Medicaid Behavioral Health: CMS Guidance Needed to Better Align Demonstration Payment Rates with Costs and Prevent Duplication

Behavioral health conditions such as depression and opioid use disorder affected an estimated 61 million U.S. adults in 2019. Research has shown that low-income individuals, such as those enrolled in Medicaid, are at greater risk of developing such conditions.

Eight states received funds to test whether changes to the delivery and payment of behavioral health care would help improve beneficiaries’ access to and use of these services.

Better federal guidance could help states ensure that payments for these services meet Medicaid requirements—especially as the tests expand to other states. Our recommendations are to help improve that guidance.

In 2016, the Department of Health and Human Services (HHS) selected eight...