Medicaid Mental Health Services

Medicaid is a federal- and state-funded, state-administered health program that aims to help people who cannot afford to pay for medical care. Medicaid makes it possible for them to seek medical attention and stay healthy. This program is available to low-income individuals or families who meet eligibility requirements recognized by federal state law. Medicaid does not pay the insured directly, but rather, pays the health care providers directly.

Medicaid covers almost all types of medical needs but it was never designed as a mental health program. In the recent years, though, Medicaid has been responsible in financing for mental health services.

States have considerable freedom in determining their Medicaid programs especially with regards to Medicaid Mental Health Services. Although States Medicaid programs meet the required Federal guidelines in health service coverage, the Federal law and regulations give States many options.

There were two programs that were approved that focused on serving individuals with mental health illness.

Ø  Montana’s 1915 (c) Home and Community-Based Services Waiver for Adults with Mental Illness.

In December 1996, the Behavioral Health Waiver for Adults with Severe Disabling Mental Illness (SDMI Waiver) was approved by CMS. This particular waiver was intended for clients who are 18 years and above. They have a choice of receiving long-term care in a community setting instead of a nursing home set-up. Even though the client chooses a community setting rather than nursing home, he/she must receive the same level of care that he/she will normally get in a nursing home. And also, the client must live in an area where SDMI Waiver is available.

The main objective of SDMI Waiver is recovery and rehabilitation. The client is also encouraged to accept personal responsibilities for services and preferred outcome. The State will also ensure that the Home and Community Based services are capable of effectively serving clients with SDMI Waiver.

There are three geographical areas where SDMI Waiver will be available. These are: Yellowstone County, Silver Bow County and Cascade County.

Yellowstone County includes counties in Big Horn, Carbon, Sweet Grass and Stillwater. Silver Bow County includes counties of Beaverhead, Deer Lodge, Powell and Granite. Cascade County includees counties of Blaine, Glacier, Liberty, Hill, Teton, Chouteau, Toole and Pondera.

The services included in SDMI Waiver package are: Case Management, Chore, Homemaker, Residential Habilitation, Day Habilitation, Adult Day Health, Personal Assistant and Specially Trained Attendant Care, Chemical Dependency Counseling, Dietitian/Nutrition/Meals, Habilitation Aide, Personal Emergency Response Systems, Private Duty Nursing, Illness Management and Recovery and Wellness Recovery Action Plan.

Ø  Iowa’s 1915(i) State Plan Amendment

The State Plan Home and Community Based Amendment allows clients to obtain home and community based services through the State plan instead of a waiver. Iowa was actually the first State to receive approval to add 1915 (i) service to its State plan. It was effective on January 1, 2007.

Iowa’s State Plan includes statewide Case Management Services and Habilitation Services. The Habilitation Services include home-based Habilitation, Day Habilitation, Prevocational Habilitation and supported employment. For individuals to receive these services, they should have a need for assistance for continuing or intermittent basis for at least two years in at least two of the following criteria:

  • Show extreme inability establish or maintain a personal social support system;
  • Require financial assistance for out-of-hospital maintenance and may be unable get this assistance without help;
  • In need of basic living skills such as managing finances, self-care, cooking and other housekeeping chores and medication management;
  • Display social behaviors that are deemed inappropriate and thus need an intervention.

It is best to consult with your local health care to find out more about Medicaid Mental Health Services.