Paying for Services

There are various ways to pay for mental healthcare services in Elkhart and St. Joseph County. These are explained below:

Private/Group Insurance may be provided by your employer through a benefits package or you may purchase it independently if you do not qualify for a public funding source. Indiana has broad based mental health parity meaning that most health insurance plans are required to provide coverage for mental health treatment that’s equal to coverage for physical illness. However, there is an exemption for group plans with fewer than 50 members. In selecting a provider, it is important to know if that provider is on the panel of approved providers for the given plan. It is important to also know which services are covered for the individual insured. Because a provider takes a certain type of insurance, like Anthem for example, it does not mean that a given service is covered on the plan for that particular individual.  The insured family should check with the provider’s business office as well as their own Human Resources Benefit Administration department or insurance agent about their coverages. If you are unsure if your health insurance provides mental health services, call the customer service number on the back of your insurance card and ask how many mental health counseling sessions your child is eligible for and what (if any) the co-pay is for these appointments.  You will need to have your member identification number which is generally located on the front of your insurance card. If you do not have an insurance card but know that you have insurance through your employers, contact the Human Resources Department of the company you work for and request an insurance card and/or the customer service phone number of your health insurance company.

Employee Assistance Programs (EAPs) are employee benefit programs offered by many employers, typically in conjunction with a health insurance plan. EAPs are intended to help employees deal with personal problems that might adversely impact their work performance, health, and well-being. EAPs generally include assessment, short-term counseling and referral services for employees and their household members. An EAP’s services are usually free to the employee or household member, having been prepaid by the employer. EAPs are generally accessed through a toll free number, which you can acquire from the Human Resources Department of your employer.

Out of pocket – In many cases you may request a “sliding scale fee” from mental health counselors for counseling sessions.  This is especially useful if your child does not have health insurance. Sliding scales offer the option of a reduced payment. Sliding scales are generally based on your income, but you can also advocate for a fee and/or payment schedule that is affordable for your family.

Public Funding Sources

Medicaid is a jointly funded state and federal program for payment of medically necessary services for people who meet certain income and resource guidelines. Several programs with various packages are part of Medicaid in Indiana, called Hoosier Healthwise. For these Medicaid programs eligibility is determined, in part, by family income.

Medicaid funding is not an easy or uncomplicated program to understand. Perhaps the two most significant principles to realize are (1) just because Medicaid can pay for a service in one setting does not mean that the service will be a covered in every setting, and (2) the type of Medicaid plan that a child has, as well as a level of need determination, will often determine the services and settings that are covered.

Some providers have access to Medicaid programs that other providers do not. In Indiana’s mental health world, Community Mental Health Centers (e.g., Oaklawn) have access to the Medicaid Rehabilitation Option (MRO).  MRO will fund service packages for children and youth based on a determination of need. Certain services (e.g., Skills Training, Care Facilitation) are rarely funded outside of MRO. A Medicaid clinic option, available for many Medicaid providers, will fund more traditional services such as therapy, medication or physician services.

Indiana participates in several Medicaid waiver programs. Waivers are a part of the federally and state funded Medicaid program that provides for reasonable and necessary medical care for persons meeting eligibility requirements. They provide funding for children and adults with disabilities to receive support and services in the home and community rather than in an institutional setting. Family income and assets are NOT considered when determining Medicaid eligibility for a child under the age of eighteen who is also applying for a waiver. Indiana does not yet have a waiver for children with significant mental health concerns. It does have a grant for a “look-alike” program called Community Alternatives to Psychiatric Residential Treatment Facilities (CA-PRTF). Medicaid is required to participate in grant services, however.

Special Education – If your child receives Special Education services through an IEP (Individualized Education Plan) and the IEP team believes that counseling is needed to assist your child in benefiting from their educational program, counseling services may be included in the IEP under “related services”.

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