OBJECTIVES: Patients with congestive heart failure (CHF) are at risk for developing comorbid behavioral health (BH) conditions. The objective of this study was to examine the impact of BH conditions on health outcomes among patients with CHF. METHODS: This retrospective cohort study used 2013-2014 claims data from adults with CHF in 2013 who were continuously enrolled in Medicare plans for 24 months. Propensity score-matched (1:1) groups with and without BH conditions were compared. Linear and logistic regression models were used to estimate differences in emergency department (ED) visits, preventable hospitalizations and medication adherence between patients with and without BH conditions. Medication adherence was measured using proportion of days (PDC) covered with PDC<80% defined as non-adherent. The models adjusted for demographics, baseline resource utilization, severity of CHF using the American Heart Association’s staging system, disability and low income subsidy status. RESULTS: The matched study groups had 59,153 patients in each arm. The most prevalent BH conditions were anxiety (28%), depression (20%), and substance abuse (10%). Among patients with CHF, those with BH had higher ED visits than those without BH (19% vs 16%) and the risk was significantly higher in the adjusted linear regression models. Patients with CHF and BH also had 14% higher likelihood to have an acute preventable hospitalization (Adjusted Odds Ratio [AOR]:1.14; 95% Confidence Interval [CI]:  1.04-1.24) and were 9% less likely to adhere to CHF medications (AOR: 0.91; 95% CI: 0.88-0.95). When examined by specific BH conditions, patients with depression, anxiety and substance use disorders were all found to be less likely to be adherent to CHF medications. CONCLUSIONS: This analysis can help to inform health insurers in designing clinical programs and educate physicians for treating patients with CHF that, in the presence of BH conditions, such patients are less adherent to medications and more prone to acute ED visits and hospitalizations.