Your Mental Health Benefits
The services covered by your State Medicaid benefit plan are listed on the next few pages. If you want a service not covered included in the list, please contact your local Mental Health Center or Venture Member Services to see if the service can be covered. Not all services are available at every provider location. If you have questions about whether the service you need is available by your local provider, ask them, or call Venture Member Services at 1 (888) 357-0016.
Your state benefit plan covers you as long as there is Medical Necessity present and as long as you are enrolled in the State Medicaid Health Plan. Not all services listed are available to all members. Some of the following services are “Alternative Services” which you may or may not be eligible for. Services will only be provided to members that meet the necessary criteria. Not all providers can provide all the services listed. Please talk to your local Community Mental Health agency to find out what services are available to you.
Covered State Medicaid Services
Benefit |
Explanation |
| Inpatient Hospitalization |
All services in a psychiatric hospital. |
| Crisis Residential Services |
A facility that provides a short-term care for customers with mental illness. The service provides an alternative to an inpatient hospital admission for those experiencing severe psychiatric crisis. |
Outpatient Partial Hospitalization Services |
Short term, intensive services that are provided through licensed non-residential treatment program that provides several services to adults diagnosed with a serious mental illness, or minors diagnosed with having serious emotional disturbance, who do not require constant mental health care. |
| Intensive Crisis Stabilization Services |
Structured treatment and support activities provided. Services by a mental health crisis team and designed to provide a short-term alternative to inpatient psychiatric services. |
| Crisis Interventions |
24-hour, 7-day per week crisis services that are available to respond to persons who have a crisis or an urgent situation requiring instant attention. |
Clubhouse Programs |
Group services provided in a facility by other persons with mental illness designed to learn, share and improve coping skills, as well as build supports. |
|
Assessment and Evaluation |
| Psychiatric Evaluation |
A face-to-face evaluation done by a psychiatrist. |
| Psychological Testing |
Tests done by a psychologist to help you determine your needs and how to treat them. |
Other Assessments
And Testing |
Other professional assessments or tests, other than psychological tests, that are given to determine the level of functioning and treatment needs. |
Applied Behavioral
Health Services |
Development, review, and approval of a treatment plan.
|
| Medication Review |
Looking at what medications have been prescribed for you and seeing how well they are working. |
| Medication Administration |
A licensed medical professional giving prescribed medications to someone. |
| Mental Health Therapy |
Includes child therapy, family therapy, group therapy, and individual therapy designed to improve functioning and your relationships with other people. |
| Occupational Therapy |
Activities prescribed by a physician, and provided by a trained OT, to decide the member’s need for services or to suggest a course of treatment. |
| Physical Therapy |
Includes the evaluation and the treatment as provided by a trained physical therapist/assistant and prescribed by a physician. |
Speech Hearing and
Language Therapy |
Includes the evaluation and treatment by a speech pathologist or audiologist and referred by a physician. |
| Health Services |
Includes health assessment, treatment, and professional treatment monitoring. |
| Person-Centered Planning |
A process you will go through to decide what goals you want to achieve. The person developing this plan with you will help you decide what services are available to you that will help you achieve these goals. |
Assertive Community
Treatment (ACT) |
Medical or rehabilitative services provided usually on a one-to-one basis in the customer’s home or other community settings by a mental health treatment team designed to prevent the need for more intensive and restrictive services. |
| Case Management |
Services that will help members in getting needed medical, social and educational needs. |
| Home-Based Services |
Services for the entire family based on the specific needs of each family. |
| Personal Care in Specialized Residential Settings |
Services to help people who live in a specialized residential home with daily living skills. |
| Intermediate Care Facility For Individuals With Mental Retardation (ICF/MR) |
Health and rehabilitative services provided in specially licensed facilities of 16 beds or less to beneficiaries with mental retardation or related conditions who need active treatment. |
| Nursing Facility Mental Health Monitoring |
A service for nursing home residents, that follows up after they have been given treatment for emerging mental health problems or needs. |
| Transportation |
Transportation to and from your home in order for you to take part in an approved Medicaid covered service. |
|
Alternative Services
| |
| Extended Observation Beds |
A stay in a psychiatric hospital lasting less than 24 hours |
| Specialized Behavioral Health (Wraparound) Services |
Individually designed set of services, for minors with serious emotional disturbance or serious mental illness and their families, to help keep the child in their home.
|
Peer-Delivered or Operated Support Services |
These are service activities, intended to give customers the chance to learn and share coping skills and strategies, and build self-esteem and self-confidence. Includes customer-run drop-in centers and other peer operated services.
|
Skill-Building Assistance |
Activities that help an individual to get financial independence and/or to engage in meaningful activities. These services provide knowledge and specialized skill development and/or support. |
| Prevention Direct Service Models |
Programs using both individual and group interventions created to reduce the needs for individuals becoming treatment customers of the mental health system. |
| Respite-Care Services |
Services that are provided in the individual’s/family’s home or outside the home to temporarily relieve the unpaid primary care giver. |
| Supported/Integrated Employment Services |
Provide initial and ongoing support services to help you get and keep a job.
|
| Assistive Technology |
Devices or appliances that are not covered under the Medicaid Health Plan, which help the individual to increase his or her activities of daily living. |
| Community Living Supports |
Supports that focus on personal self-sufficiency, independence and integration into the community. |
| Environmental Modification |
Changes to the individual’s or family’s home, vehicle, and/or work environment, to ensure health and safety and/or allow greater independence. |
| Support and Service Coordination |
Services that plan, link, and organize services and providers decided through the person centered planning process. |
| Housing Assistance |
Help with short-term or one time only expenses that the individual’s resources, and other community resources, could not cover. |
| Enhanced Pharmacy |
Doctor-ordered non-prescription or over-the counter items that are not covered by your Qualified Health Plan. |
| Family Support and Training |
Family focused services provided to the family of members who have serious mental illness, serious emotional disturbances or developmental disabilities. These services are meant to help the family relate to and care for the relative with one of these disabilities. |
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