The poorest Medicaid enrollees have high rates of social and behavioral health needs, an issue brief from the Commonwealth Fund finds. Based on a study of early Medicaid expansion enrollees in urban Minnesota, the brief, The Complex Needs of Medicaid Expansion Enrollees With Very Low Incomes (10 pages, PDF), found that 32 percent had less than a high school education, 60 percent were male, 47.2 percent were white, and 32.6 percent were African American. Of this group, 10 percent were homeless and had both substance use and mental health issues, while 25 percent faced at least two of those three challenges, with 28 percent homeless; 37.4 percent diagnosed with anxiety, mood, or schizophrenic disorders; and more than 25 percent diagnosed with substance use disorders. In addition, 20 percent had a chronic health condition such as asthma, hypertension, or diabetes. According to the brief, reducing coverage or benefits for this population would make it difficult to address their mental health and substance use disorders, and a better solution would be to improve Medicaid healthcare payment and delivery models and boost efforts to integrate physical health, behavioral health, and social services into a comprehensive package of services.