376 Youth Psychiatric Facilities, 36 States, No Federal Registry
Summary
MACPAC's June 2026 Report to Congress counts 376 psychiatric residential treatment facilities across 36 states serving Medicaid children -- up from 365 in 2025 -- but no federal, real-time registry of bed availability exists anywhere. Families and providers call facility to facility, sometimes for days, while a child in crisis boards in an emergency room. The Commission voted 17-0 to recommend Congress require to build one.
The missing map
and SAMHSA publish facility lists, but those databases "are not designed to provide real-time information on bed availability"⧉ -- and, MACPAC states, "a federal PRTF bed registry does not exist." The runs a hospital bed registry; there is no equivalent for children's psychiatric beds.
View data as table
| FY2021 | 372 |
|---|---|
| FY2023 | 344 |
| FY2024 | 360 |
| FY2025 | 365 |
| FY2026 | 376 |
What the gap costs a child
Finding a placement can require multiple phone calls and take "several hours to several days"⧉. When no bed turns up, the child stays parked in the ED -- "ED boarding" -- and a missing in-state bed can end in an out-of-state placement, far from home and hard for the state to monitor.
The Commission voted 17-0 on May 7, 2026⧉ to recommend Congress require to build the registry: real-time bed availability, conditions treated, ages served. CBO estimates it would not affect federal direct spending⧉ -- the cost is staff time has not been directed to spend.
- 376 PRTFs, 36 states, one missing tool: no federal registry shows which facility has an open bed today.
- The search is manual -- phone call by phone call, hours to days -- while a child in crisis waits in an ER.
- MACPAC's fix passed 17-0 and, per , adds nothing to federal direct spending; it needs an act of Congress.
Scope: the 376-facility figure is FY2026 data reported in the chapter. The 4.2% residential-use share and the phone-call and ED-boarding findings are prior analyses MACPAC cites, not new counts. Recommendations 4.2 (data reporting) and 4.3 (discharge planning) are outside this piece.
Sources(2) ▾
- Medicaid and CHIP Payment and Access Commission (MACPAC), Report to Congress on Medicaid and CHIP, June 2026 — Chapter 4: Addressing Appropriate Access to Residential Behavioral Health Treatment for Children in Medicaid (2026-06-15) — MACPAC's statutorily required (42 USC 1396) June 2026 Report to Congress, Chapter 4. Reports the FY2026 count of psychiatric residential treatment facilities (PRTFs), the absence of any federal real-time PRTF bed registry, the facility-to-facility search and ED boarding that families and providers face, and the three recommendations (4.1-4.3) with their May 7, 2026 Commission votes. Fetched from macpac.gov and read in full via pdftotext. macpac.gov · original document
- Medicaid and CHIP Payment and Access Commission (MACPAC), Addressing Appropriate Access to Residential Behavioral Health Treatment for Children in Medicaid (publication page) (2026-06-15) — MACPAC publication landing page for the Chapter 4 report, confirming the chapter title, June 2026 date, and the three recommendations. Used to corroborate the chapter's provenance and recommendation set. macpac.gov · original document
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MACPAC's June 2026 Report to Congress⧉ counts 376 psychiatric residential treatment facilities serving Medicaid children across 36 states -- up from 365 in 2025 -- yet no federal, real-time registry shows which of them has an open bed. Families and providers work the phones facility by facility while a child in crisis boards in an emergency room.