Not quite last among the states but clearly lagging is Louisiana — 47th on a survey of the incidence of mental illness and rates of access to care for crippling psychological ailments.

The national Mental Health Association’s 2015 survey includes 50 states and the District of Columbia. The states ranking below Louisiana are Washington, Nevada and Arizona, as well as perennial laggard Mississippi.

That rating reflects a significant failure for provision of mental health care across the spectrum, but as always, poverty is a huge factor: Louisiana’s Medicaid program is supposed to reach many with mental disorders but has not done enough.

So we are hopeful that the outgoing Jindal administration will launch a new system to deliver behavioral health services through Medicaid. Patients’ care will be integrated with the five insurance companies now paid to manage the Medicaid coverage of recipients.

The idea is a reasonable one that also is being followed in the private insurance sector, with professionals collaborating — doctors and nurses who deal with physical ailments, therapists and others working on the mental problems that patients also may be saddled with.

“You treat the whole person from the head to the toe,” said Dr. Darrell Montgomery, who has worked on the transition for the state health agency. “It will be in their best interest to have one managed care entity to manage all care.”

We hope that this meets the goal of the Department of Health and Hospitals and that it will avoid duplicative care by providers in the health care system. Medicaid managed care, a key Jindal initiative, is still a work in progress.

Given, though, the Mental Health Association survey, any new thinking in these arenas is welcome. But one of the reasons for Louisiana’s low ranking is that our state has refused to accept expanded Medicaid coverage under the federal Affordable Care Act. We have a lot of poor people who are working hand to mouth at low-wage jobs. Only the destitute basically get a Medicaid card today.

At the annual meeting of the Council for a Better Louisiana, Gov.-elect John Bel Edwards reiterated Wednesday that he intends to expand Medicaid coverage, up to the federal benchmark of 150 percent of the poverty line.

“It is not reasonable to send our tax dollars to Washington so the working poor in other states get health care coverage while ours do not,” he said.

We welcome that initiative and hope that managed care can fulfill its promises, both for physical health care and for those afflicted with mental illnesses.

The latter can destroy lives just as thoroughly as physical illnesses.