Commentary: Mental health is another reason to expand Medicaid

Commentary: Mental health is another reason to expand Medicaid

The horrific mass shooting in Uvalde and the mental health impact of the COVID-19 pandemic has refocused attention on how Texas can raise the bar above our status quo.

We have a get what you pay for challenge as we seek to do better for Texas families. The U.S. Census ranks Texas 46th in state budget spending per Texan, and Texas ranks last in health care coverage. In 2021, Texas had the highest number and highest percentage of uninsured residents – for children and adults – in the United States. About 5.2 million Texans, or 18%, were uninsured. One in five uninsured Americans lives in Texas. Our children and teens are more than twice as likely as American children to be uninsured.

Why care? Because people who do not have financial access to health care are held back and harmed, both physically and economically.

There are key policy measures that would measurably improve the lives of Texans in the areas of medical care, access to mental health, and economic security.

First, Texas should accept billions in federal funds each year to provide Medicaid to “working but poor” adults. Texas is one of 12 states without coverage for poor adults. Arkansas, Louisiana, New Mexico and West Virginia are all doing better at insuring their residents because they embraced Medicaid expansion. Experts estimate that nearly 1.4 million uninsured Texans would be eligible for coverage.

Second, remove administrative barriers to Texas Medicaid enrollment. Census estimates indicate that 350,000 or more uninsured Texan children are eligible for Medicaid or CHIP but are not enrolled because we are making it harder than necessary. When the COVID-19 policies that covered another 850,000 Texan children expire, the Texas Medicaid agency needs clear orders from the legislature to ensure coverage for eligible children and adults.

How does this help reduce barriers to mental health access in Texas? Medicaid is the largest funder of mental health services in the nation, but Texas loses by denying Medicaid to most adults. Often mislabelled, Medicaid expansion isn’t just for “able-bodied” adults, and if you thought adults with mental illness are already eligible for Medicaid, think again.

Many Texas adults with serious and chronic illnesses are not eligible for Medicaid because most adults who can still work are not eligible. Among adults with mental illness, only those with the most severe diagnoses are eligible for Texas Medicaid. Even life-threatening illnesses do not qualify an adult for Medicaid – unless the individual is expected to die within 12 months.

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