Chapter 9. Medicaid Service Array for Mental Health & Substance Use Disorders
Including Descriptions of Medicaid Specialty Supports and Services
Service Authorization
Services you request must be authorized or approved by the Thumb Alliance PIHP. The PIHP may approve all, some or none of your requests. You will receive notice of a decision within 14 calendar days after you have requested the service during person-centered planning, or within 3 business days if the request requires a quick decision.
Any decision that denies a service you request or denies the amount, scope or duration of the service that you request will be made by a health care professional who has appropriate clinical expertise in treating your condition. Authorizations are made according to medical necessity. If you do not agree with a decision that denies, reduces, suspends or terminates a service, you may file an appeal.
Notes on Getting Services
If you are a Medicaid beneficiary and have a serious mental illness, or serious emotional disturbance, or developmental disabilities, or substance use disorder, you may be eligible for some of the Mental Health Medicaid Specialty Supports and Services listed below. Before services can be started, you will take part in an assessment to find out if you are eligible for services. It will also identify the services that can best meet your needs. You need to know that not all people who come to us are eligible, and not all services are available to everyone we serve. If a service cannot help you, your Community Mental Health will not pay for it. Medicaid will not pay for services that are otherwise available to you from other resources in the community. During the person-centered planning process, you will be helped to figure out the medically necessary services that you need and the sufficient amount, scope and duration required to achieve the purpose of those services. You will also be able to choose who provides your supports and services. You will receive an individual plan of service that provides all of this information.
Payment for Services
If you are enrolled in Medicaid and meet the criteria for the specialty mental health and substance abuse services, the total cost of your authorized mental health or substance abuse treatment will be covered. If you are a Medicaid beneficiary with a deductible ("spend-down"), as determined by the Michigan Department of Human Services (DHS), you may be responsible for the cost of a portion of your services.
Services for Habilitation Supports Waiver (HSW) & Children's Support Waiver Participants
Substance Use Disorder Services
