I am in California where we have extensive Medicaid services but a very, very low payment scale so let me approach this relation as a "case study." I am a retired family doc. After I closed my personal practice I worked in a FQHC with about 100% Medicaid patients, mostly homeless. We had an in clinic psychiatrist (who could care less about ACES) and 4 therapists (MSW, psychologist or MFCC) who understood ACEs. In California (I was in San Diego) mental health services were "carved out" of the medical HMO system and given to a specific medical contractor group or provided by County Mental Health. Our clinic was in no way "trauma informed."
Treating ACES, in my opinion, requires relatively intensive, personalized cognitive behavioral therapy (see the California Evidence-Based Clearinghouse for Child Welfare (CEBC) set up to advance the effective implementation of evidence-based practices for children and families involved with the child welfare system) and cannot be done by medication or DSM symptom based therapy.
While our clinic therapists were excellent and competent and very helpful to me and my patients, our psychiatrists criticized me for not following their inadequate treatment plans and paying attention to ACES and TIC. Any care provided outside the clinic was essentially unreliable, third world, sporadic, medication management with little personal attention.
Because Medicaid has almost universally has poor reembursement, and good mental health care requires time and effort with patients and the need for mental health care is huge, there are systematic unfixable deficiencies.
California has a unique "ACES Aware" project in our MediCal which has a more optimistic look at the situation and has initiated a system wide screening program (See attached) but has not published any treatment or outcome data. Also go to its web site which has loads of resources (https://www.acesaware.org/
In many states adults who are not pregnant or do not have dependent children, may be poor and ill and suffering from child maltreatment trauma but they would not be eligible for Medicaid - a condition endured by my homeless patients before the ACA medicaid expansion.