Table 1.
Inpatient behavioral health coverage in separate CHIP programs, 2009
| State | Mental health services
|
Substance use disorder services
|
||
|---|---|---|---|---|
| Day limit | Cost sharing | Day limit | Cost sharing | |
| AL | 30 days/year | ≤150% FPL: $5 >150% FPL: $10 |
3 days detox/year | ≤150% FPL: $5 >150% FPL: $10 |
| AZ | No limit | No co-pay | No limit | No co-pay |
| AR | Not covered | 100% (service not covered) | Not covered | 100% (service not covered) |
| CA | 30 days/year | No co-pay | Detox only | No co-pay |
| CO | No limit | No co-pay | No limit | No co-pay |
| CT | No limit | No co-pay | No limit | No co-pay |
| DE | No limit | No co-pay | No limit | No co-pay |
| FL* | 30 days/year | No co-pay | 7 days/year for detox; 30 days/year residential | No co-pay |
| GA | 30 days/admission | No co-pay | 30 days/admission | No co-pay |
| ID | 10 days/yeara | No co-pay | 10 days/yeara | No co-pay |
| IL | No limit | 133–150% FPL: $2 >150% FPL: $5 |
No limit | No co-pay |
| IN | No limit | No co-pay | No limit | No co-pay |
| IA** | No limit | No co-pay | 30 days/year | No co-pay |
| KS | No limit | No co-pay | 60 days/year | No co-pay |
| KY | No limit | No co-pay | Not covered | 100% (service not covered) |
| ME | No limit | No co-pay | No limit | No co-pay |
| MA | No limit | No co-pay | No limit | No co-pay |
| MI | No limit | No co-pay | No limit | No co-pay |
| MS | 30 days/year | No co-pay | $8,000/Benefit Periodb | No co-pay |
| MO | No limit | No co-pay | No limit | No co-pay |
| MT | 21 days/year | $25 | $6000/yearb,c | $25 |
| NV | No limit | No co-pay | No limit | No co-pay |
| NH | 15 days/year | No co-pay | 30 days/year; no limit for detox | No co-pay |
| NJ | 133–200% FPL: None 201–350% FPL: 35 days/year |
No co-pay | 133–200% FPL: None 201–350% FPL: Detox only |
No co-pay |
| NY* | 30 days/yeard | No co-pay | 30 days/yeard | No co-pay |
| NC | No limit | No co-pay | No limit | No co-pay |
| ND | 45 days/yeard | $50/visit | 45 days/yeard | $50/visit |
| OR | Nonee | No co-pay | Nonee | No co-pay |
| PA* | 90 days/yearf | No co-pay | 7 days detox/admission | No co-pay |
| SC | No limit | No co-pay | No limit | No co-pay |
| SD | No limit | No co-pay | 45 days/year | No co-pay |
| TN** | No limit | <150% FPL: $5 150–200% FPL: $100 |
No limit | <150% FPL: $5 150–200% FPL: $100 |
| TX | 45 days/year | 101–150% FPL: $25 151–185% FPL: $50 186–200% FPL: $100 |
14 days/year detox/crisis stabilization, 60 days/year residential treatment | 101–150% FPL: $25 151–185% FPL: $50 186–200% FPL: $100 |
| UT** | No limit | 0–100% FPL: $50 101–150% FPL: $150 after $40/family deductible 151–200% FPL: 20% of total after$1500/family deductible |
No limit | 0–100% FPL: $50 101–150% FPL: $150 after $40/family deductible 151–200% FPL: 20% of total after$1500/family deductible |
| VT | No limit | No co-pay | No limit | No co-pay |
| VA | 30 days/year | ≤150% FPL: $15 >150% FPL: $25 |
90 days/life | ≤150% FPL: $15 >150% FPL: $25 |
| WA | No limit | No co-pay | No limit | No co-pay |
| WV | 30 days/yeard | No co-pay | 30 days/yeard | No co-pay |
| WI | ≤200% FPL: No limit 201–300% FPL: 30 days/year |
≤200% FPL: $3/day, up to $75 per stay 201–300% FPL: $50/stay |
≤200% FPL: No limit201–300% FPL: 30 days/year | ≤200% FPL: $3/day, up to $75 per stay 201–300% FPL: $50/stay |
| WY | 21 days/yearg | ≤100% FPL: $0 101–150% FPL: $30 151–200% FPL: $50 |
$6,000/yearb; 21 days/year for detox services | ≤100% FPL: $0 101–150% FPL: $30 151–200% FPL: $50 |
Source: Information collected from state policymakers, state CHIP plans, and state program/benefits information FPL Federal Poverty Level. In 2009, the FPL for a family of four was $22,020
Children in the “Enhanced Plan” (for children with special health needs) have no day limit on services, with the exception of residential treatment services for substance use disorder (which are not covered)
Combined limit for inpatient and outpatient services
Montana’s substance use disorder benefit also has a lifetime maximum benefit of $12,000; after enrollees hit lifetime limit, plan will cover services up to $2,000/year limit
Combined limit for mental health and substance use disorder services
No limit for services that fall within scope outlined in prioritized list. See http://www.oregon.gov/OHPPR/HSC/docs/Oct09MHCDlines.pdf
Combined limit for behavioral and medical/surgical health
Additional 9 days available with prior authorization
State made policy change in 2009. Data represents policies prior to change
State made policy change in 2009. Data represents policies after change