Editor's Note: This story originally appeared on Addiction-Rep.
Medicaid is the single largest payer for mental health services in the United States, playing a critical role in ensuring access to care for millions of adults with mental illness and substance use disorders.
An estimated 58.7 million U.S. adults — nearly one in four — live with a mental illness, according to national health data. Among this population, individuals enrolled in Medicaid are more likely to experience mental illness than those with private insurance, underscoring the program’s central role in combating America’s mental health crisis.
While Medicaid is federally funded, it is administered by individual states, each of which has broad discretion over how it structures, finances, and delivers services. As a result, the availability and quality of behavioral health services can vary significantly from state to state.
These differences are especially important now, as many states face financial pressures and potential budget cuts that could make it harder for people to access the care they need.
This analysis by Addiction-Rep ranks state Medicaid programs based on their performance across key behavioral health indicators. Learn more about the methodology at the end.
Here are the state Medicaid programs that provide the best mental health support.
15. Arizona
- Behavioral Health Performance Index: 53.46
- Initiation and Engagement: 64.45
- Evidence-Based Medication Use: 15.58
- Care Continuity and Follow-Up: 81.77
- Patient Experience: 52.03
14. New Mexico
- Behavioral Health Performance Index: 53.55
- Initiation and Engagement: 74.45
- Evidence-Based Medication Use: 41.60
- Care Continuity and Follow-Up: 46.07
- Patient Experience: 52.07
13. Delaware
- Behavioral Health Performance Index: 55.20
- Initiation and Engagement: 90.00
- Evidence-Based Medication Use: 45.23
- Care Continuity and Follow-Up: 23.80
- Patient Experience: 61.77
12. Tennessee
- Behavioral Health Performance Index: 55.69
- Initiation and Engagement: 74.45
- Evidence-Based Medication Use: 49.63
- Care Continuity and Follow-Up: 31.17
- Patient Experience: 67.50
11. Maryland
- Behavioral Health Performance Index: 55.81
- Initiation and Engagement: 72.25
- Evidence-Based Medication Use: 51.25
- Care Continuity and Follow-Up: 65.57
- Patient Experience: 34.17
10. Wisconsin
- Behavioral Health Performance Index: 56.81
- Initiation and Engagement: 51.10
- Evidence-Based Medication Use: 68.93
- Care Continuity and Follow-Up: 60.87
- Patient Experience: 46.33
9. Ohio
- Behavioral Health Performance Index: 62.53
- Initiation and Engagement: 95.60
- Evidence-Based Medication Use: 22.93
- Care Continuity and Follow-Up: 64.10
- Patient Experience: 67.50
8. Connecticut
- Behavioral Health Performance Index: 65.29
- Initiation and Engagement: 64.45
- Evidence-Based Medication Use: 76.20
- Care Continuity and Follow-Up: 73.33
- Patient Experience: 47.17
7. Kentucky
- Behavioral Health Performance Index: 66.02
- Initiation and Engagement: 92.20
- Evidence-Based Medication Use: 61.80
- Care Continuity and Follow-Up: 40.97
- Patient Experience: 69.10
6. Rhode Island
- Behavioral Health Performance Index: 69.73
- Initiation and Engagement: 35.55
- Evidence-Based Medication Use: 82.10
- Care Continuity and Follow-Up: 84.00
- Patient Experience: 77.27
5. Pennsylvania
- Behavioral Health Performance Index: 70.87
- Initiation and Engagement: 67.80
- Evidence-Based Medication Use: 76.95
- Care Continuity and Follow-Up: 60.70
- Patient Experience: 78.03
4. West Virginia
- Behavioral Health Performance Index: 71.93
- Initiation and Engagement: 90.00
- Evidence-Based Medication Use: 76.33
- Care Continuity and Follow-Up: 37.67
- Patient Experience: 83.73
3. Vermont
- Behavioral Health Performance Index: 73.40
- Initiation and Engagement: 74.45
- Evidence-Based Medication Use: 99.45
- Care Continuity and Follow-Up: 92.87
- Patient Experience: 26.83
2. Massachusetts
- Behavioral Health Performance Index: 74.69
- Initiation and Engagement: 64.45
- Evidence-Based Medication Use: 85.28
- Care Continuity and Follow-Up: 87.27
- Patient Experience: 61.77
1. New Hampshire
- Behavioral Health Performance Index: 74.73
- Initiation and Engagement: 82.25
- Evidence-Based Medication Use: 89.68
- Care Continuity and Follow-Up: 92.83
- Patient Experience: 34.17
Methodology
This analysis evaluates how effectively state Medicaid programs serve adult patients with mental health and substance use needs, based on data from the Centers for Medicare and Medicaid Services (CMS) Medicaid and CHIP Scorecard – Core Set Year 2023.
To compare performance across states, Addiction-Rep developed a composite score called the Behavioral Health Performance Index. This index averages scores across four key categories: initiation and engagement, evidence-based medication use, care continuity and follow-up, and patient experience.
Each category consists of multiple metrics, most of which focus on adult behavioral health patients aged 18 to 64. However, patient experience measures apply to all adult Medicaid enrollees, as condition-specific experience data is not available.
Only states with sufficient data across all four categories were included in the final rankings. However, states with partial data are still shown in visualizations and detailed tables for the metrics where data is available.
Following is a breakdown of the metrics included in the final index.
Initiation and Engagement
- SUD Initiation
- SUD Engagement
Evidence-Based Medication Use
- OUD Pharmacotherapy
- Antidepressant Acute Adherence
- Antidepressant Continuation Adherence
- Antipsychotic Adherence
Care Continuity and Follow-Up
- SUD/Overdose ED Follow-Up
- Mental Health ED Follow-Up
- Mental Health Hospital Follow-Up
Patient Experience
- Health Care Satisfaction
- Health Plan Satisfaction
- Always Got Needed Care
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