Access to mental health and substance use disorder treatment

Mental health and substance use disorder treatment 

NOTE:  HPIO posted a revised version of this brief on May 16, 2025. After HPIO originally released the brief, the Ohio Department of Medicaid discovered that the expenditure amounts they provided were incorrect because they included expenditures for a two-year lookback period (i.e. 2023 and 2024 expenditures labeled as CY2024). We have revised our brief with the corrected data and posted revised spreadsheets with county-level data (see link below).

The revised analysis continues to show that Ohio receives substantial federal funding for behavioral health services for the Medicaid expansion population. In 2024, more than $1 billion in federal funds paid for services for Ohioans such as outpatient counseling, psychiatric medical services and residential drug treatment programs.

If Medicaid expansion is eliminated, the state would have to cover those costs or face significant reductions in treatment availability. Maintaining current state investments and replacing even 50% of the federal funds would cost Ohio more than $627 million a year.

Ohio policymakers are considering discontinuation of Medicaid expansion coverage for approximately 770,000 Ohioans if the federal government reduces funding for this group. To inform the decision, HPIO is releasing a series of briefs that summarize data and research on the potential impact of the change. 

Behavioral health conditions are common among Ohioans, including those with Medicaid coverage. In calendar year 2024, 40% of Ohioans enrolled in Medicaid expansion had a primary mental health or substance use disorder diagnosis. 

This brief describes the role of Medicaid as a funder of mental health and substance use disorder services and highlights considerations for how working-age Ohioans with low incomes would access behavioral health care if expansion coverage was eliminated.

Click here for a spreadsheet with county-level data (revised 05.16.2025)

3 Key Findings for Policymakers

• High demand. Many Ohioans enrolled in Medicaid have behavioral health conditions. Forty percent of adults covered by expansion had a mental health and/or substance use disorder diagnosis in 2024.
• Significant investments. Ohio received more than $1 billion in federal funds for community-based and hospital behavioral health services for expansion enrollees in calendar year 2024.
• Potential risk. If expansion was discontinued, many Ohioans would lose access to treatment. Policy priorities such as improving supports for recovery and re-entry and suicide prevention could be curtailed.

About HPIO's 2025 Ohio Medicaid Expansion Study

HPIO has launched an expansive study on the potential impacts of the elimination of Medicaid expansion in Ohio. 

Since Ohio expanded Medicaid eligibility in 2014, hundreds of thousands of residents with lower incomes – including people who are working, parents, grandparents, veterans and caregivers – have gained access to medically necessary health care. As of March 2025, nearly 770,000 Ohioans are covered through Medicaid expansion. 

The federal Affordable Care Act (ACA) and a subsequent U.S. Supreme Court decision permitted states to expand Medicaid eligibility to adults earning less than 138% of the federal poverty level (FPL). The federal  government pays 90% of the cost of the Medicaid expansion group and the state government pays 10%. The proposed 2026-2027 biennial state budget (House Bill 96) would discontinue Medicaid expansion if the enhanced FMAP for Medicaid expansion drops below 90%. 

Resources

• More information about the study and links to additional briefs can be found on the 2025 Ohio Medicaid Expansion Study page.
• HPIO’s Policy Considerations: The Future of Group VIII (expansion) Medicaid Coverage in Ohio brief contains more general information and considerations about Medicaid expansion coverage as policymakers consider the future of the program.
• Ohio Medicaid Basics 2025 provides an overview of the Ohio Medicaid program, including eligibility, covered services, spending and recent policy changes. 
• 4-page summary of all five briefs in this series

Facts and Figures

Use HPIO graphics and data in your work. To use the data graphics in your presentations, click here to access the slides on Google Drive, click “File” and then “Download.” This will allow the option to download individual slides or the full deck into PowerPoint slides, a jpg, pdf or other available media files.

For graphics and slides from ALL phases of the study, see the 2025 Medicaid Expansion Study project page. 

Funders

This study was made possible by support from the bi3 Fund, Interact for Health, Mt. Sinai Health Foundation, The George Gund Foundation, the Harmony Project, the Columbus Foundation and HPIO’s other core funders.