For millions of low-income Americans, Medicaid is the only means of addressing healthcare needs. Only 25 states have agreed to Medicaid expansion in the United States as part of the Affordable Care Act (ACA) — and while this would mean an expansion of healthcare coverage for most services, there’s a risk that it could mean cuts to the program when it comes to mental healthcare. There is no federal requirement for states to allocate any of their budget to mental health services: consequently, states have every ability to disadvantage those dependent on mental healthcare by underfunding or cutting funding for it entirely. In the 25 states that have refused to adopt Medicaid expansion under the ACA, for instance, nearly four million people with mental illnesses will go uninsured and will be unable to afford private insurance, according to a study by American Mental Health Counselors Association. Youth are a particular concern for mental health coverage as well. Approximately four million American children and adolescents have some form of mental illness, and nearly one-tenth of all minors are hospitalized because of it. “Psych under 21,” a Medicaid benefit that allows low-income minors under 21 years of age to receive mental health services, is entirely optional for states to provide. As a result, many parents pay out-of-pocket for their dependents’ mental health care because they may not be able to afford private health insurance or qualify for Medicaid that includes mental healthcare. At minimum, the program should be required at the federal level to cover the majority of prescription costs, long- and short-term services and supports (such as stays in psychiatric health centers), and outpatient therapy visits. Non-traditional therapies, like dialectical behavioral therapy or music therapy, could also be considered as medically beneficial to mental health. The expansion of Medicaid via the ACA is certainly a good start to improving the lives of millions of Americans, but it must be seen as a first step to a greater conversation on healthcare — with mental health as a critical component. Brianna Montague is an intern for the Break the Chain Campaign.