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Mental Health Benefits in Non-Medicaid SCHIP Plans

September 2003

State	Inpatient	Outpatient	Other Benefits
Alabama	30 days/calendar year	20 visits/calendar year;  100%	Case management/care coordination
Arizona	Covered when medically necessary	Covered when medically necessary	Case management/care coordination
Arkansas	Not Covered	No maximum benefits	Case management/care coordination covered only in an acute care hospital
California2*	30 days/benefit year	20 visits/benefit year	Case management/care coordination
Colorado3	45 days/year; may be converted to outpatient visits at 2:1 rate	20 visits/year	Case management/care covered when medically necessary
Connecticut	60 days/year; 100% coverage for all conditions except mental retardation, learning and motor skills, communication and relational problems, caffeine-related disorders and other conditions;  for these, up to 35 days of inpatient hospital benefits can be converted to outpatient services (1 inpatient hospital day is equivalent to 1 sub-acute day, 2 partial hospitalization days, 2 intensive outpatient visits or 3 outpatient visits)	Limited to evaluation, crisis intervention, and treatment for conditions that, in the judgment of a physician, are subject to significant improvement $5 copayment except for conditions not covered under inpatient care; on these stated conditions: 30 visits/year 1-10 visits: 100% 11-20 visits: $25 copayment 21-30 visits: lesser of $50 copayment or 50%	Supplemental coverage available through HUSKY Plus for children who meet the criteria for the HUSKY Plus Behavioral Health Plans (see Selected Benefits for Children with Special Health Care Needs in Non-Medicaid SCHIP Plans)
Delaware4	Open-ended inpatient based on medical need	30 outpatient visits by MCO; additional visits provided as wraparound benefit by state division of child mental health
Florida	30 days/year	40 days/year
Georgia	Limited to short-term acute care in general acute care hospitals up to 30 days/admission; residential or other 24-hour therapeutically planned structural services are covered through the Multi-Agency Team for Children Program	Services covered through community mental health centers, limitations specified in the Department of Human Resources standards; licensed applied psychologists, limited to 24 hours/year; psychiatrists, limited to 12 hours/year
Illinois	Limits not specified	Limits not specified
Indiana	FY 2001, FY 2003 covered, except when provided in an institution for the treatment of mental diseases with more than 16 beds	FY 2001, FY 2003 covered, except when provided in an institution for the treatment of mental diseases with more than 16 beds
Iowa	60 days/year for Iowa Health Solutions; 30 days/year for John Deere and Wellmark	20 visits/year for Iowa Health Solutions; 30 days/year for John Deere and Wellmark
Kansas	Covered when medically necessary	Covered when medically necessary
Kentucky5*	No limits if medically necessary; prior authorization and concurrent review required; pre-set criteria established by Department for Medicaid Services	No limits provided, must be medically necessary; prior authorization required under Impact Plus	Case manager available under Impact Plus
Maine	Same as Medicaid	Same as Medicaid
Maryland	60 days/year	Limits not specified
Massachusetts	Covered subject to medical necessity	Covered subject to medical necessity
Michigan	Covered when medically necessary	Covered when medically necessary
Minnesota	Same as Medicaid	Same as Medicaid	Same as Medicaid
Mississippi	30 days/benefit period; psychiatric treatment as medically necessary; prior authorization required	52 visits/benefit period; prior authorization required
Montana	21 days/benefit year (Oct. 1-Sept. 30); partial hospitalization may be exchanged at a rate of 2:1	20 visits/benefit year (Oct. 1-Sept. 30)
Nevada	Prior authorization required for residential treatment centers, placements and extended stays	24 sessions/calendar year
New Hampshire	15 days/year of combined mental health and substance abuse services	20 visits/year of combined mental health and substance abuse services	Case management/care coordination
New Jersey	Plans B and C, limits not specified; Plan D, limited to 35 days/year	Plans B and C, limits not specified; Plan D, limited to 20 visits/year
New York	30 days/year of combined mental health, inpatient detoxification and substance abuse services	60 days/year of combined mental health, alcoholism and substance abuse services
North Carolina	Requires prior authorization from mental health case manager	26 visits/year; additional visits require  authorization from mental health case manager
North Dakota6	60 days of mental health and substance abuse inpatient hospital treatment combined; up to 120 days of residential treatment; prior authorization is required	Partial hospitalization up to 120 days for mental health and substance abuse combined; prior authorization required; up to 46 days of inpatient care can be traded for outpatient care at the rate of 2 outpatient days for 1 inpatient day	Case management/care coordination
Oregon	Medically necessary services listed on the Oregon Health Plan Prioritized List and funded by the state legislature are covered	Medically necessary services listed on the Oregon Health Plan Prioritized List and funded by the state legislature are covered	Developmental assessments; psychological services and evaluations through the Oregon School-Based Health Services Program
Pennsylvania	90 days/year in combination with medical inpatient		Case management; interventions in home, school or other community setting
South Dakota	Prior authorization required	Unlimited services from physicians and community health centers; 40 hours of individual therapy/year
Texas	With prior authorization for initial and continued stay; 30-day limit	30 days/calendar year; authorization required for longer stays	Case management/care coordination
Utah	30 days/plan year of combined substance abuse and mental health benefits	30 visits/plan year of combined substance abuse and mental health benefits	Case management/care coordination
Vermont7	Prior authorization required; limits not specified	Authorization required after 16 sessions for services provided by master’s and Ph.D. level
Virginia8	Inpatient mental health services covered for up to 30 days per calendar year, including partial day treatment services; inpatient hospital services may include room, meals, general nursing services, prescribed drugs, and ER services leading directly to admission	Outpatient mental health clinic services and outpatient substance abuse services covered; psychiatric and substance abuse services limited to no more than a combined total of 50 medically necessary visits for treatment with a licensed mental health professional each calendar year	The following community-based mental health services also are covered, but are “carved-out” of Managed Care: day treatment, intensive in-home services, crisis intervention, mental health case management
Washington7, 9	Limits not specified	Limits not specified
West Virginia	30 days/year for inpatient care;  60 visits for partial hospitalization and day programs	26 visits/12 months of coverage
Wyoming	None	None

Key

Inpatient = Includes inpatient psychiatric hospital, residential treatment centers, and inpatient rehabilitation.

Other benefits = Other benefits relevant to mental health.

Outpatient = Includes outpatient psychiatric hospitals, counseling, individual/group/family therapy, and office visits.

Notes

* Did not respond to survey.  Information current as of September 30, 2001.

1 This table describes the benefits offered through the state-designed programs in each state.  Entries for combination states contain information only on the state-designed component of the plan.  Medicaid expansion states and components are not included in this table because these states offer the same mental health benefits as the state's Medicaid program.

2 In California, children with serious emotional disturbances are referred by the health care plan to the county mental health department for treatment.

3 In Colorado, treatment for neurobiologically based mental illnesses are treated as any other illnesses and are not subject to inpatient and outpatient limitations.

4 Delaware's inpatient and outpatient services are provided by the Department of Services to Children, Youth and their Families once the SCHIP benefit ends.

5 “Impact Plus” is Kentucky’s program of community-based behavioral health services provided through an agreement between the state’s Medicaid Department and its Department for Public Health.  To be eligible for inpatient or outpatient Impact Plus-covered substance abuse services, recipients must have a current mental health diagnosis that is the primary reason for the treatment.  Substance abuse is treated as a dual diagnosis only.

6 North Dakota's case management/care coordination benefits are for seriously emotionally disturbed, developmentally disabled and pregnant women only.

7 Vermont and Washington provide the same services as their Medicaid programs.

8 Inpatient and outpatient services may include diagnostic services and mental health services, including detoxification, individual psychotherapy, group psychotherapy, psychological testing, counseling with family members to assist in the patient’s treatment and electroconvulsive therapy.

9 Washington’s mental health services are limited through the state’s regional support networks.

Sources: Data compiled from State Children’s Health Insurance Program (SCHIP) plans, amendments, evaluations and annual reports submitted to  the Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration), Sept. 30, 2001, and an additional survey of plans conducted by the National Conference of State Legislatures in October 2003.

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