Why Medicaid Matters for Mental Health: Reflections from a Rural Psychiatrist

The hospital is quiet on weekend mornings. On my drive there, the fields stretch wide and are dotted with cows and even some miniature horses. There are signs advertising maple syrup for sale and Trump for President.

In rural Wisconsin, everything moves a little slower — but the needs are just as urgent. As an inpatient psychiatrist in a small rural hospital, I see the ways mental health care weaves into the fabric of these communities. I also see how essential Medicaid is to making that care possible.

For many of our patients, Medicaid isn't just an insurance program. It’s a bridge and a lifeline. It covers hospitalization when someone is overwhelmed by depression, psychosis, or suicidality. It supports outpatient therapy, medications, substance use treatment programs, case management, and even transportation to appointments — crucial when the nearest psychiatrist or intensive group therapy program might be an hour or two away.

Without it, many would go without care altogether. Or wait until symptoms worsened to the point of emergency.

How Medicaid Supports Quiet Stories of Mental Health Recovery

I think of the stay-at-home mother of five who came to us overwhelmed by psychosis, severe OCD, and substance use. She was caught between the demands of caregiving, financial strain, and a brain that was working against her. Medicaid made it possible for her to receive inpatient stabilization, medications that helped quiet the intrusive thoughts, and connection to outpatient therapy that would support her long-term healing — giving her a chance to stay present for her children.

I think of the local factory worker who struggled quietly with depression and alcohol use disorder. It took tremendous courage for him to come in. Medicaid covered the inpatient stay that allowed him to safely detox and begin addressing his depression — helping him return to work, to his family, and to a life he could envision living again.

I think of the librarian who carried treatment-resistant depression like a hidden weight. Traditional therapies hadn’t worked. Medicaid coverage opened the door to more specialized psychiatric services — helping her regain stability and stay connected to her work, her identity, and the people who relied on her.

These are not dramatic stories. But they are stories we don't often hear about in the news. They are quiet, everyday victories — the kind that build strong communities over time.

Why Medicaid Matters for Rural Mental Health Care

In rural communities, access to care has always been a challenge. There are fewer psychiatrists, fewer therapists, fewer hospital beds. Long drives, weather barriers, and financial strain make seeking help even harder.

Medicaid doesn’t solve all of these problems. But it does remove some of the biggest barriers:

• It covers care that would otherwise be unaffordable.

  
  

• It helps keep rural hospitals and inpatient psychiatric units open.

  
  

• It funds outpatient clinics, crisis teams, and transportation programs.

Medicaid even pays for rides to medical appointments, chemical dependency treatment, and group therapy programs — a critical service in areas where many people don’t own a car or can’t afford the cost of gas for long trips. Without it, distance alone would put care out of reach for many.

It also funds group-based treatment programs that offer more than just therapy — they provide connection, accountability, and a sense of community. Group therapy programs often become lifelines: spaces where people find not just clinical support, but understanding, hope, and a reminder that they are not alone.

In a system stretched thin, Medicaid fills critical gaps that private insurance often leaves behind — especially when it comes to mental health.

When people have access to affordable, consistent care, they are more likely to seek help early. Conditions are less likely to spiral into emergencies. Families are more likely to stay together. Communities are more likely to thrive.

Building Stronger Rural Mental Health Systems

There is still much work to do. Rural mental health care remains underfunded, and bureaucratic hurdles often make access harder than it should be. But what I see every day is this: when people have the support they need at the right time, healing happens.

Medicaid isn’t a perfect system. But it is a vital one.

As conversations about healthcare funding unfold at the policy level, it’s important not to lose sight of the people at the center of it — the parents trying to stay healthy for their children, the workers trying to stay employed, the community members trying to live their lives with dignity and connection. I have been witness to this every single day I am at the hospital.

Mental health care is essential infrastructure for healthy communities. And programs that support access to that care, like Medicaid, deserve to be valued and strengthened — not just for individual well-being, but for the strength of rural America itself.

When people receive the care they need, they can return to their families, contribute to their communities, and rebuild futures that once seemed out of reach.

When we invest in care, we invest in resilience. And resilience is what keeps rural communities — and the people in them — strong.

Further Reading:

The Star Tribune recently published a thoughtful article on the broader impacts of proposed Medicaid changes, especially in rural areas. This was the inspiration for my blog post.