Chip Enrollment And Co
Depending on your income, you may have to pay an enrollment fee and co-pay for doctor visits and medicine. Enrollment fees are $50 or less per family, per year. Co-pays for doctor visits and medicine range from $3 to $5 for lower-income families and $20 to $35 for higher-income families.
CHIP has a cap for dental services. If your child needs dental services beyond the cap, you will need to get a prior authorization. Call your dental plan if you need help with prior authorizations.
Medicare Helps Cover Mental Health Services
Medicare Part A helps cover mental health care if youre a hospital inpatient. Part A covers your room, meals, nursing care, therapy or other treatment for your condition, lab tests, medications, and other related services and supplies.
Medicare Part B helps cover mental health services that you would get from a doctor and services that you generally get outside of a hospital, like visits with a psychiatrist or other doctor, visits with a clinical psychologist or clinical social worker, and lab tests ordered by your doctor. Part B may also pay for partial hospitalization services if you need intensive coordinated outpatient care. See page 10 of the article below for more information about partial hospitalization services.
Medicare Prescription Drug Coverage helps cover drugs you may need to treat a mental health condition.
People Who Qualify For Medicaid Typically Require More Intensive Services
People on Medicaid have higher rates of mental illness than people in the general population and use mental health services at a higher rate than people who have other types of insurance. They also have high rates of comorbid medical disorders. According to the Medicaid and CHIP Payment and Access Commission , about 10 percent of people on Medicaid have serious mental illness, relative to 3 percent of people with private insurance and 5 percent of people with no insurance. Only 69 percent of people on Medicaid do not have a mental health condition. About 24 percent of people on Medicaid received mental health treatment in the past year, relative to 14 percent of people with private insurance and 10 percent of people with no insurance. About 44 percent of people on Medicaid had fair or poor health status in the past year, compared to 13 percent of people with private insurance and 24 percent of people without insurance.
Recommended Reading: Medicaid Colorado Income Limits 2020
What Does Medicaid Cover In Your State
To give you a better idea of how wide the range of services can be from state to state, heres a comparison of optional benefits for Medicaid coverage in four states:
Medicaid Coverage in Nevada
What does Medicaid cover in Nevada?
Nevada Medicaid provides quality health services to low-income Nevadans who qualify based on state and federal law. Nevada Medicaid does not reimburse an individual for medical services. Payments are sent directly to health care providers when they render services to Medicaid recipients.
Nevada Check Up is offered concurrently with Medicaid and is designed for children who do not qualify for Medicaid but who come from families with incomes that are at or below 200% of the Federal Poverty Level. Nevada Medicaid is the payer of last resort, meaning that if you have other health insurance that can pay a portion of your bills, then payment will be collected from them first. Benefits covered by Nevada Medicaid and Nevada Check Up include:
- Transportation Services
- Waiver Program Services
Medicaid Coverage in Texas
What does Medicaid cover in Texas?
Texas Health and Human Services administers Medicaid and CHIP in the state. It administers four Medicaid programs: STAR, STAR+PLUS, STAR Health and traditional Medicaid. The type of Medicaid coverage a person gets depends on where the person lives and what kind of health issues the person has.
These benefits include:
Medicaid Coverage in New York
What does Medicaid cover in New York?
Getting Your Child A Mental Health Diagnosis
Getting a mental health diagnosis for your child might be a complicated process. Sometimes, your child behaves beautifully in the doctors or psychologists office and only shows the behavior that worries you at home or school. It might take a while for you to find the right therapist or doctor and schedule a visit. And your child will probably have more than one temporary diagnosis that changes as they grow and develop.
But the sooner you make that first call even if your child is still quite young the sooner your child and your family can get help.
Whether you are looking for a diagnosis or trying to find ongoing therapy or support, here are people, programs, and places that other parents and professionals say are helpful:
- Start by talking to your childs regular doctor.
- Use the Texas Psychological Association website to search for a local psychologist.
- Talk to people at your childs school like the counselor, behavioral specialist, or social worker for ideas.
- If your child has Medicaid, you can search the Medicaid provider website.
Read Also: Iowa Dhs Medicaid Income Guidelines
Texas’ Mental Health Clinics And Access Numbers
If you’re interested in substance use disorder services or have a crisis related to substance use, the best phone number to use often differs from those listed above. The providers assigned to the 11 substance use disorder treatment service areas in Texas are called Outreach, Screening, Assessment, and Referral Centers :
- Region 1 – StarCare Specialty Health System : 740-1414 or 687-7581 or 740-1421
- Region 2 – Helen Farabee Centers : 621-8504 or 673-2242, ext. 100 or 224-6200 or 397-3391
- Region 3 – Life Path Systems : 422-5939 or 562-3647 or 422-5939
- Region 3 – My Health My Resources MHMR : 866-2465
- Region 3 – North Texas Behavioral Health Authority : 260-8000 or 275-0600
- Region 4 – Andrews Center : 934-2131 or 597-1351 or 441-8639
- Region 5 – Burke / ADAC : 445-8562 or 392-8343 or 634-5753
- Region 6 The Harris Center : 970-7000 or 970-4770 or 942-4100
- Region 6 – Gulf Coast Center : 729-3848 or 704-1291
- Region 7 – Bluebonnet Trails : 841-1255 or 309-6385
- Region 8 – The Center for Health Care Services : 316-9241 or 223-7233 or 261-3076
- Region 9 – PermiaCare : 420-3964
- Region 10 – Emergence Health Network : 779-1800 or 747-3605
- Region 11 – Tropical Texas Behavioral Health : 289-7199 or 813-1233
As with mental health services, the people who answer the phone lines often have alternative referral information if they believe you may not be eligible for public services or may be better served by another program.
Genetic Testing For Lynch Syndrome
Testing for Lynch syndrome in people diagnosed with cancer begins with tumor biomarker testing. See our section on Treatment for more information. In a family with a known Lynch syndrome mutation , genetic testing is covered only for people with signs and symptoms of a Lynch-associated cancer AND a blood relative with a known Lynch syndrome mutation.
Visit the Medicare website or call 1-800-MEDICARE to learn more about covered genetic services.
Don’t Miss: Does Missouri Medicaid Cover Assisted Living
Your Texas Benefits Medicaid Card: New Medicaid Id
As of July 2011, HHSC released a new Medicaid ID system that uses digital technology to streamline the process of verifying a persons Medicaid eligibility and accessing that persons Medicaid health history. The two main elements of the system are 1) a new Medicaid card and 2) an online provider portal where providers can get up-to-date information about a persons eligibility and history of services and treatments paid by Medicaid.
Image used with permission from the Texas Department of State Health Services
- The current paper Medicaid ID form mailed to each Texas Medicaid patient each month will be replaced by a permanent plastic Your Texas Benefits Medicaid Card. Besides printed information, this card has a magnetic stripe containing the patients Primary Care Network , which can be used to access the patients Medicaid-related information. For the first few months, patients will receive both the new card and the paper ID.
- Eligibility verification is automated at patient check-in.
- Providers have access to claims-based electronic health history for Texas Medicaid patients.
- Providers can use an e-prescribing tool for prescriptions.
Providers can also still call the TMHP Contact Center at 800-925-9126 to check patient eligibility or use either the Electronic Data Interchange electronic eligibility verification or TexMed Connect , both of which are accessed through TMHP.
Medicaid Vs Medicare: They Are Not The Same
Before understanding what services Medicaid covers, its important to clear up any confusion regarding the relationship and the differences between Medicaid and Medicare. Both were created in 1965 in response to the inability of older and low-income Americans to buy private health insurance. Their goal was to allow the financial burdens of illnesses to be shared among sick and healthy people, and affluent and low-income families.
There are clear differences between Medicaid and Medicare, although many people may be eligible for both programs.
Medicaid is a state and federal program that provides health coverage if you have a very low income.
Medicare is a federal program that provides health coverage if you are 65 or older or have a severe disability, no matter what your level of income is.
Medicaid is jointly funded by the federal government and state governments. It is administered by state governments, and each one has broad leeway in determining how Medicaid is implemented. To be reimbursed by the federal government, there are certain mandatory Medicaid benefits that states much offer qualified participants.
For example, if you live in Texas, the federal government requires that inpatient and outpatient hospital services must be covered, among many other mandatory benefits. However, coverage for other services that are considered optional will vary depending on one of the four particulars plan that you decide to enroll in.
Don’t Miss: Medicaid For The Aged Blind And Disabled
Health Developmental And Independence Services
This divisions units include:
- Office of Disability Prevention for Children
- Rehabilitative & Social Services
- Health & Developmental Services
OFFICE OF DISABILITY PREVENTION FOR CHILDREN
The Office of Disability Prevention for Children was created after Governor Greg Abbott vetoed a bill that would have moved the Texas Office of Prevention of Developmental Disabilities to the University of Texas. Since the legislation was vetoed and TOPDD was eliminated, the Office of Disability Prevention for Children was created within HHSC.
ODPC focuses on the prevention of certain disabilities in children from birth through 12 years of age. While certain disabilities may be prevented, it is important to note that some individuals cannot prevent their disability but are able to learn life skills and coping strategies to live a meaningful life within the community. ODPC has identified five focus areas to address through provider and public education, promotion of public policy, working with state agencies and stakeholders, development of long-term plans, and evaluating state efforts. These areas of focus include:
One of the initial projects of this office was to facilitate trainings using The Road to Recovery: Supporting Children with Intellectual Disabilities Who have Experience Trauma developed by the National Child Traumatic Stress Network and the Hogg Foundation for Mental Health.
REHABILITATIVE AND SOCIAL SERVICES UNIT
- Independent Living Services Programs
Who Is Eligible For Medicare
To be eligible for full Medicare benefits, you must be 65 or older and a U.S. citizen or permanent legal resident who has lived in the country for five years. Also, you or your spouse must have worked long enough to be eligible to receive either Social Security or railroad retirement benefits. Your spouse must be at least 62 years old for you to receive Medicare based on their work history.
Medicare also covers younger people with disabilities in certain situations. If you have been entitled to Social Security disability benefits for at least 24 months or have received a disability pension from the Railroad Retirement Board, you can qualify for Medicare. People with end stage renal disease and Lou Gehrigs disease qualify as well.
If you or your spouses work record doesnt qualify you for full Medicare but you are a citizen or legal resident of five or more years, you can still get benefits. However, you will likely have to pay higher premiums for Medicare Parts A and B.
When you become eligible for Medicare, you should receive a statement from Social Security. If youre not sure whether youre eligible, you can use the online eligibility tool or contact your local Social Security office.
Also Check: Nursing Homes That Accept Medicaid
Medicaid And The Diabetes Prevention Program
Individual state Medicaid benefits may include coverage for the National Diabetes Prevention Program which focuses on people with prediabetes.
View a NDPP infographic.
The CDC has developed a cooperative agreement with health departments in all 50 states and the District of Columbia to strengthen chronic disease prevention and management efforts through the implementation of evidence-based strategies, including the National DPP.
As of 2018, the National DPP is covered by the following state Medicaid programs:
- MT, MN, and VT are currently covering the program.
- CA and NJ have passed legislation to cover the program and are working on implementation for 2019.
- MD and OR have been participating in a CDC funded demonstration project that ends October 2018.
- AR and PA are conducting pilots with Medicaid Managed Care Organizations in 2018.
To find out more about the CDC recognized lifestyle change programs to prevent or delay type 2 diabetes, visitResearch-Based Prevention Program.
Go to Find a Program to search for a local or online CDC-recognized lifestyle change program.
For Over 50 Years Medicaid Hasn’t Covered Long
Medicaid was established in 1965, a time when the United States government was encouraging states to build networks of community mental health programs as alternatives to hospitalization. Due to these historic circumstances, Medicaid excluded coverage for long-term inpatient care in psychiatric hospitals. Many professionals and advocacy groups are pushing for Medicaid to change this policy. Medicaid has already updated its coverage to include short-term hospital stays and has recently started allowing states to apply for waivers to cover hospital stays of up to 30 days for the treatment of mental health and substance use disorders.
You May Like: Vein Clinics That Take Medicaid
Who Is Eligible For Public Mental Health Services In Texas
Texas’s public mental health programs impose stricter eligibility requirements for services than programs in other states. Most public mental health programs in America restrict access to people who have serious mental health conditions that impact their ability to function and who are at risk of psychiatric hospitalization. For decades, Texas has limited access to public mental health services even further by only serving people with one of three diagnoses: schizophrenia, bipolar disorder, or major depressive disorder. Recently, a movement to expand services to a wider range of people has gained traction.
In 2013, the Texas Legislature approved a policy that expands eligibility for public mental health services to people with other psychiatric diagnoses. In theory, people in Texas who have post-traumatic stress disorder , anxiety disorders, attention-deficit disorders, and obsessive-compulsive disorder can now be admitted to public programs. However, the law only requires programs to serve this expanded range of clients when they have “sufficient resources,” and many LMHAs continue to limit services to people with one of the “big three” diagnoses. To know whether a program has expanded its eligibility requirements, area residents have to call and ask. Over time, more programs may update and expand their eligibility requirements.
Access And Eligibility Services
Individuals living with mental health and substance use conditions are often eligible for federal disability benefits. However, accessing those benefits can be a challenging and confusing process. While Supplemental Security Income and Social Security Disability Insurance are federally funded programs, disability determination for these services is conducted by the state through contracts with the federal government. Responsibility for disability determination is housed in the Access & Eligibility Services Division of HHSC.
In addition to conducting disability determination reviews for federal benefits, the division also partners with community organizations that assist low-income families applying for basic services such as obtaining food subsidies, temporary assistance to needy families, and Medicaid and CHIP services. With the assistance of Regional Community Relations specialists, communities work to improve access to the Medicaid and CHIP services often needed by individuals living with serious mental illness or children/youth with SED. A directory of these Regional Partnership Specialists can be found at .
DISABILITY DETERMINATION SERVICES
SOCIAL SECURITY DISABILITY INSURANCE
SUPPLEMENTAL SECURITY INCOME
People who disagree with their SSI or SSDI determination have a legal right to appeal the decision online or in writing. There are four levels of appeal:
Understanding The Levels Of Care
The levels of care used by the Texas Health and Human Services are broken down according to the American Society of Addiction Medicine . These levels of care were first defined in the 1980s to provide one national set of criteria for the care and treatment of addiction.6
- Level 1 Outpatient Services: Less than 9 hours/week less than 6 hours/week for recovery or motivational enhancement therapies/strategies
- Level 2 Intensive Outpatient Services: 9+ hours of treatment/week 6+ hours/week to treat multidimensional problems
- Level 3 Residential Inpatient Services: 24-hour care by trained professionals in a facility that more so resembles a home environment may also be called a therapeutic community
- Level 4 Intensive Inpatient Services: 24-hour nursing and doctor care in a hospital environment. Counseling is also offered to help you deal with your drug or alcohol abuse
What Makes Us Different
Gateway 2 Counselings online therapy sessions are instant, confidential, and affordable. We are the only online therapy platform that accepts Texas Medicaid. We provide you with a safe and confidential setting to communicate in a real-time environment. We have a team of qualified, experienced, and professional counselors and therapists.
The duration of the online sessions usually depends on the circumstances surrounding the patients problem. Whether you need a deep root analysis of your situation or you need immediate help with a practical issue. You can always get what you want and need.
Our online counseling services allow you to choose the therapist you want. You are allowed to try different therapists until you find the right one for you. With your anonymity assured, it becomes easier to share and discuss your difficult situations and experiences. You are at liberty to discuss any issue with our counselors.
Our therapists have gained experience through years of providing professional online counseling for different individuals. Having dealt with people with different life situations, they are well prepared to coach you through different life challenges. Talk of marital issues, love life and relationships, career and self growth, or just to maintain a happy life. Our counselors are capable and they are ready to help you.
We accept Texas Medicaid at our online counseling service.
Get the help you need right here.
Recommended Reading: Medicaid Doctors In Raleigh Nc