Skip to main content

The Implications of the Affordable Care Act for Behavioral Health Services Utilization


This analysis estimates the number of currently uninsured adults who may gain coverage and access behavioral health (BH) services under the ACA. Data on BH status, socio-demographic characteristics, insurance coverage, and services utilization were drawn from the 2008–2012 National Survey on Drug Use and Health. Multivariate logistic regression modeling was used to estimate changes in services utilization under the ACA. Estimates indicate that 2.8 million adults may receive BH treatment through Medicaid expansions, and 3.1 million through participation in health insurance exchanges. This represents a 40 % increase in BH services utilization, primarily for mental health services.

This is a preview of subscription content, access via your institution.


  1. Estimates of the logistic regression models are provided in Appendix Table 5.


  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (DSM-IV) (4th ed.). Washington: American Psychiatric Association.

    Google Scholar 

  • Beland, D., Rocco, P., & Waddan, A. (2014). Implementing health care reform in the United States: Intergovernmental politics and the dilemmas of institutional design. Health Policy, 116(1), 51–60.

    Article  PubMed  Google Scholar 

  • Beronio, K., Po, R., Skopec, L., Glied, S. (2013). Affordable Care Act will expand mental health and substance abuse disorder benefits and parity protections for 62 million Americans. ASPE Issue Brief. Accessed 3 Mar 2014.

  • Bouchery, E. E., Harwood, H. J., Dilonardo, J., & Vandivort-Warren, R. (2012). Type of health insurance and the substance abuse treatment gap. Journal of Substance Abuse Treatment, 42(3), 289–300.

    Article  PubMed  Google Scholar 

  • Buck, J. A. (2011). The looming expansion and transformation of public substance abuse treatment under the Affordable Care Act. Health Affairs, 30(8), 1402–1410.

    Article  PubMed  Google Scholar 

  • Busch, S. H., Meara, E., Huskamp, H. A., & Barry, C. L. (2013). Characteristics of adults with substance use disorder expectd to be eligible for Medicaid under the ACA. Psychiatric Services, 64(6), 520–526.

    Article  PubMed  PubMed Central  Google Scholar 

  • Congressional Budget Office (2010). Cost estimate for the amendment in the nature of a substitute for HR 4872, incorporating a proposed manager’s amendment made public on March 20, 2010. Accessed 14 Aug 2014.

  • Council of Economic Advisors (2014). Missed Opportunities: The consequences of state decision not to expand Medicaid. Accessed 19 Aug 2014.

  • Croft, B., & Parish, S. L. (2013). Care integration in the Patient Protection and Affordable Care Act: Implications for behavioral health. Administration and Policy in Mental Health and Mental Health Services Research, 40, 258–263.

    Article  PubMed  Google Scholar 

  • Frank, R. G., Beronio, K., & Giled, S. A. (2014). Behavioral health parity and the affordable care act. Journal of Social Work in Disability & Rehabilitation, 13(1–2), 31–43.

    Article  Google Scholar 

  • Garfield, R. L., Zuvekas, S. H., Lave, J. R., & Donohue, J. M. (2011). The impact of national health care reform on adults with severe mental disorders. American Journal of Psychiatry, 168(5), 486–494.

    Article  PubMed  Google Scholar 

  • Holahan, J., Buettgens, M., Carroll, C., Dorn, S. (2012). The cost and coverage implications of the ACA Medicaid expansion: National and state-by-state analysis. Kaiser Family Foundation Publication # 8384.

  • Kaiser Family Foundation. (2014). Status of State Action on the Medicaid Expansion Decision, as of September 30, 2013. Accessed 3 Mar 2014.

  • Krueger, A. B., & Kuziemko, I. (2013). The demand for health insurance among uninsured Americans: Results of a survey experiment and implications for policy. Journal of Health Economics, 32(5), 780–793.

    Article  PubMed  Google Scholar 

  • Mark, TL., Schildhaus, S., Cowell, AJ., Penne, MA., Smith, M., Levit, K. (2011). Mental Health and Substance Abuse Treatment Utilization under Expanded Medicaid: Projections for 2014. Rockville, MD: Substance Abuse and Mental Health Services Administration., October 2011 (unpublished document).

  • Miller, J. E. (2014). Dashed Hopes; Broken Promises; More Despair: How the lack of state participation in the Medicaid expansion will punish Americans with mental illness. Alexandria: American Mental Health Counselors Association.

    Google Scholar 

  • Mojtabai, R. (2005). Use of speciality substance abuse and mental health services in adults with substance use disorder in the community. Drug and Alcohol Dependence, 78, 345–354.

    Article  PubMed  CAS  Google Scholar 

  • Robst, J. (2012). Health policy analysis: Comparing methods for identifying future high-cost mental health cases in Medicaid. Value in Health, 15, 198–203.

    Article  PubMed  Google Scholar 

  • Sommers, B. D., Tomasi, M. R., Swartz, K., & Epstein, A. M. (2012). Reasons for the wide variation in Medicaid participation rates among states hold lessons for coverage expansion in 2014. Health Affairs, 31(5), 909–919.

    Article  PubMed  Google Scholar 

  • Substance Abuse and Mental Health Services Administration (2012). Behavioral Health, United States, 2012. HHS Publication No. (SMA) 13-4797. Rockville, MD.

  • Tsai, J., Rosenheck, R. A., Culhane, D. P., & Artiga, S. (2013). Medicaid expansion: Chronically homeless adults will need targeted enrollment and access to a broad range of services. Health Affairs, 32(9), 1552–1559.

    Article  PubMed  Google Scholar 

  • Zur, J., & Mojtabai, R. (2013). Medicaid expansion initiative in Massachusetts: Enrollment among substance-abusing homeless adults. American Journal of Public Health, 103(11), 2007–2013.

    Article  PubMed  PubMed Central  Google Scholar 

Download references


The views expressed here are those of the authors and do no necessarily represent the view of the Substance Abuse and Mental Health Services Administration.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Mir M. Ali.



See Tables 4 and 5.

Table 4 Estimated change in behavioral health services utilization under ACA with 57 % take-up rate, based on data for adults age 18–64 years in the 2008–2012 National Survey on Drug Use & Health, by Federal Poverty Level (numbers in thousands)
Table 5 Logistic regression result for behavioral health services utilization, based on data for adults age 18–64 years in the 2008–2012 National Survey on Drug Use & Health

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ali, M.M., Teich, J., Woodward, A. et al. The Implications of the Affordable Care Act for Behavioral Health Services Utilization. Adm Policy Ment Health 43, 11–22 (2016).

Download citation

  • Published:

  • Issue Date:

  • DOI:


  • Affordable Care Act
  • Behavioral health
  • Mental health
  • Substance abuse