If your child or teen needs mental health or behavioral health treatment, or prescription medications, you may be asking how you will pay for it. Coverage may be available through private health insurance, Medicaid, or in some cases families may need to pay on their own. Free, school-based services may also be a good option. The best approach may be to combine sources of support rather than relying on just one.

Private Health Insurance 

If your family is covered by private health insurance, either through an employer or Healthcare.gov, your health plan should cover the cost of therapy and prescription medications. As required by the Affordable Care Act, most private insurance plans are required to cover mental health and substance use services at the same level as other medical services.

Learn More: Mental health and substance use health coverage options | HealthCare.gov

Be aware that some private, self-insured plans are not required to cover these services. Check with your employee benefits department to make sure you have coverage. Also, while most private insurance plans can’t deny paying for mental health or substance-use services, they can place limits on the coverage. For example, a plan may only cover providers in their network or will require higher co-pay or deductible if a member sees an out-of-network provider. They can also limit the total number of visits per year. A good place to start is to call your health plan’s members services department to verify that the provider, treatment or medication will be covered under your plan.

Wisconsin Medicaid / Medicaid-Funded Programs

If your child is enrolled in Wisconsin Medicaid, also called BadgerCare, MA and Katie Beckett, recommended mental health, behavioral health or related services may be a covered benefit. Contact ForwardHealth Member Services at (800) 362-3002 for answers about services and limits on coverage. The mental health provider may need to submit a prior authorization (PA) request before Medicaid covers the visits. If your child has been referred to a provider or program, it is important to ask if Medicaid is accepted before starting treatment. 

If my child is not currently enrolled in Medicaid, could they qualify based on a mental health or behavioral health diagnosis? Yes, a child may be eligible for Medicaid based on their mental health or behavioral health condition. An evaluation must be completed, and a disability determination is required. Contact your County Human Services Department or call Wisconsin Wayfinder at (877) 947-2929 to learn more.

Medicaid-Funded Programs for Children with Complex Behavioral Health Needs

Children who are involved in multiple systems like child welfare, mental health services, special education, juvenile justice and may also have a developmental disability, may be eligible for Coordinated Services Team (CST). Children, teens or young adults with complex mental health needs may also benefit from Comprehensive Community Services (CCS). CCS focuses on helping the individual take control of their treatment and recovery.  Both CST and CCS are county administered programs and are covered by Wisconsin Medicaid.

Medicaid HealthCheck Other Services (HCOS)

HealthCheck Other Services is a way for those covered by Medicaid to access mental health services when other coverage options are not available. HCOS requires your child’s doctor to complete a HealthCheck exam (called a screening) that indicates that mental health or behavioral health services are medically necessary. See the Family Voices Medicaid: HealthCheck Other Services resource or see the Department of Health Services HCOS information.

Children’s Long-Term Support (CLTS) Program:

The CLTS Program (dhs.wisconsin.gov/clts/index.htm) provides flexible Medicaid funding for children living with their families, including those with severe emotional disabilities. CLTS can cover many programs and services for children. See the Family Voices CLTS series at familyvoiceswi.org/resource-library. 

Paying Out-of-Pocket

Some therapists or other mental health providers do not accept private insurance or Medicaid. Clients are billed directly for services. However, these providers often work with families to ensure that the services are affordable.

School-Based Mental Health

If a child’s mental health impacts their learning, they may be eligible for special education services. A child’s IEP team, along with a family, can determine the best supports and programs during their school day. If a student already has an IEP, counseling or psychology services can be added as a related service as part of their plan.

Many school districts have counselors, school psychologists, peer support or other services, and these staff may also be able to connect families to free community programs or support groups. 

Where to Find Support for Your Family

NAMI Wisconsin at (608) 268-6000 or (833) 860-5400 provides advocacy, education and support to those with mental health concerns and their families.

INFORMATION AND RESOURCES

Wisconsin Wayfinder: Children’s Resource Network (877) WiscWay (877 947-2929). Wisconsin Wayfinder offers families one name and phone number to find services for children with special health care needs. Wayfinder connects you to a resource guide at one of the five Children’s Resource Centers in your area.

Do you need a resource in another format or a printed copy? Contact Lynn@fvofwi.org.