Texas Behavioral Health Rankings

Despite their seeming precision, national rankings of states’ mental health service spending and quality are designed and intended to offer comparisons between states to inform future policy efforts. These ratings are not designed to provide an accurate picture of a state’s overall commitment to mental health.

In 2015, the Substance Abuse and Mental Health Services Administration (SAMHSA) analyzed state funding for behavioral health services. The resulting report is the one most often misused historically and is the source for the much quoted “Texas ranks 49th” claim. This claim is based on the report’s calculation that Texas behavioral health expenditures totaled $51.26 per person in 2015, putting Texas 49th out of all states, the District of Columbia, and Puerto Rico.

However, as the caveats stated in this report warned, this calculation did not include Medicaid spending on behavioral health, conservatively estimated at $1.5 billion for 2015. When Medicaid spending is included, per capita expenditures increase to $107.16, moving Texas’ ranking to 33^rd. The SAMHSA calculation also failed to include behavioral health payments from the Delivery System Reform Improvement Program (DSRIP), which totaled $535.6 million that year. When DSRIP payments are included, per capita expenditures increase to $127.12, and Texas moves to 27^th in the rankings.^[1] Because of these limitations, SAMHSA has never issued an update.

The Texas Legislature has made a sustained commitment to behavioral health funding over the past five biennia: increasing total spending by more than $5 billion or 77 percent since 2015.

All monetary values are in billions

^[1] Other states may not include Medicaid spending and DSRIP payments in their calculations.
^[2] Includes behavioral health funding appropriated in 87(3) SB 8.
^[3] Includes behavioral health funding appropriated in 88(R) SB 30.

View or download the full white paper on Texas and Behavioral Health Rankings.