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CMH Access and Eligibility Clarification

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MDHHS recently clarified in writing that when a community mental health service program (CMHSP) receives an initial request for services it must conduct an assessment to determine a person’s level of need for services, regardless of Medicaid eligibility.

“Individuals have been receiving inaccurate information regarding access to Community Mental Health Services Programs. Thanks to the watchful eye of our MPAS advocates, this issue is now being corrected on a statewide level,” says Michelle Roberts, MPAS Executive Director. 

If you have been denied an initial assessment after you requested services from a CMHSP, please contact MPAS at (517) 487-1755.

To see a full summary of this clarification and an official letter, stating your rights, from the Bureau of Community Based Services, please click here. 


CMH ACCESS AND ELIGIBILITY CLARIFICATION

The Michigan Department of Health and Human Services (MDHHS) recently clarified in writing that when community mental health service programs (CMHSPs) are contacted with requests for services, the CMHSPs must conduct an assessment to determine a person’s need for services, regardless of Medicaid eligibility.

INACCURATE INFORMATION
In fall of 2018, Michigan Protection & Advocacy Service, Inc. (MPAS) learned that some community mental health service programs (CMHSPs) were telling people that CMHSPs will only assess and serve Medicaid beneficiaries.

MPAS CORRECTIVE ACTION
MPAS notified the Behavioral Health and Developmental Disabilities Administration of this error. In December 2018, the Director of the Bureau of Community Based Services sent a letter to all Prepaid Inpatient Health Plans (PIHPs) and all CMHSPs clarifying the issue of access and eligibility.

CLARIFICATION

  • You cannot be denied an initial assessment because you do not have Medicaid, you have private insurance, or you have no insurance.
    • CMHSP staff may not state they only serve Medicaid recipients.
    • The Mental Health Code (MCL 330.1208) is clear that a CMHSPs can prioritize services to consumers with the most severe needs and in urgent or emergency situations.
    • The CMHSP must assess you to determine the severity of your needs or whether you have an urgent or emergency need for services.
  • You can take additional steps if you are denied
    • If you are denied CMH services for your mental health needs, you can request a second opinion and use the local dispute resolution process.
  • CMHSP website should not state only Medicaid recipients are served
     
  • Private insurance is not a sole reason to deny your assessment
    • CMHSP is required to conduct an assessment and then prioritize based on the severity or emergency nature of the need for services.
    • Your income or private insurance cannot be used to deny your eligibility for services.
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Posted on:
February 04, 2019