Q What Can I Do If I Think I Need Mental Health Or Substance Use Disorder Services For Myself Or Family Members
Here are three steps you can take right now:
What Are The Patterns Of Behavioral Health Treatment Among Nonelderly Medicaid Adults
Most nonelderly Medicaid adults receiving behavioral health treatment do so in an outpatient setting, without any inpatient services. In 2017, inpatient services were used by just under half of nonelderly Medicaid adults with SUD who received drug or alcohol treatment in the past year . A smaller share of Medicaid enrollees with mental illness who received treatment used inpatient services. The data do not distinguish services provided in IMDs from those provided in other inpatient settings such as a general inpatient hospital.
Though nonelderly Medicaid adults with behavioral health needs are significantly more likely than those who are privately insured to have used inpatient and outpatient treatment services in the past year, treatment rates are low across all payers. Among nonelderly adults with SUD, those with Medicaid are more likely have used inpatient treatment services compared to those with private insurance . Similarly, among nonelderly adults with any mental illness, those with Medicaid are more likely to have used inpatient treatment, compared to those with private insurance . Nevertheless, treatment utilization rates , particularly for inpatient treatment, remain low across payers. Inpatient treatment rates are low even for private insurers who, unlike Medicaid, are not subject to the IMD payment exclusion.
Medicare Part B And Partial Hospitalization
Partial hospitalization allows patients to avoid inpatient care while still receiving the more intensive psychiatric services their condition requires. Care is provided during the day, with the patient returning home at night.
Medicare Part B covers partial hospitalization when it is provided in either a community mental health center or hospital outpatient department setting. In addition, your doctor must certify that, without partial hospitalization, inpatient care would be required.
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What Services Are Covered By Medicaid For Mental Health
Each state has the authority to permit or prohibit Medicaid-covered services, however, for the most part, the following are some of the services that are covered:
- Counseling services
As you can see, there is a lot of medical aid available if you have a mental problem. This is fantastic news for those who are suffering and require further counseling and assistance.
Mental Health Parity And Addiction Equity Act Of 2008
MHPAEA ensures that there isnt a disparity between mental health and physical health benefits that an insurance provider offers. Basically, if insurance offers medical and surgical benefits, it cant put less favorable benefit limitations on mental health or substance use disorder benefits. This is an effort to have the insured entitled to benefits across the board, from physical health to mental health.
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Medicare Plans & Parts
- Plan A: This plan provides coverage for inpatient and hospital stays, including up to 190 days in a lifetime at a Medicare-certified psychiatric facility.4
- Plan B: Medicare Part B provides coverage for outpatient/medical coverage. This includes, but is not limited to, Medicare mental health coverage and select prescription drugs.5
- Plan C: While the majority of people with Medicare have Original Medicare, others choose to obtain their Medicare and mental health treatment through a Medicare Advantage Plan, often known as a Medicare private health plan or Part C. Plan C is provided by many insurance providers, including Anthem, Blue Cross Blue Shield, Cigna, United Healthcare, and Aetna.
- If you enroll in an MA Plan, you still have Medicare. As a result, youll most likely have to pay a monthly premium for Part B. Most MA plans include Plan D. If you have an MA Plan, you should receive the same benefits as if you had Original Medicare.
- Keep in mind that MA plans may differ in their network of providers, coverage rules, premiums , and cost-sharing for covered services.6
- The most common types of MA Plans are:
- Health Maintenance Organizations
- Private Fee-For-Service
- Special Needs Plans
- Plan D: This is the Medicare prescription drug program, which covers the majority of outpatient prescription medications. Private firms offer Part D as a stand-alone plan for those enrolled in Original Medicare or as a set of benefits included with your Medicare Advantage Plan.7
Ohio Medicaid Income Guidelines
To meet the requirements for Ohio Medicaid on the status of income, you or your household must make less than a certain amount of money each year. For example, consider the following examples of household sizes and maximum annual income requirements:
- One-person household: $17,131
- Three-person household: $29,207
- Four-person household: $35,245
Medicaid is also associated with the Childrens Health Insurance Program , the program that covers the children of low-income families. Keep in mind that because Medicaid is state-run, income requirements and other eligibility will vary between states.
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Provider Networks And Service Delivery Changes
In addition to covering new services, states took steps to expand or maintain IMD residential provider networks for SUD services. San Diego County has worked to develop its residential provider network, while Vermont is focused on maintaining its long-standing network. One challenge in San Diego and other California counties has been helping residential providers establish the record keeping and quality improvement initiatives needed to successfully bill for Medicaid services.73 San Diegos initiatives in this area include gentle reimbursement withholding incentives, in which a portion of provider payment is delayed until certain performance standards are met. San Diego also has spent substantial county staff time offering technical assistance to providers and introduced advance payments so that providers had funding available upfront to establish the needed administrative infrastructure.
States also worked to expand their community-based provider networks and increase payment rates. Virginia has been able to use state funds to fund significant provider rate increases for intensive outpatient and partial hospitalization services intended to build the Medicaid provider network. Californias waiver broadens the range of approved SUD treatment providers and allows counties to pay providers at higher than state plan rates to account for geographic differences and encourage providers to add capacity.74
Access To Health Coverage Improves Behavioral Health Among Low
Closing the coverage gap would ensure millions of uninsured people have a pathway to coverage that includes behavioral health services and mental health parity protections. The Mental Health Parity and Addiction Equity Act prohibits group health plans and health insurance issuers that provide mental health or substance use disorder benefits from imposing less favorable benefit limitations on those benefits than apply to medical benefits. These requirements also apply to certain Medicaid and Childrens Health Insurance Program plans, including the benchmark Medicaid plans that people eligible for Medicaid expansion enroll in. While the services covered vary, the ACA includes behavioral health services and preventive health screenings among the ten essential health benefits that must be covered by all marketplace and Medicaid expansion plans.
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How Do People With Behavioral Health Needs Qualify For Medicaid
Many people with behavioral health needs are eligible for Medicaid, although there is no single pathway dedicated to covering them. Most beneficiaries with behavioral health conditions qualify for Medicaid because of their low incomes. For example, adults may be eligible for Medicaid if they live in a state that expanded its program under the Affordable Care Act and have incomes up to 138% of the federal poverty level . In states that did not expand their programs, coverage for non-disabled individuals is typically limited to parents, pregnant women, and children. In non-expansion states, the median income eligibility level for parents is 44% FPL in 2017, but eligibility for children and pregnant women is higher. As of 2017, most states provide Medicaid or CHIP to children and pregnant women at or above 200% FPL.8 In total, over one in five adults and one in 10 children eligible for Medicaid based on income have a behavioral health diagnosis as of 2011.9
Fifty percent of adults and 47% of children eligible for Medicaid based on having a disability have a behavioral health diagnosis as of 2011.12 Additionally, among Medicaid beneficiaries with behavioral health conditions , over four in 10 adults and one in six children are eligible for Medicaid based on having a disability .13
Figure 1: Eligibility Pathways Among Non-Elderly, Non-Dual, Medicaid Enrollees with a Behavioral Health Diagnosis, 2011
Demonstration Project To Increase Substance Use Provider Capacity
On October 24, 2018, the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act became law. Under section 1003 of the SUPPORT Act, the Centers for Medicare & Medicaid Services , in consultation with the Substance Abuse and Mental Health Services Administration and the Agency for Healthcare Research and Quality, is conducting a 54-month demonstration project to increase the treatment capacity of Medicaid providers to deliver substance use disorder treatment and recovery services. The demonstration project includes:
- Planning grants awarded to 15 states for 18 months and
- 36-month demonstrations with up to 5 states that received planning grants.
States participating in the 36-month demonstration will receive enhanced federal reimbursement for increases in Medicaid expenditures for substance use disorder treatment and recovery services.
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What Types Of Mental Health Conditions Does Medicaid Cover
Medicaid covers many mental health conditions. To reimburse therapists or clients, Medicaid requires that the client receive a diagnosis from their therapist. This diagnosis guides treatment and insurance coverage.
Examples of eligible mental health conditions include:
What Needs To Be Done To Improve Care For Those Covered By Medicaid
When reflecting back on all of the challenges facing both Medicaid patients and practitioners, Trivedi said that its no surprise that the current pandemic has made things hard on both ends.
We are seeing problems with what we call the social determinants of health. So, housing instability, food insecurity, loss of jobs, all of those factors impact mental health care and mental illness, which is increasing need at the same time theres been a lot of stress and burnout placed upon providers, Trivedi said. Its an urgent problem.
Looking to the future, Lennig said its difficult to imagine a post-pandemic world while were living through this crisis. That being said, she hopes as we continue to find a way to safely navigate COVID-19, its variants, and ways to gather safely that those working in the behavioral health space can return to doing the work they love the way they love it.
Social workers get into this because we are pretty social, we like being around people. The struggle this year has been a lot of my extroverted staff miss that time getting together and meeting in person, they dont want to stare at a screen anymore, she said.
If we can go into that post-pandemic world and have meetings on a regular basis, meet and have lunch together, I think morale will help in that space and we can assist further. I think its been hard for people to compartmentalize and do self-care when they are working out of their homes.
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Medicaid Covers Mental Health Services That Most Private Insurance Policies Don’t Cover
Due to growing public awareness of the importance of mental health care and laws like the 2008 Mental Health Parity and Addiction Equity Act, private insurance plans are covering more mental health services than ever before.
However, its rare for private insurance plans to cover intensive services that many Medicaid plans cover, such as nursing home and other long-term care, round-the-clock services, supported employment, case management, and in-home mental health care.
In fact, many older adults who need nursing home care or other intensive services often elect to spend down assets so they can qualify for Medicaid coverage for these specialized and otherwise expensive services.
Most Medicaid plans also cover basic mental health services like therapy, psychiatrist visits, and clinic care.
Treatment Is Effective Recovery Is Possible
We supervise Wisconsin’s public mental health system. Wisconsin’s 72 counties are responsible for delivering services and providing for the well-being, treatment, and care of individuals living with mental health concerns. This often is done in partnership with community-based agencies and organizations.
Private practice professionals licensed by the state also provide care and treatment to people living with mental health conditions.
Who is a mental health professional?
- Someone who can help people get relief from mental health conditions, and find ways to improve mental wellness and resiliency.
- They may be a psychiatrist, psychologist, social worker, marriage and family therapist, psychiatric nurse, or counselor with mental health training.
How can a mental health professional help?
- If you feel unhappy, depressed, anxious, fearful, moody, or in need of emotional help, a mental health professional can help you to understand your problems and to feel better.
- They have specialized training to identify and understand problems that may be causing you discomfort or putting you at risk.
- They also have specialized training in helping people with a variety of mental health conditions.
- If you need it, they can prescribe medicine, or can connect you with someone who can determine whether you need medication.
- They are trained to offer an objective, independent viewpoint.
- They can help you to connect with other professionals and specialists, if needed.
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Medicare Inpatient Mental Health Services
If you do need inpatient care as part of your treatment, Medicare Part A covers services during an inpatient hospital or psychiatric hospital stay. Theres a limit to Medicare coverage if you stay at a psychiatric hospital thats dedicated to treating mental health patients, as opposed to a general hospital. Medicare Part A pays for up to 190 days of psychiatric hospital care in your lifetime.
Even during inpatient stays, Medicare Part B still covers certain mental health benefits, such as physician services.
Elderly Iowans Can Apply For Medicaid Waive
An Iowa resident who is over the age of 65 is eligible for the HCBS Elderly Waiver. There are 65 or older people who qualify for this age range. Applicants must be residents of Iowa for at least six months prior to the application submission date. An individual with both physical and mental abilities that can receive care at home or in a community setting. Chronic or terminal illnesses that have caused a disability may prevent you from receiving Medicare or Medicaid. The Iowa Department of Human Services will assess eligibility based on the application received. Services are available at home, in a supported living facility, or in a community setting. More information or to apply for the HCBS Elderly Medicaid Waiver can be found by contacting your local county office of the Iowa Department of Human Services.
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Coverage Expansion Contributes To Positive Mental Health
Being uninsured can create and compound stress by causing people to worry about medical bills and the cost of care, including behavioral health care. These financial concerns can lead people to delay seeking treatment until they are in crisis. Low-income people who are newly insured often experience improved mental health. For example, among low-income parents, Medicaid expansion meaningfully contributed to reductions in severe psychological distress as well as reduced difficulty paying medical bills. There is also evidence of improved mental health among low-income childless adults, who report fewer poor mental health days and fewer depression diagnoses.
What Is Not Covered By Medicaid For Mental Health
Although many therapies are covered, there is one significant exception: long-term inpatient care. This has never been paid by Medicaid, but the government is working on a new option that can assist these individuals and their expenditures.
Medicaid has already expanded its coverage to include short-term hospital stays, and states can now request exemptions to cover hospital stays of up to 30 days for the treatment of mental health and drug use issues.
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Medicaid And Medicare For Mental Health Services In Ohio
Georgetown Behavioral Hospital gladly works with patients to simplify the confusion in paying for rehab. We accept many different health insurances including Medicare and Medicaid. Learn more about the difference between Medicare and Medicaid for mental health coverage and whether Medicare or Medicaid is the right option for you.
How Are Behavioral Health Services Delivered To Medicaid Enrollees
States use a combination of fee-for-service and managed care arrangements to deliver behavioral health care to Medicaid beneficiaries. Historically, Medicaid paid for services, including those for behavioral health conditions, on a FFS basis, through which providers are paid for each billable service they deliver. During the past several decades, Medicaid payment has shifted to managed care arrangements, through which providers are paid for some or all services at a prepaid rate. Behavioral health services are increasingly provided through managed care arrangements, but some states carve out behavioral health services from their managed care contracts, and these services are instead provided and financed under another contractual arrangement, such as a prepaid health plan, or on a FFS basis.30 However, many of these states are moving to carve in these services and deliver them through the same managed care contracts as physical health services.31 For example, in 2016, 20 states covered outpatient mental health services, 24 covered inpatient mental health services, and 24 covered SUD services through comprehensive managed care contracts.32
Figure 2: Number of States Using ACA Options for Behavioral Health Service Delivery
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