Nearly one in six Americans suffers from a serious mental illness. Medicaid pays approximately 25 percent of national expenditures and 45 percent of public expenditures for mental health and substance abuse services—with spending projected to rise in the years ahead. Facing rising state and federal budgets for behavioral health services, policymakers need accurate, data-driven information to make informed decisions.

In a project for the Substance Abuse and Mental Health Services Administration, Mathematica conducted research, surveys, data collection, and analysis to offer insights and information about current trends in Medicaid-funded behavioral health services. We conducted a survey of Medicaid officials on state administration of mental health services and compared multiple national data sources to identify beneficiaries with mental illness in nursing facilities. We also examined the use of antipsychotic drugs in nursing facilities for residents with and without mental health diagnoses and analyzed the use of mental health services in out-of-home, residential settings among Medicaid beneficiaries under the age of 21.

Drawing on this research, Mathematica behavioral health experts published a series of journal articles and a chartbook that creatively use Medicaid data to address important questions about Medicaid policies affecting behavioral health services for beneficiaries of all ages. The articles are broad in scope, covering topics relating to nursing home residents, welfare recipients, youth in residential treatment facilities, and prisoners.

The chartbook, Mental Health and Substance Abuse Services in Medicaid, 2003, was based on a comprehensive set of tables for each of the 50 states and the District of Columbia that documents service use and Medicaid expenditures for beneficiaries with mental illness or substance use disorders for 1999 and 2003. It provides the best and most comprehensive information currently available on Medicaid beneficiaries who use substance abuse and mental health services.