Access to Care Ranking 2020
The Access Ranking indicates how much access to mental health care exists within a state. The access measures include access to insurance, access to treatment, quality and cost of insurance, access to special education, and workforce availability. A high Access Ranking indicates that a state provides relatively more access to insurance and mental health treatment.
The 9 measures that make up the Access Ranking include:
- Adults with AMI who Did Not Receive Treatment
- Adults with AMI Reporting Unmet Need
- Adults with AMI who are Uninsured
- Adults with Disability who Could Not See a Doctor Due to Costs
- Youth with MDE who Did Not Receive Mental Health Services
- Youth with Severe MDE who Received Some Consistent Treatment
- Children with Private Insurance that Did Not Cover Mental or Emotional Problems
- Students Identified with Emotional Disturbance for an Individualized Education Program
- Mental Health Workforce Availability
| Rank Sort descending | State |
|---|---|
| 01 | Vermont |
| 02 | Massachusetts |
| 03 | Rhode Island |
| 04 | Iowa |
| 05 | Maine |
| 06 | Wisconsin |
| 07 | Minnesota |
| 08 | Connecticut |
| 09 | District of Columbia |
| 10 | New Hampshire |
| 11 | Ohio |
| 12 | Maryland |
| 13 | Pennsylvania |
| 14 | Delaware |
| 15 | Michigan |
| 16 | New York |
| 17 | Colorado |
| 18 | North Dakota |
| 19 | Hawaii |
| 20 | Illinois |
| 21 | New Mexico |
| 22 | Indiana |
| 23 | Alaska |
| 24 | Oregon |
| 25 | Washington |
| 26 | Missouri |
| 27 | California |
| 28 | Montana |
| 29 | West Virginia |
| 30 | South Dakota |
| 31 | Kentucky |
| 32 | Idaho |
| 33 | New Jersey |
| 34 | Nebraska |
| 35 | Arkansas |
| 36 | Arizona |
| 37 | Virginia |
| 38 | Utah |
| 39 | Oklahoma |
| 40 | Florida |
| 41 | Louisiana |
| 42 | Tennessee |
| 43 | Kansas |
| 44 | North Carolina |
| 45 | Wyoming |
| 46 | Alabama |
| 47 | South Carolina |
| 48 | Mississippi |
| 49 | Nevada |
| 50 | Georgia |
| 51 | Texas |
Adults with AMI who are Uninsured 2020
10.3% (over 4.7 million) of adults with a mental illness remain uninsured.
Under the Affordable Care Act (ACA), the U.S. continues to see a decline in Americans who are uninsured. There was a 1.9 percent reduction from last year’s dataset.
Thirty-nine states saw a reduction in Adults with AMI who are uninsured. The largest reductions were seen in Louisiana (5.3%), New York (4.7%), Iowa (4.6%) and Arkansas (4.2%).
Each of the bottom 17 states, with the exception of Louisiana, are states that have not expanded Medicaid. Louisiana, however, has had the largest reductions in the rate of uninsured adults with AMI since the state expanded Medicaid in 2016, from 20 percent of adults with AMI to 14.7%.
The rankings for this indicator used data from the 2016-2017 NSDUH. Some states, such as Arkansas, that had a reduction in uninsured adults with AMI passed Medicaid work requirements in 2018, which may lead to a large change in coverage in future reports.
The state prevalence of uninsured adults with mental illness ranges from 2.4% in Massachusetts to 22.9% in Wyoming.
| Rank Sort descending | State | Percentage | Number | Year |
|---|---|---|---|---|
| 01 | District of Columbia | 2.5 | 3000 | 2021 |
| 02 | Vermont | 3.9 | 4000 | 2021 |
| 03 | Massachusetts | 4.2 | 51000 | 2021 |
| 04 | Connecticut | 4.6 | 25000 | 2021 |
| 05 | Kentucky | 4.8 | 37000 | 2021 |
| 06 | New York | 5.1 | 139000 | 2021 |
| 07 | Rhode Island | 5.8 | 11000 | 2021 |
| 08 | Pennsylvania | 6 | 108000 | 2021 |
| 09 | Michigan | 6.4 | 93000 | 2021 |
| 10 | New Mexico | 6.4 | 19000 | 2021 |
| 11 | Hawaii | 6.4 | 12000 | 2021 |
| 12 | Delaware | 6.8 | 10000 | 2021 |
| 13 | Maryland | 7 | 55000 | 2021 |
| 14 | Ohio | 7.1 | 138000 | 2021 |
| 15 | Minnesota | 7.3 | 58000 | 2021 |
| 16 | Wisconsin | 7.4 | 62000 | 2021 |
| 17 | New Hampshire | 7.5 | 17000 | 2021 |
| 18 | California | 7.8 | 434000 | 2021 |
| 19 | South Dakota | 8.2 | 9000 | 2021 |
| 20 | West Virginia | 8.3 | 31000 | 2021 |
| 21 | Iowa | 8.4 | 39000 | 2021 |
| 22 | New Jersey | 8.8 | 94000 | 2021 |
| 23 | North Dakota | 8.8 | 9000 | 2021 |
| 24 | Illinois | 8.9 | 151000 | 2021 |
| 25 | Colorado | 9 | 84000 | 2021 |
| 26 | Oregon | 9 | 67000 | 2021 |
| 27 | Arizona | 9.6 | 97000 | 2021 |
| 28 | Louisiana | 9.7 | 72000 | 2021 |
| 29 | Nebraska | 10.3 | 25000 | 2021 |
| 30 | Montana | 10.3 | 17000 | 2021 |
| 31 | Nevada | 10.5 | 51000 | 2021 |
| 32 | Washington | 10.6 | 140000 | 2021 |
| 33 | Arkansas | 10.9 | 51000 | 2021 |
| 34 | Indiana | 11.4 | 134000 | 2021 |
| 35 | Alaska | 11.6 | 12000 | 2021 |
| 36 | Utah | 11.7 | 67000 | 2021 |
| 37 | Kansas | 12.4 | 52000 | 2021 |
| 38 | South Carolina | 12.5 | 85000 | 2021 |
| 39 | Maine | 12.7 | 29000 | 2021 |
| 40 | Virginia | 13.5 | 147000 | 2021 |
| 41 | Idaho | 13.7 | 46000 | 2021 |
| 42 | North Carolina | 13.8 | 204000 | 2021 |
| 43 | Oklahoma | 15.9 | 92000 | 2021 |
| 44 | Missouri | 16.2 | 169000 | 2021 |
| 45 | Florida | 17.4 | 503000 | 2021 |
| 46 | Georgia | 18.5 | 255000 | 2021 |
| 47 | Alabama | 18.8 | 154000 | 2021 |
| 48 | Tennessee | 19 | 171000 | 2021 |
| 49 | Texas | 20.1 | 664000 | 2021 |
| 50 | Mississippi | 22.2 | 95000 | 2021 |
| 51 | Wyoming | 23 | 21000 | 2021 |
| 52 | National | 10.8 | 511,400 | 2021 |
Adults with AMI who Did Not Receive Treatment 2020
- 57.2% of adults with a mental illness received no treatment.
- Over 26 million individuals experiencing a mental health illness are going untreated.
- The state prevalence of untreated adults with mental illness ranges from 40.7% in Vermont to 64.8% in California.
| Rank Sort descending | State | Percentage | Number | Year |
|---|---|---|---|---|
| 01 | Vermont | 42.8 | 45000 | 2021 |
| 02 | Arkansas | 47.5 | 221000 | 2021 |
| 03 | Rhode Island | 49 | 89000 | 2021 |
| 04 | Wisconsin | 49.2 | 412000 | 2021 |
| 05 | Massachusetts | 49.5 | 597000 | 2021 |
| 06 | Delaware | 49.7 | 75000 | 2021 |
| 07 | Iowa | 49.8 | 231000 | 2021 |
| 08 | Maine | 49.9 | 114000 | 2021 |
| 09 | Ohio | 50.7 | 978000 | 2021 |
| 10 | Kentucky | 50.9 | 392000 | 2021 |
| 11 | Colorado | 50.9 | 475000 | 2021 |
| 12 | Kansas | 51.1 | 213000 | 2021 |
| 13 | Utah | 51.2 | 294000 | 2021 |
| 14 | South Carolina | 51.4 | 349000 | 2021 |
| 15 | Tennessee | 51.7 | 463000 | 2021 |
| 16 | New Hampshire | 51.9 | 116000 | 2021 |
| 17 | West Virginia | 52.2 | 193000 | 2021 |
| 18 | District of Columbia | 52.2 | 68000 | 2021 |
| 19 | Minnesota | 52.6 | 416000 | 2021 |
| 20 | Arizona | 52.7 | 535000 | 2021 |
| 21 | Pennsylvania | 53 | 953000 | 2021 |
| 22 | Nebraska | 53 | 128000 | 2021 |
| 23 | Washington | 53.5 | 704000 | 2021 |
| 24 | Idaho | 53.5 | 177000 | 2021 |
| 25 | Michigan | 53.8 | 779000 | 2021 |
| 26 | Connecticut | 53.9 | 287000 | 2021 |
| 27 | Montana | 54.2 | 89000 | 2021 |
| 28 | Virginia | 54.5 | 589000 | 2021 |
| 29 | North Dakota | 54.5 | 56000 | 2021 |
| 30 | South Dakota | 54.8 | 57000 | 2021 |
| 31 | Missouri | 55.3 | 576000 | 2021 |
| 32 | Illinois | 55.8 | 946000 | 2021 |
| 33 | Indiana | 55.9 | 653000 | 2021 |
| 34 | North Carolina | 56.5 | 833000 | 2021 |
| 35 | New Mexico | 56.6 | 167000 | 2021 |
| 36 | Alabama | 56.7 | 463000 | 2021 |
| 37 | Mississippi | 57.7 | 247000 | 2021 |
| 38 | Oklahoma | 58.9 | 340000 | 2021 |
| 39 | Maryland | 59.1 | 459000 | 2021 |
| 40 | Oregon | 59.3 | 442000 | 2021 |
| 41 | Texas | 59.6 | 1960000 | 2021 |
| 42 | New Jersey | 60 | 644000 | 2021 |
| 43 | New York | 60.3 | 1655000 | 2021 |
| 44 | Nevada | 60.3 | 282000 | 2021 |
| 45 | Louisiana | 62 | 459000 | 2021 |
| 46 | Florida | 63 | 1816000 | 2021 |
| 47 | Wyoming | 64.8 | 60000 | 2021 |
| 48 | Georgia | 64.9 | 888000 | 2021 |
| 49 | California | 65 | 3620000 | 2021 |
| 50 | Alaska | 65.5 | 70000 | 2021 |
| 51 | Hawaii | 65.8 | 124000 | 2021 |
| 52 | National | 57 | 267,970 | 2021 |
Adults with AMI Reporting Unmet Need 2020
Almost a quarter (22.3%) of all adults with a mental illness reported that they were not able to receive the treatment they needed. This number has not declined since 2011.
Individuals seeking treatment but still not receiving needed services face the same barriers that contribute to the number of individuals not receiving treatment:
- No insurance or limited coverage of services
- Shortfall in psychiatrists, and an overall undersized mental health workforce.
- Lack of available treatment types (inpatient treatment, individual therapy, intensive community services).
- Disconnect between primary care systems and behavioral health systems.
- Insufficient finances to cover costs – including, copays, uncovered treatment types, or when providers do not take insurance.
The state prevalence of adults with AMI reporting unmet treatment needs ranges from 14.3% in Alabama to 31.2% in Utah.
| Rank Sort descending | State | Percentage | Number | Year |
|---|---|---|---|---|
| 01 | Alabama | 14.3 | 106,000 | |
| 02 | Hawaii | 14.7 | 25,000 | |
| 03 | Iowa | 18.2 | 82,000 | |
| 04 | Texas | 19.2 | 620,000 | |
| 05 | Wyoming | 19.2 | 17,000 | |
| 06 | Minnesota | 19.4 | 141,000 | |
| 07 | Maine | 19.7 | 39,000 | |
| 08 | New York | 20.1 | 536,000 | |
| 09 | Louisiana | 20.2 | 133,000 | |
| 10 | Ohio | 20.4 | 363,000 | |
| 11 | West Virginia | 20.4 | 70,000 | |
| 12 | Vermont | 20.7 | 21,000 | |
| 13 | North Dakota | 21.2 | 21,000 | |
| 14 | Arizona | 21.3 | 189,000 | |
| 15 | Idaho | 21.7 | 72,000 | |
| 16 | South Dakota | 21.7 | 24,000 | |
| 17 | Delaware | 21.8 | 29,000 | |
| 18 | Illinois | 21.8 | 331,000 | |
| 19 | North Carolina | 21.8 | 302,000 | |
| 20 | California | 21.9 | 1,196,000 | |
| 21 | Mississippi | 21.9 | 92,000 | |
| 22 | Alaska | 22 | 23,000 | |
| 23 | Florida | 22 | 632,000 | |
| 24 | Michigan | 22 | 307,000 | |
| 25 | Tennessee | 22 | 208,000 | |
| 26 | Wisconsin | 22 | 178,000 | |
| 27 | Colorado | 22.2 | 186,000 | |
| 28 | Massachusetts | 22.3 | 262,000 | |
| 29 | Oklahoma | 22.4 | 129,000 | |
| 30 | Georgia | 22.5 | 309,000 | |
| 31 | Maryland | 22.6 | 180,000 | |
| 32 | Nebraska | 22.6 | 54,000 | |
| 33 | Connecticut | 22.9 | 113,000 | |
| 34 | Kentucky | 22.9 | 178,000 | |
| 35 | New Jersey | 22.9 | 254,000 | |
| 36 | Montana | 23.3 | 36,000 | |
| 37 | New Mexico | 23.8 | 65,000 | |
| 38 | Rhode Island | 24.3 | 39,000 | |
| 39 | District of Columbia | 24.5 | 30,000 | |
| 40 | Washington | 24.5 | 327,000 | |
| 41 | Pennsylvania | 24.7 | 435,000 | |
| 42 | South Carolina | 24.8 | 173,000 | |
| 43 | Arkansas | 25 | 119,000 | |
| 44 | Missouri | 25 | 238,000 | |
| 45 | Indiana | 25.2 | 272,000 | |
| 46 | Kansas | 25.9 | 109,000 | |
| 47 | Virginia | 28.3 | 337,000 | |
| 48 | Oregon | 28.5 | 224,000 | |
| 49 | Nevada | 28.6 | 121,000 | |
| 50 | New Hampshire | 28.8 | 57,000 | |
| 51 | Utah | 31.2 | 163,000 |
Adults with Disability Who Could Not See a Doctor Due to Costs 2020
29.4% of adults with a cognitive disability were not able to see a doctor due to costs.
According to the Centers for Disease Control (CDC), 11.4% of people in the United States had a cognitive disability, even when adjusted for age. 1 The percentage of people with cognitive disability ranged from 7.8 percent in some states to 19.1 percent.
A 2017 study found that compared to working-age adults without disabilities, those with disabilities are more likely to live below the federal poverty level and to use public insurance. Their average health costs were also 3-7 times higher than those without disabilities, and they were more likely to face access problems to care, including cost.
The prevalence of adults with disability who couldn’t see a MD due to cost ranges from 16.87% in Iowa to 41.03% in Texas.
| Rank Sort descending | State | Percentage | Number | Year |
|---|---|---|---|---|
| 01 | Iowa | 16.87 | 37,908 | |
| 02 | Vermont | 18.63 | 9,188 | |
| 03 | Massachusetts | 20.44 | 110,799 | |
| 04 | Alaska | 20.69 | 9,859 | |
| 05 | Rhode Island | 20.7 | 20,592 | |
| 06 | Hawaii | 20.86 | 19,358 | |
| 07 | Ohio | 22.23 | 239,773 | |
| 08 | New York | 22.35 | 315,572 | |
| 09 | California | 22.47 | 647,176 | |
| 10 | Pennsylvania | 22.97 | 254,064 | |
| 11 | Connecticut | 23.06 | 51,647 | |
| 12 | New Hampshire | 23.99 | 23,315 | |
| 13 | Minnesota | 24.81 | 98,572 | |
| 14 | Montana | 25.1 | 22,931 | |
| 15 | Delaware | 25.4 | 24,687 | |
| 16 | Maryland | 25.74 | 100,730 | |
| 17 | District of Columbia | 25.88 | 14,059 | |
| 18 | Nebraska | 26.66 | 33,510 | |
| 19 | Kentucky | 26.77 | 145,055 | |
| 20 | Wisconsin | 26.98 | 112,237 | |
| 21 | Washington | 27.19 | 158,208 | |
| 22 | Michigan | 27.29 | 280,450 | |
| 23 | West Virginia | 27.54 | 74,517 | |
| 24 | North Dakota | 27.67 | 12,131 | |
| 25 | Colorado | 27.72 | 102,075 | |
| 26 | Oregon | 28.37 | 103,596 | |
| 27 | Idaho | 28.49 | 33,213 | |
| 28 | Indiana | 28.78 | 167,315 | |
| 29 | Illinois | 29.06 | 237,367 | |
| 30 | Maine | 29.34 | 32,555 | |
| 31 | Arizona | 29.84 | 170,006 | |
| 32 | Kansas | 29.99 | 65,857 | |
| 33 | South Dakota | 30.13 | 18,219 | |
| 34 | Nevada | 30.76 | 77,939 | |
| 35 | South Carolina | 30.79 | 147,202 | |
| 36 | Utah | 31.19 | 70,771 | |
| 37 | Arkansas | 31.42 | 107,117 | |
| 38 | New Mexico | 31.51 | 61,938 | |
| 39 | Missouri | 32.21 | 195,362 | |
| 40 | Tennessee | 33.23 | 239,969 | |
| 41 | Alabama | 33.24 | 191,499 | |
| 42 | North Carolina | 33.36 | 290,888 | |
| 43 | Florida | 33.37 | 684,912 | |
| 44 | Mississippi | 33.97 | 113,045 | |
| 45 | Wyoming | 34.35 | 15,974 | |
| 46 | Oklahoma | 34.43 | 150,379 | |
| 47 | Virginia | 34.48 | 213,282 | |
| 48 | New Jersey | 35.07 | 245,583 | |
| 49 | Georgia | 36.06 | 322,610 | |
| 50 | Louisiana | 38.23 | 201,908 | |
| 51 | Texas | 41.03 | 983,751 |
Youth with MDE who Did Not Receive Mental Health Services 2020
- 59% of youth with major depression do not receive any mental health treatment.
- Youth experiencing MDE continue to go untreated. Even among the states with greatest access for youth, almost 50% of youth are still not receiving the mental health services they need.
- The state prevalence of untreated youth with depression ranges from 39.5% in Rhode Island to 74.3% in North Carolina.
| Rank Sort descending | State | Percentage | Number | Year |
|---|---|---|---|---|
| 01 | Rhode Island | 39.5 | 4,000 | |
| 02 | Connecticut | 43.9 | 16,000 | |
| 03 | Wisconsin | 44.3 | 27,000 | |
| 04 | Maine | 45.3 | 7,000 | |
| 05 | North Dakota | 46.7 | 2,000 | |
| 06 | Minnesota | 47.5 | 27,000 | |
| 07 | Ohio | 48.6 | 63,000 | |
| 08 | District of Columbia | 48.7 | 1,000 | |
| 09 | Virginia | 51.3 | 44,000 | |
| 10 | Maryland | 52.5 | 33,000 | |
| 11 | Louisiana | 52.7 | 18,000 | |
| 12 | Utah | 53.8 | 24,000 | |
| 13 | Pennsylvania | 53.9 | 59,000 | |
| 14 | West Virginia | 54.2 | 10,000 | |
| 15 | Massachusetts | 54.5 | 38,000 | |
| 16 | New Hampshire | 54.7 | 7,000 | |
| 17 | Indiana | 54.8 | 40,000 | |
| 18 | New York | 55.1 | 83,000 | |
| 19 | Vermont | 55.3 | 3,000 | |
| 20 | Colorado | 55.6 | 30,000 | |
| 21 | Oregon | 55.6 | 27,000 | |
| 22 | Idaho | 55.7 | 13,000 | |
| 23 | South Dakota | 55.7 | 4,000 | |
| 24 | Illinois | 56.1 | 80,000 | |
| 25 | Tennessee | 57 | 37,000 | |
| 26 | Florida | 57.2 | 106,000 | |
| 27 | Delaware | 57.3 | 4,000 | |
| 28 | New Jersey | 57.8 | 40,000 | |
| 29 | Hawaii | 57.9 | 6,000 | |
| 30 | Missouri | 59 | 45,000 | |
| 31 | Washington | 59.1 | 40,000 | |
| 32 | Iowa | 59.8 | 20,000 | |
| 33 | Michigan | 59.8 | 64,000 | |
| 34 | Arizona | 60.2 | 38,000 | |
| 35 | Arkansas | 61.3 | 19,000 | |
| 36 | Nevada | 61.4 | 22,000 | |
| 37 | New Mexico | 61.4 | 16,000 | |
| 38 | Kentucky | 62 | 19,000 | |
| 39 | Wyoming | 62.5 | 4,000 | |
| 40 | Montana | 63.2 | 6,000 | |
| 41 | Mississippi | 63.7 | 16,000 | |
| 42 | California | 63.9 | 245,000 | |
| 43 | Texas | 65.4 | 180,000 | |
| 44 | Alaska | 65.6 | 5,000 | |
| 45 | Oklahoma | 65.8 | 28,000 | |
| 46 | Alabama | 67.5 | 26,000 | |
| 47 | Kansas | 70.8 | 22,000 | |
| 48 | Georgia | 70.9 | 67,000 | |
| 49 | Nebraska | 71.3 | 14,000 | |
| 50 | South Carolina | 73.7 | 33,000 | |
| 51 | North Carolina | 74.3 | 68,000 |
Youth with Severe MDE who Received Some Consistent Treatment 2020
- Nationally, only 28.2% of youth with severe depression receive some consistent treatment (7-25+ visits in a year).
- Late recognition in primary care settings and limited coverage of mental health services often prevent youth from receiving timely and effective treatment.
- The state prevalence of youth with severe depression who received some outpatient treatment ranges from 53.9% in Maryland to 13.5% in South Carolina.
| Rank Sort descending | State | Percentage | Number | Year |
|---|---|---|---|---|
| 01 | Maine | 50 | 5000 | 2021 |
| 02 | Maryland | 49.2 | 21000 | 2021 |
| 03 | Vermont | 45.4 | 2000 | 2021 |
| 04 | Delaware | 41.5 | 2000 | 2021 |
| 05 | Rhode Island | 41.2 | 3000 | 2021 |
| 06 | Wisconsin | 40.4 | 23000 | 2021 |
| 07 | Oregon | 37.9 | 14000 | 2021 |
| 08 | Massachusetts | 37.7 | 15000 | 2021 |
| 09 | District of Columbia | 37.3 | 1000 | 2021 |
| 10 | Pennsylvania | 37.1 | 23000 | 2021 |
| 11 | Wyoming | 36.3 | 2000 | 2021 |
| 12 | Ohio | 36 | 28000 | 2021 |
| 13 | Nebraska | 35.9 | 5000 | 2021 |
| 14 | Idaho | 35.8 | 6000 | 2021 |
| 15 | New Hampshire | 34.9 | 3000 | 2021 |
| 16 | Kentucky | 34.2 | 10000 | 2021 |
| 17 | Minnesota | 33.7 | 13000 | 2021 |
| 18 | North Dakota | 33 | 1000 | 2021 |
| 19 | New Jersey | 32.5 | 16000 | 2021 |
| 20 | Louisiana | 32 | 9000 | 2021 |
| 21 | Kansas | 31.1 | 7000 | 2021 |
| 22 | Arkansas | 30 | 7000 | 2021 |
| 23 | Alaska | 29.9 | 2000 | 2021 |
| 24 | Michigan | 29.8 | 24000 | 2021 |
| 25 | Montana | 29.3 | 2000 | 2021 |
| 26 | South Dakota | 29.2 | 1000 | 2021 |
| 27 | Iowa | 28.8 | 7000 | 2021 |
| 28 | South Carolina | 28.3 | 9000 | 2021 |
| 29 | Hawaii | 28.3 | 2000 | 2021 |
| 30 | West Virginia | 27.8 | 4000 | 2021 |
| 31 | Tennessee | 27.3 | 12000 | 2021 |
| 32 | Washington | 26.7 | 13000 | 2021 |
| 33 | Indiana | 26.1 | 16000 | 2021 |
| 34 | Virginia | 26.1 | 16000 | 2021 |
| 35 | Alabama | 25.9 | 6000 | 2021 |
| 36 | Texas | 25 | 54000 | 2021 |
| 37 | Illinois | 25 | 26000 | 2021 |
| 38 | Arizona | 24.7 | 15000 | 2021 |
| 39 | California | 24.6 | 59000 | 2021 |
| 40 | Utah | 24.5 | 8000 | 2021 |
| 41 | Oklahoma | 23.5 | 8000 | 2021 |
| 42 | New Mexico | 22.6 | 5000 | 2021 |
| 43 | New York | 21.9 | 22000 | 2021 |
| 44 | North Carolina | 21.9 | 21000 | 2021 |
| 45 | Connecticut | 21.6 | 5000 | 2021 |
| 46 | Colorado | 21.5 | 8000 | 2021 |
| 47 | Florida | 19.7 | 24000 | 2021 |
| 48 | Georgia | 19.2 | 15000 | 2021 |
| 49 | Missouri | 19 | 9000 | 2021 |
| 50 | Mississippi | 14.9 | 2000 | 2021 |
| 51 | Nevada | 11.2 | 3000 | 2021 |
| 52 | National | 27.3 | 614000 | 2021 |
Children with Private Insurance that Did Not Cover Mental or Emotional Problems 2020
The Mental Health Parity and Addiction Equity law (MHPAE) was enacted a decade ago and promised the equal coverage of mental health and substance use services. However, the rate of children with private insurance that does not cover mental or emotional problems continues to increase, and private insurance companies continue to place subtle restrictions on coverage for mental health treatments.
Earlier this year, a federal judge ruled that United Behavioral Health, the nation’s largest behavioral health insurer, had violated parity by using overly restrictive guidelines for coverage of mental health and substance use services. In his decision, Judge Spero wrote, “one of the most troubling aspects of UBH’s guidelines is their failure to address in any meaningful way the different standards that apply to children and adolescents with respect to the treatment of mental health and substance use disorders.” To improve the worsening mental health of children and adolescents in the U.S., insurance companies must achieve parity in coverage.
The state prevalence of children lacking mental health coverage ranges from 2.0% in New Hampshire to 18.1% in Mississippi.
| Rank Sort descending | State | Percentage | Number | Year |
|---|---|---|---|---|
| 01 | Vermont | 0.6 | 0 | 2021 |
| 02 | Massachusetts | 1.2 | 4000 | 2021 |
| 03 | New Hampshire | 2.5 | 1000 | 2021 |
| 04 | Connecticut | 3.3 | 5000 | 2021 |
| 05 | Maine | 3.4 | 2000 | 2021 |
| 06 | New Jersey | 4 | 14000 | 2021 |
| 07 | District of Columbia | 4.6 | 1000 | 2021 |
| 08 | Washington | 5.2 | 16000 | 2021 |
| 09 | Rhode Island | 5.3 | 2000 | 2021 |
| 10 | Montana | 5.4 | 2000 | 2021 |
| 11 | South Dakota | 5.4 | 2000 | 2021 |
| 12 | Michigan | 5.5 | 23000 | 2021 |
| 13 | Wisconsin | 5.5 | 16000 | 2021 |
| 14 | Ohio | 5.9 | 26000 | 2021 |
| 15 | Missouri | 5.9 | 14000 | 2021 |
| 16 | Alabama | 5.9 | 7000 | 2021 |
| 17 | Pennsylvania | 6.1 | 29000 | 2021 |
| 18 | Georgia | 6.5 | 23000 | 2021 |
| 19 | Virginia | 6.6 | 21000 | 2021 |
| 20 | Oregon | 6.7 | 10000 | 2021 |
| 21 | Delaware | 6.9 | 3000 | 2021 |
| 22 | Indiana | 7.1 | 22000 | 2021 |
| 23 | Illinois | 7.2 | 34000 | 2021 |
| 24 | Maryland | 7.2 | 18000 | 2021 |
| 25 | West Virginia | 7.2 | 4000 | 2021 |
| 26 | California | 7.5 | 100000 | 2021 |
| 27 | Minnesota | 7.5 | 20000 | 2021 |
| 28 | Mississippi | 7.5 | 6000 | 2021 |
| 29 | Iowa | 7.5 | 10000 | 2021 |
| 30 | Louisiana | 7.6 | 10000 | 2021 |
| 31 | New Mexico | 7.8 | 4000 | 2021 |
| 32 | Utah | 7.8 | 16000 | 2021 |
| 33 | Oklahoma | 7.9 | 11000 | 2021 |
| 34 | Kansas | 7.9 | 9000 | 2021 |
| 35 | New York | 8.3 | 49000 | 2021 |
| 36 | Colorado | 8.3 | 17000 | 2021 |
| 37 | Hawaii | 9.2 | 3000 | 2021 |
| 38 | Florida | 9.4 | 52000 | 2021 |
| 39 | North Carolina | 10 | 33000 | 2021 |
| 40 | Alaska | 10.3 | 2000 | 2021 |
| 41 | Kentucky | 11 | 17000 | 2021 |
| 42 | Texas | 11.5 | 108000 | 2021 |
| 43 | Wyoming | 12 | 3000 | 2021 |
| 44 | Arizona | 12.1 | 32000 | 2021 |
| 45 | Nevada | 12.6 | 13000 | 2021 |
| 46 | Nebraska | 12.6 | 10000 | 2021 |
| 47 | Idaho | 12.7 | 10000 | 2021 |
| 48 | North Dakota | 13.5 | 5000 | 2021 |
| 49 | Tennessee | 13.5 | 27000 | 2021 |
| 50 | Arkansas | 14.4 | 13000 | 2021 |
| 51 | South Carolina | 14.8 | 23000 | 2021 |
| 52 | National | 7.8 | 901000 | 2021 |
Students Identified with Emotional Disturbance for an Individualized Education Program 2020
Only .73%* of students are identified as having an ED for IEP.
For purposes of an IEP, the term “Emotional Disturbance” is used to define youth with a mental illness that is affecting their ability to succeed in school.
Early identification for IEPs is critical. IEPs provide the services, accommodations and support students with ED need to receive a quality education. Inadequate education leads to poor outcomes such as low academic achievement, social isolation, unemployment, and involvement in the juvenile system. Further, the federal eligibility criteria to identify students as having an emotional disturbance for an IEP have indicated extremely poor reliability among school psychologists, and therefore must be revised to adequately identify students in need of more supports.
*The rate for this measure is shown as a rate per 1,000 students. The calculation was made this way for ease of reading. Unfortunately, doing so hides the fact that the percentages are significantly lower. If states were doing a better job of identifying whether youth had emotional difficulties that could be better supported through an IEP – the rates would be closer to 7 percent instead of .7 percent.
The state rate of students identified as having an Emotional Disturbance (ED) for an IEP ranges from 27.72% per 1,000 students in Vermont to 2.02% per 1,000 students in Alabama.
High percentages are associated with positive outcomes and low percentages are associated with poorer outcomes
| Rank Sort descending | State | Percentage | Number | Year |
|---|---|---|---|---|
| 01 | Vermont | 27.72 | 2071 | |
| 02 | Minnesota | 19.76 | 15666 | |
| 03 | Massachusetts | 18.81 | 16338 | |
| 04 | Wisconsin | 16.18 | 12217 | |
| 05 | Pennsylvania | 15.50 | 24746 | |
| 06 | Maine | 13.73 | 2243 | |
| 07 | Indiana | 13.42 | 12798 | |
| 08 | Iowa | 12.98 | 5741 | |
| 09 | District of Columbia | 12.78 | 840 | |
| 10 | Rhode Island | 12.49 | 1618 | |
| 11 | New Hampshire | 12.32 | 2039 | |
| 12 | Connecticut | 11.51 | 5526 | |
| 13 | North Dakota | 10.86 | 1066 | |
| 14 | Illinois | 10.17 | 18373 | |
| 15 | Ohio | 9.80 | 15208 | |
| 16 | South Dakota | 9.76 | 1184 | |
| 17 | Oregon | 9.54 | 5122 | |
| 18 | Nebraska | 9.50 | 2664 | |
| 19 | New York | 9.49 | 23429 | |
| 20 | Virginia | 8.39 | 9752 | |
| 21 | Delaware | 8.32 | 1037 | |
| 22 | Michigan | 8.26 | 11273 | |
| 23 | Missouri | 8.25 | 6738 | |
| 24 | Mississippi | 7.90 | 3487 | |
| 25 | Maryland | 7.69 | 6085 | |
| 26 | Kentucky | 7.35 | 4468 | |
| 27 | Arizona | 7.31 | 7551 | |
| 28 | Colorado | 6.90 | 5578 | |
| 29 | Oklahoma | 6.78 | 4073 | |
| 30 | Georgia | 6.70 | 10653 | |
| 31 | Wyoming | 6.63 | 570 | |
| 32 | Montana | 6.35 | 848 | |
| 33 | New Mexico | 6.20 | 1889 | |
| 34 | New Jersey | 6.12 | 7690 | |
| 35 | Texas | 6.09 | 28884 | |
| 36 | Alaska | 5.93 | 707 | |
| 37 | Hawaii | 5.92 | 979 | |
| 38 | Florida | 5.84 | 14933 | |
| 39 | Kansas | 5.48 | 2409 | |
| 40 | Washington | 5.11 | 5142 | |
| 41 | Idaho | 4.95 | 1354 | |
| 42 | West Virginia | 4.94 | 1180 | |
| 43 | Nevada | 4.45 | 1931 | |
| 44 | California | 4.36 | 24818 | |
| 45 | North Carolina | 3.81 | 5394 | |
| 46 | Tennessee | 3.72 | 3342 | |
| 47 | South Carolina | 3.20 | 2208 | |
| 48 | Utah | 3.17 | 1889 | |
| 49 | Louisiana | 2.79 | 1773 | |
| 50 | Arkansas | 2.24 | 988 | |
| 51 | Alabama | 2.02 | 1365 |
Mental Health Workforce Availability 2020
Mental Health Workforce Availability
The term “mental health provider” includes psychiatrists, psychologists, licensed clinical social workers, counselors, marriage and family therapists, and advanced practice nurses specializing in mental health care.
The rate of mental health providers has improved in nearly every state since last year’s report. However, projections from the Health Resources and Services Administration (HRSA) still indicate an immense shortage of mental health and substance use treatment providers to meet the demand in 2030. Mental health provider shortages result in little access to care, high burnout rates among providers, and long waits for necessary treatment.
Additionally, there is a maldistribution of behavioral health providers throughout the county, as illustrated by the map above. In 2016, more than half the counties throughout the U.S. had 0 psychiatrists. While integrating primary care and behavioral health care is a necessary first step in reducing the impact of the shortage, primary care providers cannot solely fill the void created by a lack of psychiatrists. Further efforts must be made to improve access to necessary mental health care throughout the country, such as expanding the use of telepsychiatry and employing peer support specialists and other paraprofessionals as providers of care.
The state rate of mental health workforce ranges from 180:1 in Massachusetts to 1,100:1 in Alabama.
| Rank Sort descending | State | Number |
|---|---|---|
| 01 | Massachusetts | 180 |
| 02 | Oregon | 210 |
| 03 | District of Columbia | 220 |
| 04 | Maine | 220 |
| 05 | Vermont | 230 |
| 06 | Alaska | 260 |
| 07 | New Mexico | 260 |
| 08 | Oklahoma | 260 |
| 09 | Rhode Island | 260 |
| 10 | Connecticut | 270 |
| 11 | Colorado | 300 |
| 12 | California | 310 |
| 13 | Washington | 310 |
| 14 | Wyoming | 310 |
| 15 | Utah | 330 |
| 16 | Louisiana | 340 |
| 17 | New Hampshire | 350 |
| 18 | Montana | 360 |
| 19 | New York | 370 |
| 20 | Michigan | 400 |
| 21 | Nebraska | 400 |
| 22 | Delaware | 410 |
| 23 | Hawaii | 430 |
| 24 | Maryland | 430 |
| 25 | Minnesota | 430 |
| 26 | North Carolina | 440 |
| 27 | Arkansas | 460 |
| 28 | Ohio | 470 |
| 29 | Illinois | 480 |
| 30 | Kentucky | 490 |
| 31 | New Jersey | 500 |
| 32 | Idaho | 510 |
| 33 | Nevada | 510 |
| 34 | Kansas | 530 |
| 35 | Pennsylvania | 530 |
| 36 | Wisconsin | 530 |
| 37 | Missouri | 550 |
| 38 | North Dakota | 570 |
| 39 | South Dakota | 590 |
| 40 | South Carolina | 610 |
| 41 | Virginia | 630 |
| 42 | Florida | 670 |
| 43 | Indiana | 670 |
| 44 | Iowa | 700 |
| 45 | Mississippi | 700 |
| 46 | Tennessee | 700 |
| 47 | Arizona | 790 |
| 48 | Georgia | 790 |
| 49 | West Virginia | 830 |
| 50 | Texas | 960 |
| 51 | Alabama | 1100 |