ANCHOR Act Offers States Option to Fund Mental Health and Addiction Treatment for Uninsured Low-Income Adults

The Access to New Community Health Opportunities and Recovery Act of 2025, or the ANCHOR Act, creates a new option for states to use Medicaid funding to cover uninsured adults struggling with serious mental illness (SMI) or substance use disorders (SUDs). Essentially, this is a targeted, optional Medicaid expansion specifically for behavioral health needs. If a state opts in, it can provide full Medicaid benefits to adults who are uninsured, have an income at or below 100% of the federal poverty line, and have been diagnosed with a qualifying condition like SMI, opioid use disorder, or stimulant use disorder.

Who Gets Anchored?

This section of the bill focuses squarely on getting treatment to some of the most vulnerable people who currently fall through the cracks: the uninsured poor dealing with severe mental health or addiction issues. For someone working a part-time job that doesn't offer insurance, or someone who has been out of the workforce due to their condition, this could be a lifeline. The coverage is provided for a continuous one-year period, after which the state must redetermine eligibility. This annual check-in is crucial, though if the state’s administrative process is slow, it could create a stressful gap in care for people who need consistent treatment.

The Care Plan Catch

If a state decides to offer this coverage, it has two key requirements. First, it must report specific behavioral health quality measures to the federal government, which means we’ll get better data on how well these programs are actually working. Second, and perhaps most important for the individual, the state must ensure that every enrolled person gets a formal care plan developed by a qualified provider within 60 days of enrollment. This isn't just about handing out an insurance card; it’s about making sure people are connected to actual treatment and recovery services quickly. Think of this as the bill saying, 'You get coverage, but you also get a roadmap for recovery.'

Where the Line is Drawn

While this is a major step for behavioral health access, the eligibility criteria are strict. The income ceiling is set at 100% of the federal poverty line. This means that someone earning just a few dollars over that threshold—say, a cashier working full-time at minimum wage who can't afford private insurance—would still be excluded, even if they have the same serious mental health needs. This highlights a common challenge with targeted programs: they help those most in need, but often leave out the near-poor who are still struggling to pay for care.

Another interesting provision is the list of entities that can determine if someone has a “qualifying condition.” While it includes standard medical providers and clinics, it also lists state judicial, law enforcement, and child welfare agencies. While this could potentially speed up enrollment for people encountered by the justice system, it’s a bit unusual to have non-clinical entities making medical determinations. For the average person, this just means there are multiple pathways to get assessed and enrolled, which is good for access, but it will be up to the states to ensure the process remains focused on clinical need rather than administrative convenience.