We are living through a period of extraordinary medical and scientific innovation. Yet for some serious mental health conditions, many of today’s treatments are not fundamentally different from those available in the 1970s. Too many people continue to struggle given limited options and effectiveness of care.

Recently, I joined leaders from across the research, clinical practice, policy, and philanthropy sectors at the Clinton Global Initiative headquarters for a discussion of one area of growing interest: psychedelic-assisted therapy (PAT). PAT refers to both the psychedelic medicines and the therapeutic supports that accompany their delivery, and is currently most associated with the treatment of major depressive disorder and post-traumatic stress disorder. The conversation centered on an important question for Medicaid leaders: How can we ensure that Medicaid enrollees have access to emerging evidence-based behavioral health treatments?

The discussion was timely, as the U.S. Food and Drug Administration (FDA) is currently reviewing three psychedelic medications for possible approval, and state Medicaid programs will likely have to determine their coverage policies in the not-too-distant future. Amid the conversation, I had the opportunity to share early findings from a new report, developed by the Center for Health Care Strategies (CHCS) for the Psychedelic Mental Health Access Alliance, that explores an array of considerations for Medicaid coverage and access.

I’ll be honest: when I first started learning about PAT, I was skeptical. Like many people, I associated psychedelics with something on the fringe, outside the norms of traditional health policy circles. But as I began to understand the evidence behind these treatments, I reconsidered my bias. After hearing from researchers, providers, and people who have experienced the benefits of PAT, I came away convinced that this is an area Medicaid leaders should be paying attention to.

Here are five reasons why.

1. The need for innovation is long overdue. The evidence of a national behavioral health crisis is everywhere, with few families left untouched and most communities yearning for more resources. And yet, compared to other areas of medicine, behavioral health has not seen the same level of research, funding, or therapeutic innovation. There have been few behavioral health breakthroughs comparable to the medical impact of, for example, GLP-1s, or cell and gene therapies. Accordingly, when promising new behavioral health treatments emerge, we should be inclined to lean in rather than shy away.
2. The evidence is difficult to ignore. Research on PAT for conditions such as post-traumatic stress disorder and treatment-resistant depression has produced results significant enough to attract interest from researchers, providers, veterans’ advocates, and policymakers across the political spectrum. Clinical trials, including randomized controlled trials, have shown reductions in symptoms and improved treatment response, and may offer more rapid improvement than existing treatments. While the evidence to date is specific to individual medications and targeted conditions, it collectively points to a compelling therapeutic approach that warrants serious attention. That said, it is also clear that we need more targeted research on the effectiveness of PAT among safety-net populations, who often have more complex needs than those included in clinical trials. If future evidence continues to demonstrate safe, effective, and scalable delivery, PAT could become an important addition to the behavioral health treatment toolkit.
3. The people who may benefit most often face the greatest barriers to access. Medicaid is the largest payer for behavioral health services and includes many of the highest acuity cases. Still, only about half of the Medicaid population has access to the routine behavioral health care they need. Meanwhile, access to emerging treatments like PAT — to the extent FDA approval occurs — is often out of reach for Medicaid populations. We need to make sure that any new, evidence-based treatments reach the groups with the highest concentration of need, and that means ensuring that the settings where Medicaid enrollees receive their care — such as community mental health centers and certified community behavioral health clinics — are well poised to integrate these new approaches.
4. Coverage alone does not create access. Medicaid’s experience with other effective behavioral health treatments, and new benefits more generally, shows that access depends on much more than coverage alone. For example, recently introduced medications for treatment-resistant depression, such as esketamine, have seen slow uptake in Medicaid. If these therapies are to reach the populations that could benefit most, we will need scalable implementation strategies, a trained workforce, and sustainable Medicaid reimbursement — not just for the medicines, but for the broader array of therapeutic supports that may be associated with evidence-based delivery.
5. Preparation should start now. As the evidence base grows and potential FDA approvals draw nearer, states have an opportunity to begin planning before they need to make decisions. Policymakers, providers, and advocates can begin building public understanding, addressing misconceptions about psychedelics, and fostering trust in the evidence, while maintaining a clear-eyed view of the gaps in knowledge that need to be addressed. Early collaboration, shared learning, and implementation planning can help state Medicaid agencies, their health plan partners, providers, and communities move forward confidently as these new treatments reach the market.

Looking Ahead

A growing group of philanthropists, researchers, and clinicians recognize that Medicaid is uniquely positioned to help expand PAT access to a large group of high-need patients. PAT is no silver bullet, but I am excited about its potential to offer meaningful improvements in well-being to people for whom existing treatments have not yet offered sufficient help. I am equally excited that people are paying attention to Medicaid access on the front end, rather than as an after-thought. This is a moment to demonstrate how Medicaid can lead — working collaboratively across states, engaging key stakeholders to inform implementation, adapting delivery models to ensure access and sustainability, and building upon the evidence as we go.