State Options for Medicaid Coverage of Inpatient Behavioral Health Services

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.1

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.2

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.3

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.4

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.5

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.6

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.7

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.8

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.9

Substance Use Disorder: Recurring use of alcohol or drugs that causes significant clinical and functional impairment.10

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 2023.11

(Back to top)

Appendix Table 1: Medicaid Beneficiaries Aged 21-64 Receiving SUD and/or Mental Health Services – Inpatient vs. Outpatient Care, FY2013
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.
Appendix Table 2: Key Components of Approved Section 1115 Waivers for the IMD Payment Exclusion as of Oct. 2019
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
Appendix Table 3: States Using Medicaid Managed Care “in lieu of” Authority to Fund IMD Services in FY2019 and/or FY2020
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.
Appendix Table 4: Disproportionate Share Hospital (DSH) Payments to Mental Health Treatment Facilities in FY 2018
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
Report