The US Medicaid program requires that all states must screen and treat Medicaid-eligible children for mental health issues. But that wasn’t always the case in Massachusetts.
A BRIEF HISTORY
In 2001, a federal class action suit was filed against the Commonwealth of Massachusetts because families of children receiving Medicaid (called MassHealth) claimed the state was not properly evaluating and meeting the needs of children around mental and social-emotional health.
In 2006, in the now-famous Rosie D. decision, the US District Court found that those children who qualified for MassHealth were in fact not adequately evaluated and treated around their psychiatric, behavioral, and emotional disabilities. The state of Massachusetts was then mandated to comply with the Medicaid Act’s Early and Periodic Screening, Detection, and Treatment (EPSDT) policy.
In response, the state created the Children’s Behavioral Health Initiative (CBHI), which is now responsible for screening and treating children age 2 thru 21 who a) qualify for MassHealth and b) require mental health services.
A CLOSER LOOK INTO CBHI SERVICES
CBHI allows a range of services to support children and families including:
- Intensive Care Coordination (ICC)—to organize providers who are working with a child and provide resources and referrals
- In-Home Therapy (IHT)—a trained adult-clinician to support the child and family the community
- Family Support and Training (FS&T and/or ‘Family Partner’)
- In-Home Behavioral Services (IHBS)—including functional behavioral assessment
- Therapeutic Mentoring (TM)—a trained adult mentor who can support the child in the community (for children 8 and older)
- Mobile Crisis Intervention (MCI)—24 hour access to face-to-face response for youth, including safety planning and referrals
In order to get these services, MassHealth must agree that they are medically necessary. You can help by giving them proof of your family member’s social, emotional, or behavioral disabilities. This can include diagnoses, evaluation reports, or letters from therapists.
There is one version of the assessment for children ages 2-4 and another assessment for children 5 through 21. Eligible youths may receive these services until their 21st birthday.
HOW TO ACCESS CBHI SERVICES
CBHI services are offered after a referral and subsequent evaluation for eligibility.
To get a referral, speak with your child’s primary care provider and request a behavioral health screening. You can also request an evaluation by a mental health provider.
To qualify, children must demonstrate a Serious Emotional Disturbance (SED) What does that mean?
The definition of SED under the Individuals with Disabilities Education Act (IDEA), a federal law, states that the child has characteristics over a period of time that adversely affect their learning, including physical symptoms associated with attending school (like stomachaches or headaches), unsatisfactory relationships with teachers and peers, inappropriate feelings for normal situations, pervasive unhappiness, or an inability to learn not related to intellectual, sensory, or health factors.
The federal Substance Abuse and Mental Health Services Administration (SAMHSA) defines it as a youth whose life is affected in the home, school or community around a diagnosable mental, emotional, or behavioral disorder.
If your child is deemed eligible for CBHI, there are several programs which are approved to provide CBHI services in Massachusetts. You can look up programs serving your area here.
Visit the free Exceptional Lives Health Insurance Guide, to learn more about CBHI services in Massachusetts: