Mental Health Services

Mental health services are the direct outpatient treatment of mental health conditions that are provided by licensed professionals. Component services are crisis interventions; counseling; individual, family, or group therapy sessions; the prescription of psychotropic medications or explanations about the use and management of medications; and combinations of therapeutic approaches to address multiple problems.

Which HHS programs might be used to provide these services?

Medicaid

Medicaid pays for a broad range of mental health services provided by qualified providers to people who are enrolled in Medicaid coverage. While Federal law does not include explicit provisions regarding the exact types of mental health services that are available, all State Medicaid programs provide some form of mental health services to enrollees. Each State must develop a State Medicaid Plan that describes the benefits its program will provide, (including what optional services will be covered), and must have this plan approved by the U.S. Department of Health and Human Services’ (HHS’s) Centers for Medicare and Medicaid Services (CMS).

Federal law and CMS regulations prescribe a core set of benefits that each State must provide. Mandatory benefits include inpatient and outpatient hospital services; nursing facility, rural health clinic, Federally Qualified Health Center (FQHC) services, prenatal and freestanding birth center services; physician, nurse-midwife, and certified pediatric and family nurse practitioner services; home health, family planning, tobacco cessation, laboratory, X-ray services; and early and periodic screening, diagnostic, and treatment (EPSDT) services for children under age 21. State plan services, managed carewaivers, and Early Period Screening, Diagnostic and Testing (ESPTD) are all vehicles by which States can support community mental health services in Medicaid.

States may decide to cover additional optional services. Optional benefits include clinic services; prescription drugs; rehabilitative services; case management; home and community based services (HCBS) as an alternative to institutionalization; physical, occupational, speech, hearing, and language therapy; diagnostic, screening, and a variety of other services that may be approved by CMS.  States may limit eligibility for certain additional services to specific groups of people. States may modify their Plan’s coverage of services beyond the federally-mandated core, including changes in provider qualifications, definitions of covered services, target populations, and payment mechanisms for optional benefits.

For both Mandatory and Optional benefits, an individual still must meet “medical necessity” criteria to be eligible for particular covered services. These criteria take into consideration a person’s diagnosis and other factors such as functional impairments.

Who is eligible?

Medicaid is an “entitlement” program, meaning that eligible individuals are entitled to receive covered health, behavioral health, and long-term care services as defined within the State’s approved Medicaid Plan. The Affordable Care Act expands Medicaid eligibility to persons with incomes under 133% of the Federal Poverty Level (FPL), and allows States to determine eligibility under their Medicaid plans.

How is it financed?

The Medicaid program operates under broad State discretion, and is funded by a combination of State and Federal matching funds.  Each State must develop a State Medicaid Plan that describes the benefits its program will provide.  Many Medicaid benefits, including those most likely to cover behavioral health services delivered in settings such as shelters, drop-in centers, or supportive housing programs, are “optional” benefits, meaning that States can decide if and how to cover these services.  Federal spending on Medicaid is considered a “mandatory” program, meaning that the federal government matches State spending for all covered services provided to eligible individuals.  This makes Medicaid distinct from other HHS health and supportive services programs, which operate as “discretionary” programs with funding levels that can change from year to year based on actions taken by Congress and the President.

Where can I learn more about using Medicaid to pay for mental health services?

SAMHSA Community Mental Health Services Block Grant (MHBG)

MHBG is given to States to address their unique behavioral health issues.  There are two main SAMHSA block grants, the Substance Abuse Prevention and Treatment Block Grant (SABG) and the Community Mental Health Services Block Grant (MHBG).  Specifically the Block Grant funds are directed toward four purposes:

  • Fund priority treatment and support services for individuals without insurance or for whom coverage is terminated for short periods of time.
  • Fund those priority treatment and support services not covered by Medicaid, Medicare, or private insurance for low income individuals and that demonstrate success in improving outcomes and/or supporting recovery.
  • Fund primary prevention - universal, selective and indicated prevention activities and services for persons not identified as needing treatment.

Who is eligible?

The target population of the funding is adults and older adults with Serious Mental Illness (SMI) and children with Severe Emotional Disturbances (SED), as defined in the Federal Register.

How is it financed?

States apply for the grant funding through SAMHSA and determine how to spend the funds for prevention, treatment, recovery supports and other services that will supplement services covered by Medicaid, Medicare and private insurance.  States fund a network of providers to deliver services, sometimes through a formula funding process.

Where can I find a local MHBG provider with which to partner?

MHBG Grantees by State

Health Care for the Homeless Programs and Community Health Centers

Health Care for the Homeless Programs and Community Health Centers deliver primary care and preventive health services as well as oral health services and services to address substance use disorders and mental health.  Some behavioral health services may be delivered directly or through partnerships or referral arrangements with other providers of treatment services. Health Care for the Homeless programs also offer extensive outreach, engagement and case management services, and they often offer transportation and interpretive services, to help people access health care and behavioral health services, as well as assistance with accessing public benefits. Health Care for the Homeless programs are targeted to persons who are homeless and local programs are encouraged to participate in the local CoC planning process.  The first step for any Continuum should be to reach out to any HCH program in its jurisdiction and connect to current services.

Who is eligible?

Individuals and families who are literally homeless as well as those living in hotels or motels, transitional housing, or permanent supportive housing.

How is it financed?

These programs receive grant funding from the Health Resources and Services Administration (HRSA) as well as a grant under Section 330 of the Public Health Service Act, qualifying them as Federally Qualified Health Centers (FQHCs). FQHCs must serve an underserved area or population, offer a sliding fee scale, provide comprehensive services, have an ongoing quality assurance program, and have a governing board of directors. In addition, they receive Medicaid reimbursement for some of the services they provide to people who are enrolled in Medicaid.

Where can I find a local HCH provider with which to partner?

Healthcare for the Homeless Grantees

Where can I find a local Community Health Center with which to partner?

Find a Health Center

PATH (Projects for Assistance in Transition from Homelessness)

PATH programs provide services to people who are experiencing mental illness and are experiencing homelessness or risk of homelessness.  PATH eligible services include habilitation and rehabilitation services, case management services, referrals, and housing support services, as well as outreach and a range of other behavioral health services. PATH programs are administered by the State.  State mental health authorities select providers, usually through a competitive process.  PATH providers are encouraged to participate in the local CoC process and all PATH providers are in the process of transitioning data and reporting practices to participate in HMIS.”

Who is eligible?

Individuals determined to be experiencing serious mental illness or co-occurring serious mental illness and substance abuse disorder; and (2) experiencing homelessness or is at imminent risk of homelessness.

How is it financed?

PATH is administered by the Substance Abuse and Mental Health Services Administration (SAMHSA). PATH is a formula grant provided to all 50 S tates, the District of Columbia, and US Territories, and allocated to more than 480 local organizations.

Where can I find a local PATH provider with which to partner?

SAMHSA’s PATH Programs

Cooperative Agreements to Benefit Homeless Individuals (CABHI)

This SAMHSA services program supports infrastructure development at the community level. The major goal of the Cooperative Agreements to Benefit Homeless Individuals program is to ensure that the most vulnerable individuals who are chronically homeless receive access to sustainable permanent housing, treatment, and recovery supports through mainstream funding sources. CABHI funds support three primary types of activities: 1) behavioral health, housing support, and other recovery-oriented services not covered under a State's Medicaid plan; 2) coordination of housing and services for chronically homeless individuals and families at the State and local level which support the implementation and/or enhance the long-term sustainability of integrated community systems that provide permanent housing and supportive services; and 3) efforts to engage and enroll eligible persons who are chronically homeless in Medicaid and other mainstream benefit programs (e.g., SSI/SSDI, TANF, SNAP). 

Who is eligible?

Persons who experience chronic homelessness with substance use disorders or co-occurring substance use and mental disorders.

How is it financed?

The Substance Abuse and Mental Health Services Administration (SAMHSA), the Center for Substance Abuse Treatment (CSAT), and the Center for Mental Health Services (CMHS) provided grant funding to communities and states.

Where can I find CABHI grantees with which to partner?

CABHI Grantees

Which states received CABHI-States funding?

The Substance Abuse and Mental Health Services Administration (SAMHSA), the Center for Substance Abuse Treatment (CSAT), and the Center for Mental Health Services (CMHS) recently modified its Cooperative Agreement to Benefit Homeless Individuals (CABHI), which provided grants directly to entities that provide services, into the ‘CABHI-States’ program focused on building State infrastructure and improving the capacity of state treatment service systems to provide services essential to ending chronic homelessness among people with substance abuse, mental health, and/or co-occurring disorders.

For FY 2013, eligible applicants for CABHI-States are the single State agencies for substance abuse in the District of Columbia (D.C.) and the following States: Arizona, California, Colorado, Florida, Georgia, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Michigan, Nevada, New York, Oregon, Pennsylvania, Texas, and Washington. Services to be created through CABHI-States should include recovery-oriented services not covered under the State’s Medicaid plan including: treatment services; permanent supportive housing; peer supports; CMHS-funded peer navigator(s); assistance with streamlining application processes for mainstream benefits; and more. 

SAMHSA awarded eleven grants for up to $711,818 per year for up to 3 years.   The States that were funded are: Arizona, Georgia, Hawaii, Washington, Louisiana, Illinois, Pennsylvania, Massachusetts, Michigan, Colorado and Nevada. Each CABHI-State grantee will implement its own approach to issuing funding for services. Organizations seeking funding for services should contact the single State agencies who received an award for more information. 

Other HHS programs

Community Services Block Grant (CSBG)

CSBG funding is used to provide a broad range of services and activities to reduce poverty. Services can include health-related services as well as substance use disorder services.  In most cases, CSBG funds are allocated to Community Action Agencies (CAAs). 

Who is eligible? 

The Federal Poverty Guidelines must be used as the primary criterion in determining income eligibility. In order to receive assistance under any CSBG project involving direct services, an applicant's total household income must not exceed 125% of the poverty level. Household is defined by the Bureau of Census as consisting of all persons who occupy a housing unit (i.e., house or apartment), whether they are related to each other or not. Total household income is based on income at the time of application.

How is it financed?

CSBG funding is provided as a block grant to States, tribes and territories.  States pass through no less than 90 percent of block grant funds to a network of local entities, primarily Community Action Agencies (CAAs), and some local governments, migrant and seasonal farm worker organizations, that delivery the services in the communities.  CAAs are non-profit agencies created as a network of entities by the Economic Opportunity Act of 1964.  States contract with CAAs to plan, develop, implement, evaluate and provide local services. 

Where can I find CSBG grantees with which to partner?

CSBG Grantees by State

Community Action Agencies by State and County

Social Services Block Grant (SSBG)

SSBG funding is allocated to each State or territory to meet the needs of its residents through locally relevant social services, through programs that help people to achieve or maintain economic self-sufficiency to prevent, reduce or eliminate dependency on social services. Services can include health-related services as well as substance use disorder services. 

Who is eligible? 

Each State or territory has the flexibility to determine what services (within the broad service categories) will be provided; set the eligibility limits (to low-income households) to receive services; and determine how funds are distributed among various services within the State.

How is it financed?

SSBG funding is allocated to each State or territory to meet the needs of its residents through locally relevant social services, through programs that help people to achieve or maintain economic self-sufficiency to prevent, reduce or eliminate dependency on social services.

Where can I find SSBG grantees with which to partner?

SSBG Grantees by State

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