Ranking State Medicaid Programs on Mental Health: Where Does Your State Stand?
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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.
Below is a breakdown of the metrics included in the final index, organized by category, along with descriptions of each:
Initiation & Engagement
- SUD Initiation (14d): Share of new substance use disorder (SUD) treatment episodes where the patient began treatment within 14 days of diagnosis.
- SUD Engagement (34d): Share of new SUD treatment episodes where the patient attended additional treatment within 34 days of starting care.
Evidence-Based Medication Use
- OUD Pharmacotherapy: Share of adults with opioid use disorder (OUD) who received FDA-approved medication-based treatment options, such as buprenorphine or methadone.
- Antidepressant Acute Adherence (12w): Share of adults with major depression who remained on prescribed antidepressants during the initial 12-week treatment phase.
- Antidepressant Continuation Adherence (6m): Share of adults with major depression who remained on prescribed antidepressants through a six-month treatment period.
- Antipsychotic Adherence: Share of adults with schizophrenia or schizoaffective disorder who remained on prescribed antipsychotic medications for at least 80% of their treatment duration.
Care Continuity & Follow-Up
- SUD/Overdose ED Follow-Up (7d): Share of emergency department visits for substance use or drug overdose with a follow-up visit within seven days.
- Mental Health ED Follow-Up (7d): Share of emergency visits for mental illness or intentional self-harm with a follow-up visit within seven days.
- Mental Health Hospital Follow-Up (7d): Share of adults discharged after hospitalization for mental illness or self-harm who had a follow-up visit within seven days.
Patient Experience
- Health Care Satisfaction (9–10 Rating): Share of adults who rated their overall health care experience as a 9 or 10 on a 10-point scale.
- Health Plan Satisfaction (9–10 Rating): Share of adults who rated their Medicaid health plan as a 9 or 10 out of 10.
- Always Got Needed Care: Share of adults who reported “always” getting the care they needed, based on a four-point response scale ranging from “never” to “always.”
For complete results, see Ranking State Medicaid Programs on Mental Health: Where Does Your State Stand? on Addiction-Rep.
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