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Mental Health and Substance Abuse  

Man with eyes closedDetermining who is responsible for providing Mental Health and Substance Abuse Services to Medicaid beneficiaries depends upon the severity of their needs and whether the beneficiary is enrolled in a particular program.

For persons enrolled in Medicaid Fee-for-Service, their mental health benefit is described in the Practioner chapter of the Medicaid Provider Manual.  These services are provided by various mental health processionals and are designed to treat beneficiaries with mild to moderate mental health needs. These professionals also help maintain beneficiaries with stable mental health conditions.

Medicaid Beneficiaries with more involved or severe mental health conditions that are not likely to respond to traditional outpatient treatment need to be referred to the Specialty mental health and substance abuse carve out provider system. Not only are the providers in this system in a position to provide more specialized inpatient and outpatient mental health services but they are also the gate way for all Medicaid substance abuse treatment services.

For those not enrolled in the Medicaid program, there is a public mental health and a substance use disorder service network that can be accessed. Mental health services are available statewide through the local government community mental health services program. They are also responsible for providing all MIChild and Adult Benefit Waiver mental health services. Similarly, the Substance Abuse Coordinating Agency system provides services to the general public and is also responsible for providing the substance use disorder treatment benefits to both MIChild and Adult Benefit Waiver enrollees.                                       


Provider Enrollment 
Access provider enrollment forms and information, as well as instructions for initiating Electronic Funds Transfers (EFT) 

Eligibility Verification 
Access information and options available related to verfying beneficiary eligibility. 

Draft Policy Bulletins for Public Comment 
Draft policy bulletins issued for public review and comment. 

Specialty MH/SA Carveout 

Managed Health Care 

 

 



                              Fee for Service Information  

People in training sessionCommunications and Training gives access to Provider Update newsletters, numbered letters, information on training opportunities, etc.  Hands ShakingPrior Authorization gives access to the Medicaid Nursing Facility Level of Care Determination tool. 
Hand WritingGet information about Policy and Forms like the Medicaid Provider Manual, draft and final policy bulletin, etc.  Group of People ClappingWaivers includes information related to current and proposed Medicaid waivers.  

Bills with Paid markedIn Billing and Reimbursement , find information necessary for claim submission, including billing tips, provider-specific procedure code databases (including fee screens), electronic billing information, Sanctioned Provider list, Beneficiary Co-Payment Requirements, Third Party Liability, etc.