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This study reviews Medicaid policies to restrict access to psychiatric medications. Policies on prior authorization, preferred drug lists, limitations on the number of prescriptions, fail-first requirements, and use of generics are reviewed. All states apply one or more of those policies to medications for mental illness, and many apply several. A large number of states have legislated exemptions from those policies for certain medications, particularly antipsychotics and antidepressants. Other psychiatric medications are less well protected. Some states appear to restrict access severely. Questions have been raised as to whether these policies actually save money in the long term.

Under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) mandate, states are required to screen Medicaid-insured children for mental health and substance use disorders. This national study found that states vary considerably in their policies. Nearly half the states (23 in total) have not addressed behavioral health issues in their EPSDT screening tools at all. More states have screening tools that address mental health than substance use disorders. Most states have created their own screening tools, which suggests discomfort with or a lack of awareness of the standard tools available. Screening policy options to increase behavioral health screening rates are discussed.

This article examines the status of a national mental health policy for children in need of mental health services. The need for systems planning and services integration involving multiple agencies is presented. The different programs of the major governmental agencies involved in the delivery of services to children are reviewed, as are the range of services provided. This article demonstrates the fragmentation and duplication that is endemic in all aspects of mental health, and that consequently makes policy implementation exceedingly difficult.

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