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Across the nation, Medicaid is the single largest payer for mental health care, and in rural America, residents disproportionately rely on the public insurance program.
But Medicaid cuts in the massive tax and spending bill signed into law earlier this month will worsen mental health disparities in those communities, experts say, as patients lose coverage and rural health centers are unable to remain open amid a loss of funds.
“The context to begin with is, even with no Medicaid cuts, the access to mental health services in rural communities is spotty at best, just very spotty at best — and in many communities, there’s literally no care,” said Ron Manderscheid, former executive director of the National Association of County Behavioral Health and Developmental Disability Directors.
Cuts during the next 10 years could force low-income rural families to pay for mental health care out of pocket on top of driving farther for care, experts say. Many will simply forgo care for depression, bipolar disorder and other illnesses that need consistent treatment.
“Not only do you have very few services available, but you don’t have the resources to pay for the services,” Manderscheid said. “That makes the problem even worse.”
Rural communities are already at higher risk of suicide, with rates almost doubling during the past two decades. Already, rural communities are grappling with a shortage in mental health professionals, making them more vulnerable to losses compared with more urban areas, experts say.
Paul Mackie, assistant director of the Center for Rural Behavioral Health at Minnesota State University-Mankato, studies rural mental health workforce shortages.
“If it (coverage) goes away, what would then be the person’s next option if they already don’t have the resources?” said Mackie, who grew up on a rural Michigan dairy farm. “You can have a rural psychologist or a rural clinical social worker working under a shingle, literally alone.”
Small rural hospitals often provide critical behavioral health care access, he said. One analysis found the cuts next year would leave 380 rural hospitals at risk of shutting down.
Under President Donald Trump’s signature legislation, states that expanded Medicaid through the 2010 Affordable Care Act will have to redetermine eligibility twice a year on millions enrolled in the program. Some Medicaid recipients also will have to prove work history.
The new law creates work requirement exceptions for those with severe medical conditions — including mental disorders and substance use — but experts say proving those conditions may be convoluted. The exact qualifications and diagnoses for the exceptions haven’t been spelled out, according to a report by KFF, a health policy research organization.
Not only do you have very few services available, but you don’t have the resources to pay for the services. That makes the problem even worse.
– Ron Manderscheid, former executive director of the National Association of County Behavioral Health and Developmental Disability Directors
“You can’t work when your mental illness is not treated,” said Dr. Heidi Alvey, an emergency and critical care medicine physician in Indiana. “It’s so counter to the reality of the situation.”
Alvey worked seven years at Baylor Scott & White Health’s hospital in Temple, Texas. As nearby rural critical access hospitals and other mental health centers shut down, the hospital became the only access point for people hours away, she said.
“People who just had absolutely no access to care were coming hours in to see us,” she said. Many had serious untreated mental health conditions, she said, and had to wait days or weeks in the emergency department until a care facility had an open bed.
She’s concerned that Medicaid cuts will only make those problems worse.
Jamie Freeny, director of the Center for School Behavioral Health at advocacy group Mental Health America of Greater Houston, worries for the rural families her center serves. The organization works with school districts across the state, including those in rural communities. Nearly 40% of the state’s more than 1,200 school districts are classified as rural.
She remembers one child whose family had to drive to another county for behavioral health. The family lost coverage during the Medicaid unwinding, as pandemic provisions for automatic re-reenrollment expired. The child stopped taking mental health medication and ended up dropping out of school.
“The child wasn’t getting the medicine that they needed, because their family couldn’t afford it,” Freeny said. “The catalyst for that was a lack of Medicaid. That’s just one family.
“Now, you’re multiplying that.”
Family medicine physician Dr. Ian Bennett sees Medicaid patients at the Vallejo Family Health Services Center of Solano County in California’s Bay Area. The community health clinic serves patients from across the area’s rural farm communities and combines primary care with mental health care services, Bennett said.
“When our patients lose Medicaid, which we expect that they will, then we’ll have to continue to take them, and that will be quite a strain on the finances of that system,” Bennett said. The center could even close, he said.
“The folks who are having the most difficulty managing their lives — and that’s made worse by having depression or substance use disorder — are going to be the folks most likely to drop off,” said Bennett, a University of Washington mental health services researcher. “The impacts down the road are clearly going to be much worse for society as we have less people able to function.”
The psychiatric care landscape across Michigan’s rural western lower peninsula is already scarce, said Joseph “Chip” Johnston. He’s the executive director of the Centra Wellness Network, a publicly funded community mental health care provider for Manistee and Benzie counties. The network serves Medicaid and uninsured patients from high-poverty communities.
“I used to have psychiatric units close by as an adjunct to my service,” he said. “And they’ve all closed. So, now the closest [psychiatric bed] for a child, for example, is at least two hours away.”
Those facilities are also expensive. A one-night stay in an inpatient psychiatric facility can be anywhere from $1,000 to $1,500 a night, he said.
This story was first published by Stateline which is part of States Newsroom, a nonprofit news network, including the Daily Montanan, supported by grants and a coalition of donors as a 501c(3) public charity.
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PNS - Friday, August 15, 2025 - CA Governor announces mid-decade redistricting plan. Economists worry inflation is rising due to Trump's tariffs and Social Security workers fight back against cuts on the agency's 90th anniversary.
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PNS - Friday, August 15, 2025 - Putin to offer financial incentives to Trump at Ukraine summit; 'Perfect storm' hits Florida community health centers; Rural OR non-profit to expand Medicaid enrollment with new funding; CT part of national protest of Wells Fargo policies; IN voices join national battle over gerrymandering.
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ButteNews
Aug 15,2025
5:59 pm
The possible affected contamination area has bee greatly reduced according to Butte-Silver Bow Chief Executive JP Gallaher.vArea of Affected area is located south of Farrell, west of Continental, north of Ottawa and east of Farragut and Howard (see map)
On 8/13/2025 the Butte-Silver Bow Water Utility Division was notified of a cross connection in the distribution system. Due to the nature of this cross connection and the possibility of unknown contaminants, this Do Not Consume Advisory is being issued to protect public health. This situation may have led to the introduction of multiple contaminants in the drinking water; these contaminants may include total coliform bacteria, fecal coliform bacteria and various chemicals.
What does this mean?
- If you live or work in the affected area, the use of bottled water is recommended at this time. Do not use the water for drinking, making ice, brushing teeth, washing dishes, making baby formula or food preparation. Bottled water should be used for all of the above necessities until further notice.
- People with severely compromised immune systems, infants and some elderly may be at increased risk when exposed to contaminated water. These people should seek advice about drinking water from their health care providers. General guidelines on ways to lessen the risk of infection by microbes are available from EPA’s website: https://epa.gov/safewaterhotline [epa.gov]
- Fecal coliforms and E. coli are bacteria whose presence indicates that the water may be contaminated with human or animal wastes. Microbes in these wastes can cause diarrhea, cramps, nausea, headaches, or other symptoms. They may pose a special risk for infants, young children and people with severely compromised immune systems. The symptoms above are not caused only by organisms in drinking water. If you experience any of these symptoms and they persist, you may want to seek medical advice. People at increased risk should seek advice about drinking water from their health care providers.
What is being done?
System flushing and sampling is occurring, and results do not indicate widespread contamination of the distribution system allowing for a smaller identified area of concern. Butte Silver Bow will continue to update the community as more information becomes available.
For more information contact: Butte-Silver Bow Emergency Hotline at (406) 497-6440
BUTTE - As of 6:30 p.m. on August 14, the DEQ has informed Butte-Silver Bow that results received so far from both Butte-Silver Bow’s internal analysis and the MT State Lab are promising, with no signs of contamination.
Butte-Silver Bow continues to work with Energy Labs in Helena, the State Lab in Helena, and the Bureau of Mines at Montana Tech as well as ongoing internal sampling and lab analysis. We are still awaiting results from the Bureau of Mines, which is testing for metals, and we hope to receive those results early in the afternoon on August 15.
Butte-Silver Bow water treatment employees are continuing to collect samples, with an additional seven samples from the affected area to be collected this evening. These will be delivered to the State Lab by 8 a.m. on August 15. Butte-Silver Bow crews have also been flushing the affected water lines throughout the day.
The “Do Not Consume” order will remain in effect until all testing is complete and the DEQ officially rescinds the order.
The BSB Hotline will be open until 10 p.m. on August 14 and will reopen at 7 a.m. on August 15. The hotline number is 406-497-6440.
BUTTE - As of 5:00 PM, Thursday, August 14, the Civic Center Water Distribution operation has again run out of water. We will be expecting additional shipments tomorrow. In the meantime, citizens can visit Montana Resources on Shields Avenue until 7:00 PM tonight. They will continue distributing water again beginning at 8:00 AM on Friday.
