Emily Cerciello, Emerging Fellow for Health Care for 2014-2015 and UNC-Chapel Hill Class of 2015, details why North Carolina should expand Medicaid in order to cover to mentally ill residents. New Medicaid expansion enrollees are more likely to have high rates of mental illness, with estimates showing rates of nearly 25 percent among such enrollees in Delaware, Vermont, Ohio, and West Virginia, and nearly 30 percent in Nebraska and Minnesota.The North Carolina legislature has repeatedly declined expanding Medicaid to eligible residents while the state is also experiencing formidable challenges in providing affordable mental health care services. Nevertheless, new and emboldened leadership has the opportunity to expand Medicaid as part of a greater effort to improve mental health care in North Carolina. While systems will need to expand to meet the demand of new patients, North Carolina can be an example for the country for turning the challenge of Medicaid expansion into an asset for improved access to healthcare and job creation. This paper was presented to a panel of experts at the White House in December 2014.