Technical Assistance Brief: State Options for Integrating Physical and Behavioral Health Care

ehavioral health conditions, including mental illness and substance use disorders, are widespread among Medicaid's highneed, high-cost beneficiaries, many of whom also have chronic physical conditions. Over half of all Medicaid beneficiaries with disabilities are diagnosed with a mental illness.1 For those with common chronic conditions, health care costs are as much as 75 percent higher for those with mental illness compared to those without a mental illness2 and the addition of a co-occurring substance use disorder results in twoto three-fold higher health care costs.3 Among individuals eligible for Medicare and Medicaid (also known as dual eligible individuals), 44 percent have at least one mental health diagnosis.4 For the 20 percent of dual eligible individuals with more than one mental health diagnosis, annual spending averages more than $38K—twice as high as average annual spending for the dual eligible population as a whole.5 The prevalence of serious mental illness is especially high among dual eligible individuals under age 65 – at least three times higher than for those age 65 and older.6 Meanwhile, substance use disorder, with and without co-occurring mental illness, is also more common among dual eligible individuals than among Medicare-only beneficiaries.7