Table 2.
Outpatient behavioral health coverage in separate CHIP programs, 2009
| State | Mental health services
|
Substance use disorder services
|
||
|---|---|---|---|---|
| Visit limit | Cost sharing | Visit limit | Cost sharing | |
| AL | 20 visits/year | No co-pay | 20 visits/year | No co-pay |
| AZ | No limit | No co-pay | No limit | No co-pay |
| AR | No limit | $10/visit | Nonea | $10/visit |
| CA | 20 visits/year | $5/visit | 20 visits/year | $5/visit |
| CO | No limit | 101–150% FPL: $2 >150% FPL: $5 |
No limit | 101–150% FPL: $2 >150% FPL: $5 |
| CT | No limit | No co-pay | No limit | No co-pay |
| DE | 30 visits/year | No co-pay | 30 visits/year | No co-pay |
| FL* | 40 visits/year | $5/visit | 40 visits/year | $5/visit |
| GA | No limit | No co-pay | No limit | No co-pay |
| ID | 26 services/yearb | No co-pay | 12 h/year for counseling | No co-pay |
| IL | No limit | 133–150% FPL: $2 >150% FPL: $5 |
No limit | No co-pay |
| IN | 50 visits/year | No co-pay | 50 visits/year | No co-pay |
| IA** | No limit | No co-pay | 20 or 30 visits/year depending on plan | No co-pay |
| KS | No limitc | No co-pay | No limitc | No co-pay |
| KY | No limit | No co-pay | Not covered | 100% (service not covered) |
| ME | 2 h/week | $2/day of serviced | 3 h/week | $2/day of serviceb |
| MA | No limit | No co-pay | No limit | No co-pay |
| MI | No limit | No co-pay | No limit | No co-pay |
| MS | 52 visits/year | $5/visit | $8,000/Benefit Periode | $5/visit |
| MO | No limit | No co-pay | No limit | No co-pay |
| MT | 20 visits/year | $3 | $6000/yeare,f | $3 |
| NV | No limit | No co-pay | No limit | No co-pay |
| NH | 20 visits/yeard | $10/visit | 20 visits/yeard | $10/visit |
| NJ | 133–200% FPL: None 201–350% FPL: 20 days/year |
133–200% FPL: None 201–350% FPL: $25 |
133–200% FPL: None 201–350% FPL: Detox only |
133–200% FPL: None 201–350% FPL: $25 |
| NY* | 60 days/yeard | No co-pay | 60 days/yeard | No co-pay |
| NC | 26 visits/yeard,g | ≤150% FPL: none >150% FPL: $5 |
26 visits/yeard,g | ≤150% FPL: none >150% FPL: $5 |
| ND | 30 h/year | No co-pay | 20 visits/year | No co-pay |
| OR | No limith | No co-pay | No limith | No co-pay |
| PA* | 50 visits/year | No co-pay | 90 visits/year | No co-pay |
| SC | No limit | No co-pay | No limit | No co-pay |
| SD | 40 h/year for individual therapy; otherwise, no limit | No co-pay | 60 h/year | No co-pay |
| TN** | No limit | <150% FPL: $5 150–200% FPL: $20 |
No limit | <150% FPL: $5 150–200% FPL: $20 |
| TX | 60 visits/year plus 60 rehabilitative treatment days/year | 101–150% FPL: $5 151–185% FPL: $7 186–200% FPL: $10 |
12 weeks/year for intensive outpatient plus6 months/year for outpatient services | 101–150% FPL: $5 151–185% FPL: $7 186–200% FPL: $10 |
| UT** | No limit | 101–150% FPL: $5 151–200% FPL: $30 |
No limit | 101–150% FPL: $5 151–200% FPL: $30 |
| VT | No limit | No co-pay | No limit | No co-pay |
| VA | 50 visits/yeard | ≤150% FPL: $2 >150% FPL: $5 |
50 visits/yeard | ≤150% FPL: $2 >150% FPL: $5 |
| WA | No limit | No co-pay | No limit | No co-pay |
| WV | 26 visits/yeard | No co-pay | 26 visits/yeard | No co-pay |
| WI | No limit | ≤200% FPL $0.50–$3/visit 201–300% FPL $10–$15/visiti |
No limit | ≤200% FPL $0.50–$3/visit 201–300% FPL $10–$15/visiti |
| WY | 20 visits/yearg | ≤100% FPL: $0 101–150% FPL: $5 151–200% FPL: $10 |
$6,000/year in/outpatient combined; 21 days/year for detox services | ≤100% FPL: $0 101–150% FPL: $5 151–200% FPL: $10 |
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
Primary diagnosis must be mental health; otherwise, service not covered
Children in the “Enhanced Plan” (for children with special health needs) receive up to 45 h/year psychotherapy, 12 h/week for partial care, and 10 h/week for psychosocial rehabilitation
Outpatient Treatment Request required after first 6 sessions
Combined limit for mental health and substance use disorder services
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
Additional visits allowed with prior approval
No limit for services that fall within scope outlined in prioritized list. See http://www.oregon.gov/OHPPR/HSC/docs/Oct09MHCDlines.pdf
Co-pay for up to 200% FPL is based on Medicaid/BadgerCare Plus maximum allowable fee for the service provided; no copay for narcotic treatment services. Co-pay for 200–300% FPL does not apply to laboratory tests, electroconvulsive therapy, and pharmacological management
State made policy change in 2009. Data represents policies prior to change
State made policy change in 2009. Data represents policies after change