Mental Health Services with Medicare and Medicaid

May was Mental Health Awareness Month.  Mental health and well-being are always important, and the added stressors of COVID-19 have increased the need for mental health awareness.  Medicare and Medicaid cover a variety of mental health and substance use disorder treatment services. 

Medicare Part A pays for inpatient psychiatric and substance use disorder services.  Medicare Part B covers outpatient mental health and substance use disorder services.  Part B mental health services include one depression screening per year by a primary care physician, individual and group psychotherapy, family counseling, testing to find out if you’re getting the services you need, psychiatric evaluation, medication management, certain prescription drugs such as injections, diagnostic testing, and partial hospitalization treatment.  Part B substance use disorder services include outpatient counseling and treatment, and medication assisted treatment such as methadone and buprenorphine that can be obtained at certified opioid treatment programs. Medicare Part D covers an array of medications for treatment of mental health diagnoses.

Medicare Advantage plans may cover additional services; beneficiaries should check their Medicare Advantage plan’s member handbook.  Medicare beneficiaries enrolled in a Medicare Advantage plan must access behavioral health providers in their plan’s network. 

Medicaid covers even more mental health and substance use disorders services than Medicare (Individuals with both Medicare and Medicaid coverages must coordinate access to services and can call PHLP’s Helpline for assistance).  Pennsylvania’s Medicaid Behavioral Health Managed Care plans are responsible for authorizing and providing mental health inpatient hospitalization, partial hospital programs, crisis intervention services, peer support services, outpatient therapy, and targeted case management.  Children and youth (under age 21) can also receive family-based mental health services, intensive behavioral health services and residential treatment facility services.  Substance use disorder services include inpatient detox, inpatient drug and alcohol treatment, outpatient services and methadone maintenance.  Medicaid Behavioral Health Managed Care plans may also offer additional services such as psychiatric rehabilitation, assertive community treatment and certified recovery specialists.  Medicaid recipients should check with their behavioral health plans to find out about additional services offered in their county.

Medicaid behavioral health services can be delivered remotely by means of telecommunications technology (telehealth).  The state Office of Mental Health and Substance Abuse Services (OMHSAS) released an updated Bulletin expanding use of telehealth in February 2020.  OMHSAS issued a May Memorandum (after Governor Wolf’s emergency disaster declaration) clarifying the expanded use. 

The state Department of Human Services (DHS) also launched a statewide Support & Referral Helpline staffed by skilled and compassionate staff who are available 24/7 to assist Pennsylvanians struggling with anxiety and other challenging emotions due to the COVID-19 emergency and refer them to community-based resources that can further help to meet individual needs.  The toll-free, round-the-clock support line is officially operational. The number to call is 1-855-284-2494. For TTY, dial 724-631-5600.

Our readers are encouraged to take care of their physical and mental health during these especially difficult times.  Individuals with Medicaid or Medicare and Medicaid having difficulty accessing mental health or substance use disorder services can contact PHLP’s Helpline at 1-800-274-3258.