New evidence shows additional benefits of Medicaid expansion in Texas

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Alithea McFarlane

Robiel Abraha

Texas is doubling down on its efforts to improve the state’s mental and behavioral health system. During the 2015 Legislative Session, state lawmakers not only created the House Select Committee on Mental Health, they also authorized $2.7 billion in state general revenue funds to be spent on mental health and substance abuse services. Despite these efforts, the Legislature left one critical topic out of the discussion: Medicaid expansion.

Recently, the U.S. Department of Health and Human Services released an issue brief showing the impact of Medicaid expansion on behavioral healthcare access. According to the brief, only nine percent of low-income, uninsured Texans with a mental health or substance abuse problem received treatment. However, researchers found that 14 percent of insured Texans with the same problems received treatment. This disparity is concerning given the higher rates of substance abuse and mental illness among uninsured adults across the state. It’s no surprise that the report shows cost is a significant barrier to treatment. Uninsured individuals cited “lack of affordability” as the most prominent reason for not seeking care.

The new study shows Medicaid expansion in other states is “associated with a reduction in unmet need for mental health and substance use disorder treatment” among low-income adults, increasing the likelihood that they will receive treatment by 30%. This increase in treatment results in better health outcomes. Researchers argue that if Texas expanded Medicaid, the number of people experiencing symptoms of depression would drop by 101,000 – more than any other non-expansion state. Furthermore, recent studies have shown that Medicaid expansion could also provide moderate to substantial savings in state spending on behavioral health services.

Tremendous work is needed to overcome the stigma and discrimination associated with mental illness, as well as the personal, social and economic factors that lead to substance abuse. Medicaid expansion alone will not address every hurdle, but it can improve access to health services for hundreds of thousands of low-income, uninsured Texans with mental illness and behavioral health problems who would otherwise forego care. After Texas lawmakers created the House Select Committee on Mental Health, Speaker Joe Straus said it was important not to look at mental and behavioral health issues in isolation, but rather to “take a comprehensive view of how to improve the system.” If Texas is serious about improving the state’s overall system of mental and behavioral health, state officials need to re-evaluate their position on Medicaid expansion.