
3% |
56% |
41% |
17,800 |
| Nebraska |
3,000 |
20% |
73% |
7% |
22,200 |
4% |
84% |
13% |
4,300 |
5% |
47% |
49% |
29,600 |
| Nevada |
2,900 |
28% |
66% |
7% |
15,700 |
4% |
87% |
9% |
3,600 |
6% |
42% |
53% |
22,200 |
| New Hampshire |
1,800 |
11% |
83% |
6% |
19,300 |
3% |
90% |
8% |
4,300 |
2% |
63% |
35% |
25,500 |
| New Jersey |
10,700 |
17% |
78% |
6% |
82,100 |
3% |
88% |
9% |
12,700 |
3% |
49% |
48% |
105,500 |
| New Mexico |
5,700 |
18% |
74% |
9% |
44,500 |
3% |
90% |
7% |
7,500 |
3% |
55% |
43% |
57,700 |
| New York |
133,300 |
27% |
64% |
9% |
514,400 |
6% |
80% |
14% |
162,700 |
7% |
37% |
56% |
810,400 |
| North Carolina |
29,800 |
17% |
76% |
7% |
115,600 |
5% |
88% |
8% |
24,500 |
5% |
59% |
36% |
169,900 |
| North Dakota |
1,000 |
20% |
70% |
10% |
8,100 |
4% |
85% |
11% |
1,500 |
7% |
47% |
47% |
10,500 |
| Ohio |
82,000 |
9% |
85% |
6% |
243,000 |
3% |
86% |
11% |
87,000 |
2% |
59% |
38% |
412,100 |
| Oklahoma |
13,300 |
18% |
75% |
7% |
68,900 |
4% |
87% |
9% |
18,400 |
4% |
53% |
43% |
100,700 |
| Oregon |
17,100 |
7% |
87% |
6% |
67,900 |
3% |
90% |
7% |
20,500 |
1% |
72% |
27% |
105,500 |
| Pennsylvania |
41,900 |
22% |
73% |
5% |
133,700 |
10% |
83% |
7% |
30,900 |
17% |
49% |
34% |
206,400 |
| Rhode Island |
2,200 |
23% |
68% |
9% |
22,400 |
3% |
86% |
12% |
3,900 |
3% |
51% |
46% |
28,500 |
| South Carolina |
16,200 |
20% |
73% |
7% |
53,800 |
5% |
87% |
8% |
12,500 |
6% |
54% |
39% |
82,400 |
| South Dakota |
1,000 |
20% |
70% |
10% |
9,800 |
4% |
85% |
11% |
1,400 |
0% |
50% |
50% |
12,300 |
| Tennessee |
33,200 |
17% |
78% |
5% |
113,200 |
6% |
86% |
8% |
35,400 |
7% |
53% |
40% |
181,600 |
| Texas |
27,800 |
29% |
62% |
9% |
196,400 |
5% |
82% |
12% |
33,100 |
7% |
40% |
53% |
257,200 |
| Utah |
2,900 |
17% |
76% |
7% |
31,900 |
4% |
86% |
10% |
4,100 |
2% |
56% |
41% |
39,000 |
| Vermont |
3,500 |
17% |
80% |
3% |
24,200 |
3% |
91% |
6% |
4,400 |
7% |
52% |
41% |
32,100 |
| Virginia |
17,200 |
34% |
58% |
8% |
81,200 |
6% |
80% |
13% |
22,800 |
8% |
39% |
52% |
121,100 |
| Washington |
19,000 |
13% |
81% |
7% |
104,800 |
3% |
91% |
6% |
25,100 |
3% |
67% |
30% |
148,900 |
| West Virginia |
5,000 |
34% |
56% |
10% |
48,100 |
3% |
87% |
10% |
8,700 |
6% |
36% |
59% |
61,900 |
| Wisconsin |
23,700 |
10% |
85% |
5% |
115,900 |
3% |
90% |
8% |
26,900 |
3% |
62% |
35% |
166,500 |
| Wyoming |
1,100 |
18% |
73% |
9% |
5,400 |
6% |
85% |
9% |
1,200 |
8% |
50% |
42% |
7,700 |
NOTES: FY 2013 data for Colorado and Rhode Island are unavailable. RI data is FY 2012. Kansas has only 1 quarter of FY 2013 data available. North Carolina has only 3 quarters of FY 2013 data available. Totals may not sum due to rounding.
SOURCE: KFF analysis of FY2013 Medicaid Statistical Information System. |
–
| State |
Waiver/Program Name |
Approval Date |
IMD Authority Begins |
IMD Authority Expires |
SUD Authority |
Mental Health Authority |
Day Limit |
Due Dates |
| Evaluation Findings |
Midpoint Assessment Due |
|
|
| Alaska |
Alaska Substance Use Disorder and Behavioral Health Program |
11/21/2018 |
1/1/2019 |
12/31/2023 |
✓ |
|
30-day statewide average |
6/30/2025 |
11/1/2020 |
| California |
Drug Medi-Cal Organized Delivery System (DMC-ODS) |
8/13/2015 |
1/1/2016 |
12/31/2020 |
✓ |
|
30-day statewide average; 90 day maximum |
120 days after demonstration |
One year prior to the end of demonstration |
| Delaware |
Delaware Diamond State Health Plan |
7/31/2019 |
8/1/2019 |
12/31/2023 |
✓ |
|
30-day statewide average |
6/30/2025 |
12/31/2021 |
| Illinois |
Illinois Behavioral Health Transformation |
5/7/2018 |
7/1/2018 |
6/30/2023 |
✓ |
|
30-day statewide average |
12/31/2025 |
12/31/2020 |
| Indiana |
Healthy Indiana Plan |
2/1/2018 |
2/1/2018 |
12/31/2020 |
✓ |
|
30-day statewide average |
7/31/2022 |
1/31/2020 |
| Kansas |
KanCare |
12/18/2018 |
1/1/2019 |
12/31/2023 |
✓ |
|
30-day statewide average |
6/30/2025 |
9/30/2022 |
| Kentucky |
KY Health (KY Helping to
Engage & Achieve Long Term Health) |
1/12/2018 |
1/12/2018 |
9/30/2023 |
✓ |
|
Not specified |
3/30/2025 |
4/12/2021 |
| Louisiana |
Healthy Louisiana OUD/SUD Demonstration |
2/1/2018 |
2/1/2018 |
12/31/3022 |
✓ |
|
Not specified |
6/30/2024 |
11/16/2020 |
| Massachusetts |
MassHealth |
10/30/2014 |
10/30/2014 |
6/30/2022 |
✓ |
|
90 day maximum |
12/31/2022 |
6/30/2021 |
| Maryland |
Maryland HealthChoice |
12/22/2016 |
1/1/2017 |
12/31/2021 |
✓ |
|
30 day maximum |
6/30/2023 |
Not specified |
| Michigan |
Michigan Pathway to Integration |
4/5/2019 |
4/5/2019 |
9/30/2024 |
✓ |
|
30-day statewide average |
3/30/2026 |
12/31/2022 |
| Minnesota |
Minnesota Substance Use Disorder System Reform |
6/28/2019 |
7/1/2019 |
6/30/2024 |
✓ |
|
30-day statewide average |
12/31/2025 |
12/31/2022 |
| North Carolina |
North Carolina’s Medicaid Reform Demonstration |
10/19/2018 |
1/1/2019 |
10/31/2024 |
✓ |
|
30-day statewide average |
5/1/2026 |
11/1/2021 |
| Nebraska |
Nebraska Substance Use Disorder Section 1115 Demonstration |
7/9/2019 |
7/9/2019 |
6/30/2024 |
✓ |
|
30-day statewide average |
12/31/2025 |
1/1/2022 |
| New Hampshire |
New Hampshire SUD Treatment and Recovery Access |
7/10/2018 |
7/10/2018 |
6/30/2023 |
✓ |
|
30-day statewide average |
12/31/2024 |
3/30/2021 |
| New Jersey |
New Jersey FamilyCare Comprehensive Demonstration |
10/31/2017 |
7/1/2017 |
6/30/2022 |
✓ |
|
30-day statewide average |
12/31/2023 |
Between DYs 7 and 8 |
| New Mexico |
Centennial Care 2.0 1115 Medicaid Demonstration |
12/14/2018 |
1/1/2019 |
12/31/2023 |
✓ |
|
30-day statewide average |
7/1/2025 |
6/1/2022 |
| Ohio |
Ohio Section 1115 Demonstration Waiver for Substance Use Disorder Treatment |
9/24/2019 |
10/1/2019 |
09/30/2024 |
✓ |
|
30-day statewide average |
03/30/26 |
12/31/2021 |
| Pennsylvania |
Pennsylvania Medicaid Coverage Former Foster Care Youth From a Different State & SUD Demonstration |
6/28/2018 |
7/1/2018 |
9/30/2022 |
✓ |
|
30-day statewide average |
3/30/2024 |
10/31/2020 |
| Rhode Island |
Rhode Island Comprehensive Demonstration |
12/20/2018 |
1/1/2019 |
12/31/2023 |
✓ |
|
30-day statewide average |
7/1/2025 |
6/30/2020 |
| Utah |
Utah Primary Care Network |
10/31/2017 |
11/1/2017 |
6/30/2022 |
✓ |
|
Not specified |
12/31/2023 |
Between DYs 17 and 18 |
| Virginia |
The Virginia GAP and ARTS Delivery System Transformation |
12/15/2016 |
4/01/2017 |
12/31/2019 |
✓ |
|
30-day statewide average |
7/1/2021 |
Not specified |
| Vermont |
Vermont Global Commitment to Health |
1/1/96 |
1/1/96 |
12/31/2021 (SUD)
Phase out by 2025 (MH) |
✓ |
✓ |
30-day statewide average |
7/1/2023 |
12/31/2020 |
| Washington |
Washington Medicaid Transformation Project |
7/17/2018 |
7/17/2018 |
12/31/2021 |
✓ |
|
30-day statewide average |
1/30/2022 |
12/31/2020 |
| Wisconsin |
Wisconsin BadgerCare Reform |
10/31/2018 |
10/31/2018 |
12/31/2023 |
✓ |
|
30-day statewide average |
7/1/2025 |
Not specified |
| West Virginia |
West Virginia Creating a Continuum of Care for Medicaid Enrollees with Substance Use Disorders |
10/6/2017 |
1/1/2018 |
12/31/2022 |
✓ |
|
30-day statewide average |
7/1/2024 |
Not specified |
| SOURCE: KFF analysis of Section 1115 waivers for the IMD Payment Exclusion |
–
| Managed Care States (41 states) |
Using “in lieu of” Authority? |
| TOTAL |
35 |
| Arizona |
✓ |
| Arkansas |
✓ |
| California |
|
| Colorado |
✓ |
| Delaware |
✓ |
| District of Columbia |
✓ |
| Florida |
✓ |
| Georgia |
|
| Hawaii |
✓ |
| Illinois |
✓ |
| Indiana |
✓ |
| Iowa |
✓ |
| Kansas |
|
| Kentucky |
✓ |
| Louisiana |
✓ |
| Maryland |
|
| Massachusetts |
✓ |
| Michigan |
✓ |
| Minnesota |
✓ |
| Mississippi^ |
✓ |
| Missouri |
✓ |
| Nebraska |
✓ |
| Nevada |
✓ |
| New Hampshire |
✓ |
| New Jersey |
✓ |
| New Mexico |
✓* |
| New York |
✓ |
| North Carolina^ |
✓ |
| North Dakota |
|
| Ohio |
✓ |
| Oregon |
✓ |
| Pennsylvania |
|
| Rhode Island |
✓ |
| South Carolina |
✓ |
| Tennessee |
✓ |
| Texas |
✓ |
| Utah |
✓ |
| Virginia |
✓ |
| Washington |
✓ |
| West Virginia |
✓* |
| Wisconsin |
✓ |
| Non Managed Care States (10 states) |
| Alabama |
| Alaska |
| Connecticut |
| Idaho |
| Maine |
| Montana |
| Oklahoma |
| South Dakota |
| Vermont |
| Wyoming |
NOTES: *NM and WV in FY 2019 only. ^MS and NC in FY 2020 only. NC did not have managed care in FY 2019.
SOURCE: KFF 50-state Budget Survey for SFY 2019 and 2020. |
–
| State |
DSH Payments to Mental Health Facilities |
Share of National DSH Payments to Mental Health Facilities |
| Alaska |
$15,110,912.00 |
0.51% |
| Arizona |
$28,474,900.00 |
0.95% |
| Arkansas |
$805,823.00 |
0.03% |
| California |
– |
0.00% |
| Colorado |
– |
0.00% |
| Connecticut |
$105,573,725.00 |
3.54% |
| Delaware |
$5,660,538.00 |
0.19% |
| District of Columbia |
$6,545,136.00 |
0.22% |
| Florida |
$117,127,905.00 |
3.93% |
| Georgia |
– |
0.00% |
| Hawaii |
– |
0.00% |
| Idaho |
– |
0.00% |
| Illinois |
$89,298,594.00 |
2.99% |
| Indiana |
– |
0.00% |
| Iowa |
– |
0.00% |
| Kansas |
$29,367,269.00 |
0.98% |
| Kentucky |
$37,443,073.00 |
1.25% |
| Louisiana |
$77,613,298.00 |
2.60% |
| Maine |
$43,445,330.00 |
1.46% |
| Maryland |
$53,692,663.00 |
1.80% |
| Massachusetts |
– |
0.00% |
| Michigan |
$140,187,859.00 |
4.70% |
| Minnesota |
$9,785.00 |
0.00% |
| Mississippi |
– |
0.00% |
| Missouri |
$207,597,893.00 |
6.96% |
| Montana |
– |
0.00% |
| Nebraska |
$1,811,337.00 |
0.06% |
| Nevada |
– |
0.00% |
| New Hampshire |
$36,535,356.00 |
1.22% |
| New Jersey |
$357,370,459.00 |
11.98% |
| New Mexico |
– |
0.00% |
| New York |
$537,750,000.00 |
18.02% |
| North Carolina |
$161,840,524.00 |
5.42% |
| North Dakota |
$741,360.00 |
0.02% |
| Ohio |
$93,432,758.00 |
3.13% |
| Oklahoma |
$3,273,248.00 |
0.11% |
| Oregon |
$19,975,088.00 |
0.67% |
| Pennsylvania |
$294,758,874.00 |
9.88% |
| Rhode Island |
– |
0.00% |
| South Carolina |
$60,903,051.00 |
2.04% |
| South Dakota |
$751,299.00 |
0.03% |
| Tennessee |
– |
0.00% |
| Texas |
$292,467,199.00 |
9.80% |
| Utah |
– |
0.00% |
| Vermont |
– |
0.00% |
| Virginia |
$7,262,564.00 |
0.24% |
| Washington |
$137,239,120.00 |
4.60% |
| West Virginia |
$18,864,905.00 |
0.63% |
| Wisconsin |
– |
0.00% |
| Wyoming |
– |
0.00% |
| SOURCE: KFF analysis of form CMS-64 FY 2018 data |
