State Policies for Behavioral Health Services Covered under the State Plan

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June 2016 | Benefits

All state Medicaid programs offer certain mandatory behavioral health services such as medically necessary inpatient hospital services, outpatient hospital services, rural health clinic services, nursing facility services, home health services, and physician services. States may also choose to provide coverage for additional optional services under state plan authority, most commonly under the so-called rehab option which allows states to cover a wide variety of recovery-oriented services to individuals in the community for both mental health and substance use disorders (SAMHSA 2013).

To identify the services offered in the states through state plan authority, MACPAC reviewed Medicaid state plans, provider manuals, billing manuals, fee schedules, and other publicly available official documents in September 2015. We grouped services into categories based on the home and community-based services (HCBS) taxonomy published by the Centers for Medicare & Medicaid Services (CMS) in 2014. Services were grouped into the following categories: case management, round-the-clock services, supported employment, day services, home-based services, and caregiver support. (See the methodology and definitions tab of the document for more information.) In addition, we gathered information on additional services, such as inpatient and outpatient detoxification, Institution for Mental Diseases (IMD) coverage for eligible age groups, other inpatient services and partial hospitalization services, psychotherapy and other therapies, peer support, crisis intervention, telemedicine, and substance use disorder (SUD) treatment drugs.

This document does not include waiver services or additional services provided by managed care organizations, unless the managed care organization serves all beneficiaries in the state. For purposes of this compendium, behavioral health services covered in California and Pennsylvania were determined for a large county in these states to show an example of which services are available to Medicaid beneficiaries in the state, as services can vary at the county level.

Most services are subject to limits of amount, duration, and scope; such limits may vary by state and service. Several states do not differentiate between mental health and substance use services. If a state did not explicitly differentiate between the services, for purposes of this document, we did not differentiate either.

Publication Type: State Policy Compendia

Tags: behavioral health, case management, crisis, home and community-based services (HCBS), hospital outpatient department services, Inpatient psychiatric hospital, prescription drugs, substance use treatment, waivers