Medicaid Is Mental Health Care. Full Stop.

A new report highlights how changes to Medicaid could impact states

Most people don’t walk around thinking about Medicaid policy. Maybe that’s the problem.

As health journalist Jonathan Cohn recently asked:

“Do Republicans realize whose health care they’re cutting?”

It’s a good question, and not just a political one. Cohn notes that congressional leaders are moving forward with a sweeping health care proposal that includes deep cuts to Medicaid, despite clear signs that the public opposes it.

A recent KFF tracking poll shows 64 percent of Americans view the current bill unfavorably, compared to just 35 percent who support it. Similar findings came from Washington Post–Ipsos and Quinnipiac, where opposition outpaced support by roughly two to one.

Even more striking: according to Navigator Research, Medicaid is extremely popular amongst the general public, and most of us know someone who is on Medicaid.

But the consequences of these cuts aren’t hypothetical. Medicaid is the largest funder of mental health and addiction care in the country. It keeps rural hospitals open, funds maternity wards and nursing homes, pays for addiction treatment, therapy, case management, and more.

I’ve seen firsthand how important it is.

One of my first jobs out of college was working as a case manager for a community mental health agency. I visited families in their homes and schools, helped manage treatment plans, and tried to make the system work for people who had almost nothing.

Coverage was the hinge. If Medicaid covered it, we could try to make it happen. If it didn’t, our hands were tied. And most of the families I served, kids, single parents, veterans, were on Medicaid. It wasn’t just helpful for them, in many ways it was their foundation.

That’s why this moment is so alarming.

A new report from Inseparable lays it out plain: Medicaid is the single largest payer for mental health and addiction treatment in the U.S. If you’ve read anything I have written before, you know how vital this program. Anytime we strip it down, we don’t just “tighten budgets” we scorch the mental health scaffolding that’s propping up millions of lives.

In the always well done way they do, Inseparable breaks this down state by state.

Here’s some examples:

Alabama

46,090 Alabamians could lose Medicaid. That’s nearly 1 in 5 residents.
More than 1 in 5 people on Medicaid in Alabama live with a mental illness or addiction. And 66 percent of disabled Medicaid recipients don’t receive disability income, meaning they’re stuck in a bureaucratic no-man’s-land where they’re too sick to work but not “disabled enough” to qualify. Red tape keeps people from treatment, but yet we call this policy?

Tennessee

Tennessee could lose 162,246 people from Medicaid, where 34 percent of enrollees live with a mental health or substance use condition.
One in three children in Tennessee rely on Medicaid. The state already has a history of hospital closures, cut Medicaid, and the state is not just reducing care they’re erasing access entirely, especially in rural areas. When we do this, our crisis doesn’t disappear, it just shows up in other places.

Colorado

In Colorado, over 123,000 residents stand to lose coverage. A full 23 percent of Medicaid enrollees there are managing a mental illness or addiction, and more than 18,000 Coloradans received opioid use disorder treatment through Medicaid in 2022 alone. Overdose deaths dropped in 2024 because of access to care. Why would we cut the very thing that’s helped?

You don’t reduce the problems by making it harder to get help.

And about those “work requirements”? Let’s be real: they hurt people who are already struggling. Many can’t navigate the paperwork, don’t have internet access, or are battling conditions that make consistent employment impossible. And as a reminder, two-thirds of disabled Medicaid enrollees don’t get disability income. The system that’s being proposed isn’t designed to support them, it’s designed to drop them.

Cutting Medicaid doesn’t just remove coverage it creates a bigger problem.

This is not a new notion. We have tons of stories and data. Consider the following:

• Medicaid expansion reduces overdose deaths.

• Kids lose coverage when their parents do.

• Hospitals close when uncompensated care skyrockets.

• Mental health systems buckle without Medicaid reimbursement.

So no, Medicaid isn’t just some insurance program. It’s a suicide prevention strategy. It’s a substance use lifeline. It’s family preservation. It’s child welfare. It’s what holds the line for millions.

I’ve seen what happens when it’s there. I don’t want to see what happens when it’s not. There’s no clean split between “health care” and “mental health care.” There never was.

Medicaid is mental health. If we want a system that works, we’d better act like it.