Medicaid Mental Health Coverage Illinois

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Who Is Eligible For Medicaid In Illinois

Illinois governor signs new legislation for Medicaid coverage

Federal law specifies mandatory and optional coverage groups for Medicaid. States must cover the mandatory groups to receive federal Medicaid funding, and they qualify for additional funding if they cover optional groups.

The federal government specifies minimum thresholds for eligibility for the various groups, and states can set their requirements at or above the minimum threshold. Illinois has established requirements that are near national averages.

Out Of State Providers

For medical services, the provider rendering the service at the distant site can be a physician, physician assistant, podiatrist or advanced practice nurse, who is licensed by the State of Illinois or by the state where the patient is located.

For psychiatric services, the provider rendering the service at the distant site must be a physician licensed by the State of Illinois, or by the state where the patient is located, who has completed an approved general psychiatry residency program or a child and adolescent psychiatry residency program.

Top 5 Rehab Centers That Accept Illinois Medicaid

Medicaid insurance plans are widely accepted in the state of Illinois, with over 100 facilities accepting Medicaid coverage for addiction and mental health services.

This list of top 5 rehab centers in Illinois which accept Medicaid was compiled based on:

  • facility accreditation
  • degree of program excellence

Read Also: Michigan Medicaid Income Limits 2020

Lutheran Social Services Of Illinois Des Plaines Illinois

Lutheran Social Services treats many residents in several areas at its addiction treatment centers throughout Illinois.

Services include residential, detox, outpatient, and transitional and sober living homes. Programs are designed according to individual need.

If one program through Lutheran Social Services does not provide the treatment an individual needs, he or she can be referred to its sister locations.

Addiction treatment services provided include:

  • medication-assisted treatment

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Therapists Fear Denials Audits Clawbacks

Illinois Association of Medicaid Health Plans (IAMHP)

Many therapists and psychiatrists say they also shun health insurance because of the frustrations of dealing with insurance companies.

Matthew Jones, a former Chicago therapist, was rocking his 3-month-old daughter to sleep in April, when he took to Twitter. He wrote a screed that started with the declaration, Insurance companies hate therapists.

He detailed why he had recently decided to stop taking insurance, describing low and delayed payments and hours spent on the phone with insurance companies when claims for care were denied.

His tweets drew thousands of reactions, ranging from therapists who agreed with him to patients who lamented that they cant afford therapy because of decisions like his.

I was very surprised, he said of the passion of some of the responses. But Jones, who is now a licensed psychologist in Denver, doesnt regret posting the thread.

I think theres a tendency among the public at large to blame therapists as these gatekeepers who are withholding care because theyre selfish and theyre making so much more than the clients theyre servicing … and thats what I wanted to push back on, Jones said.

Therapists who take insurance describe being told by some insurance companies to shorten their sessions from 60 minutes to 45 minutes. They also worry about being audited.

But many therapists find the prospect, along with other insurance company practices, threatening.

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Training On Medicaid Managed Care Billing:

As a part of Phase II of the MTAC, ICOY is piloting training resources for providers. We began with the highest priority topic as indicated by oursurvey, to help providers bill Medicaid managed care. In February 2020 ICOY released the 12-part training series How to Bill Medicaid Managed Care: A Training for Healthcare Providers. Trainings are available to all Illinois providers and are not limited to ICOY members.

Hepatitis C Drug Coverage Expanded In Stages Now Available To Anyone With The Disease

In the past few years, drugs that can cure Hepatitis C have burst onto the medical scene, heralded as miracles. But they can also be a strain on budgets, as the pill initially could cost more than $1,000 per day, and the treatment course lasts 12 weeks. Medicaid programs across the country have been grappled with how to handle the situation, and Illinois announced in September 2016 that they would loosen their guidelines in terms of when Hepatitis C drugs would be covered.

Rather than restricting coverage only to the sickest patients, Illinois Medicaid began to cover Hepatitis C drugs for people with stage 3 and 4 liver scarring, rather than just 4. Advocates cheered the new rules, but cautioned that there was still no coverage for treatment in people with chronic Hepatitis C that hadnt progressed as far as stage 3 liver scarring, and urged the state to continue to consider the issue.

By 2018, the price of Hepatitis C medications had declined, and a generic version was set to hit the market in early 2019, priced at $24,000 for the full treatment course . And in October 2018, the state eliminated the restrictions on access to Hepatitis C drugs, allowing several thousand Illinois residents to obtain Hepatitis C medication through Medicaid, regardless of the stage of their disease and without having to prove sobriety.

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When Should You Go To A State Mental Health Program

Community mental health programs are often the best option people who are in crisis and need help right away. The people who answer county and regional crisis lines can help determine the best response to a crisis, whether its inpatient treatment or an appointment with a counselor.

Community mental health programs ensure that people who lack the means to access services in the private sector can receive the mental health care they need. This means people who have limited income should consider inquiring first with public providers.

However, the mental health system can serve more people. When Illinois introduced behavioral health clinics and started allocating funds to programs for people with more moderate needs, its mental health system started to become more inclusive. Even people who dont qualify for public funds can often still access affordable services from publicly-funded programs that offer sliding scale fees.

Mental Health America currently ranks Illinois 11 out of 51 states for quality of mental health care and 18 out of 51 states for access to mental health care. Even so, 55 percent of people in Illinois who have a mental health condition dont get treatment, often because they dont know accessible options are available nearby.

Feds Ok Illinois Expansion Of Medicaid Mental Health Coverage

Illinois To Use $2B In Medicaid Funds For Behavioral Health Programs

Gov. Bruce Rauner announces the new program at an event in Chicago on May 7, while HFS Director Felicia Norwood, left, looks on.

lllinois’ three million Medicaid users will soon have more access to mental health and substance abuse treatments. Officials in Washington, D.C. okayed a new state program that sets aside about $2 billion in Medicaid funds for the services.

If youre someone who uses Medicaid, youre covered if you go to the doctors office or hospital when you get physically sick. But if you have a mental health issue like depression, for example, and want a counselor to come visit you at home, its a different story.

Healthcare and Family Services Director Felicia Norwood says thatll change with the new program. Money will now be set aside to help people pay for things like in-home counseling and even addiction recovery.

Mental health, behavioral health is something that impacts everyone in our state. It knows no geography, young and old.

The move is part of the Rauner administrations effort to spend Medicaid dollars on less-expensive outpatient services. Governor Rauner himself says expanding those kinds of treatments will set the state apart.

Were gonna become national leaders in the way mental health services are provided to the residents of our state,” he explained. “Were gonna become much more proactive in preventive health services and community-based health services.

Story source: Illinois Public Radio

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The Medicaid Technical Assistance Center :

Medicaid provides crucial behavioral and physical healthcare services that position Illinois young people and families for higher-quality, more self-sufficient lives. However, when Illinois transitioned to Medicaid managed care to improve healthcare outcomes for low-income individuals and reduce healthcare costs, the proper provider readiness supports were not put in place. This has slowed providers capacity to build the infrastructure needed to bill MMC, meaning that Medicaid beneficiaries experience poor network adequacy including limited or no choice of providers, and a lack of access to providers that can provide culturally competent care.

To support the billing infrastructure of behavioral health providers — mainly their efforts to efficiently bill MMC — ICOY has piloted Illinois first Medicaid Technical Assistance Center program. The purpose of the MTAC is to help all Illinois healthcare providers thrive in a Medicaid Managed Care billing environment. ICOY is taking a systems approach, and piloting supports for any healthcare provider who can or is serving Medicaid-eligible individuals in Illinois. We plan to ease the burden of Medicaid billing for providers at all readiness levels from those who have never billed Medicaid, to those who are in value-based payment arrangements.

Get MTAC and Medicaid Policy Updates:

Medicaid Billing Readiness Survey:

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Finding A Rehab Center That Accepts Illinois Medicaid

Illinois Medicaid provides addiction treatment coverage for a large percentage of its policyholders, with substance abuse treatment making up half of the states Medicaid spending.

With recent expanded coverage for addiction and mental health treatment services through Illinois Medicaid, finding an adequate alcohol or drug rehab program may be easier now than in previous years.

To learn more about Illinois Medicaid coverage and the rehab centers that accept it, contact us today.

Written by the Addiction Resource Editorial Staff

Addiction Resource aims to provide only the most current, accurate information in regards to addiction and addiction treatment, which means we only reference the most credible sources available.

These include peer-reviewed journals, government entities and academic institutions, and leaders in addiction healthcare and advocacy. Learn more about how we safeguard our content by viewing our editorial policy.

  • HealthInsurance.org Illinois and the ACAs Medicaid Expansion

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Illinois Medicaid Insurance Coverage For Addiction And Mental Health Treatment

Illinois residents who have been deemed eligible for Medicaid will first have to enroll in one of the programs managed care plans.

Depending on where they reside in the state, all Medicaid residents have access to at least five different plans.

Managed care plans for Illinois Medicaid are provided through commercial insurance carriers and include the following:

  • Blue Cross Blue Shield of Illinois
  • NextLevel Health

What Kinds Of Mental Health Providers Are Available In Illinois

Medicaid health plans release " comprehensive"  manual intended to reduce ...

There are many different kinds of mental health providers available in Illinois, including psychologists, clinical social workers, and mental health counselors. As long as the provider is licensed in your state, the factor that matters most to therapy outcomes is the therapeutic alliance, or the relationship you build with your therapist. Common types of therapy provided in Illinois include cognitive therapies, like Cognitive Behavioral Therapy and Dialectical Behavior Therapy , and insight-oriented therapies like psychodynamic therapy. Other providers offer a blend of techniques for a more interpersonal, holistic approach. Some mental health therapists in Illinois also offer specialized treatment services, like couples therapy, premarital counseling, and family therapy. While most Illinois providers are qualified to treat general challenges, like depression, anxiety disorders, trauma, relationship difficulties, and low self-esteem, for concerns such as substance abuse, personality disorders, and eating disorders, consider seeking expert care. Together with your therapist, youll build a treatment plan that addresses your reasons for seeking therapy and monitor progress toward your wellness goals and overall well being.

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How Can I Find A Therapist In Illinois Who Sees Clients After Hours

Find a therapist who sees clients after hours on Zencare. Many therapists inIllinois offer appointments outside of traditional business hours. Simply filter by Office Hours under More Filters to choose the time of day that works best for you, whether that be early morning before work, in the evenings, or even over the weekend. After hours sessions are a good option for busy individuals, couples, and families dealing with hectic schedules and who need a flexible option for their mental health care.

Illinois Mental Health Services Guide

Many people dont realize that publicly-funded mental health services are available in their state. People looking for free or low-cost counseling often think their only options are counselors in private practice and dont know that publicly-funded providers in their communities may also offer counseling services.

While state-based programs are not for everyone, they are often a great place to start for people who face geographic or financial barriers to therapy. Intake specialists at community mental health programs can help people learn whether they qualify for state-funded services and can refer people who dont qualify to other low-cost programs that may be able to meet their needs.

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  • BetterHelp makes starting therapy easy.
  • At OpenCounseling we have used BetterHelp and think they are a great option.
  • Sign up today and get matched to a licensed therapist online.
  • Get 20% off your first month with the link below.

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Mental Health And Substance Use State Fact Sheets

Throughout the pandemic, many people have experienced poor mental health, with over 30% of adults in the U.S. reporting symptoms of anxiety and/or depressive disorder, up from 11% of adults prior to the pandemic. Negative mental health outcomes have also affected children and adolescents over 20% of school-aged children have experienced worsened mental or emotional health since the pandemic began. Substance use issues have also worsened deaths due to drug overdose increased by nearly 30% from 2019 to 2020, primarily driven by opioids. This increase in mental health and substance use issues comes at a time when resources are already strained, and people with mental health diagnoses often face barriers to care. Among adults with symptoms of anxiety and/or depressive disorder during the pandemic, over 20% report needing, but not receiving, mental health counseling or therapy.

Behavioral Health Crisis Line

Illinois To Use $2B In Medicaid Funds For Behavioral Health Programs

The Behavioral Health Crisis Line is available 24 hours a day, 7 hours a week. This service is offered to help intervene and stabilize during a crisis. Any member having a psychiatric or behavioral health crisis can call this number. A qualified mental health professional will be sent to provide a face-to-face screening.

When should you call the Behavioral Health Crisis Line? Call if there is:

  • Feelings of hopelessness
  • A high level of anxiety or agitation
  • An increase in risky behaviors or substance abuse
  • Suicidal and/or homicidal thoughts

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How Does Paying For Therapy Work In Illinois

There are several options for paying for therapy in Illinois. For many people, the most affordable way to seek mental health services is to look for a provider who is in-network with your insurance. Due to high demand and low availability, in-network providers often have long waitlists to widen your options and start therapy sooner, you might also consider looking for an out-of-network provider. When you see an out-of-network therapist inIllinois, you can ask for a sliding scale if you are unable to afford their typical session fees, or seek reimbursement from your insurance company if you have a PPO or POS plan. For clients who have an insurance plan with a high deductible and low medical costs, therapy costs are often comparable when you see a therapist in- or out-of-network. While paying for therapy can be a substantial investment, its also a great way to improve relationships, boost self-esteem, address symptoms of mental illness, and ultimately live a happier, more self-directed life.

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How Do I Find A Therapist In Illinois Who Offers In

Find a therapist who offers in-person sessions on Zencare. Many therapists inIllinois have resumed offering in-person sessions you can filter by In-Person to find a provider who is accepting new clients for in-office sessions. You can also search by map to find providers in Illinois near you. While some clients prefer in-person sessions because they offer a safe, neutral ground for the session to take place, for the widest range of therapist options, consider expanding your search to also include providers licensed in your state who offer telehealth, or therapy sessions via remote video call.

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Does Insurance Cover Therapy In Illinois

Yes, most Illinois health insurance carriers provide mental health benefits that cover therapy. However, the exact amount of coverage will vary based on the plan details and whether the selected provider is in-network or out-of-network with your insurance. If the therapist is in-network with your insurance, youll pay only a copay at each session after meeting your annual deductible. If the therapist is out-of-network with your insurance, you may still be able to receive reimbursement after paying the fee at the time of therapy session. If you have a PPO or POS insurance plan, you can likely receive some reimbursement when you see a therapist out-of-network in Illinois. If you have an HMO, EPO, or Medicaid/Medicare plan, you likely cannot receive reimbursement, and would be responsible for the full out-of-network session fee. Note that services designed to treat topics which are not diagnosed mental health conditions, such as couples counseling and life coaching, are not typically covered by health insurance. The potential mental health provider must also be a licensed therapist in your state for the insurance company to cover services.

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