Behavioral health is a term that includes mental health and substance abuse issues. Behavioral health services are services used to evaluate and treat people who have mental health and/or substance abuse problems. See What are MassHealth mental health services? and What are MassHealth substance abuse treatment services? below.

What are MassHealth mental health services?

MassHealth mental health services include crisis intervention, diagnostic assessments, and treatments for a wide range of mental and emotional disorders. To be covered by MassHealth, mental health services must be medically necessary and provided by a professional health care worker who meets MassHealth requirements.

Many of the rules about mental health services are in the Mental Health Center Manual (130 CMR 429) (PDF) on the Health and Human Services web site.

What are MassHealth substance abuse treatment services?

MassHealth substance abuse treatment services are limited to methadone treatment programs, inpatient substance abuse treatment programs, outpatient counseling services, and special services for pregnant women.

Substance abuse treatment programs must meet MassHealth requirements.

Many of the rules about substance abuse treatment services are in the Substance Abuse Treatment Manual (130 CMR 418) (PDF) on the Health and Human Services web site.

Am I eligible?

MassHealth members with the following coverage types are eligible for mental health and substance abuse treatment services:

MassHealth Standard
MassHealth Basic
CommonHealth
MassHealth Family Assistance (Direct Care, and Premium Assistance for HIV members)
MassHealth Essential

For other coverage types:

MassHealth Limited and Prenatal members are not covered for mental health or substance abuse treatment services.
Members with Premium Assistance or Buy-In are covered only if their private insurance plan includes these services.
EAEDC recipients are covered for substance abuse treatment services at public detoxification and outpatient substance abuse treatment centers.

What benefits will I get?

Mental health services

To be covered by MassHealth, mental health services must be medically necessary and must be provided by health care professionals who meet MassHealth requirements. There are limits on the length and frequency of services.

Covered mental health services include:

diagnostic services and psychological testing
short-term and long-term therapy
individual, couple, family, and group therapy
medication visits
consultations
crisis intervention and emergency services
home visits
care coordination

For detailed information about covered mental health services, see the Mental Health Center Manual (130 CMR 429) (PDF) on the Health and Human Services web site.

Substance abuse treatment

To be covered by MassHealth, substance abuse treatment services must be provided by programs licensed or approved by the Massachusetts Department of Public Health.

The following services are covered:

methadone treatment programs
acute inpatient substance abuse treatment services
substance abuse outpatient counseling, case consultation, and acupuncture detoxification
special services for pregnant women, including intensive outpatient services, enhanced inpatient services, case management, and day treatment

There are limits on the length and frequency of counseling, consultation, and acupuncture detoxification sessions.

For detailed information about covered substance abuse treatment services, see Substance Abuse Treatment Manual (130 CMR 418) (PDF) on the Health and Human Services web site.

How do I apply?

To get MassHealth mental health and substance abuse treatment services, you must be an eligible member of MassHealth. If you are not a member, you must apply for MassHealth. For information on how to apply, see MassHealth: How do I apply?

How do I find a mental health provider?

The way to find a MassHealth mental health provider depends on the type of health plan you have:

Primary Care Clinician (PCC) Plan members:

If you are enrolled in the MassHealth Primary Care Clinician (PCC) Plan, your MassHealth mental health and substance abuse services are managed by a company called the Massachusetts Behavioral Health Partnership (MBHP). MassHealth will only pay for services from MBHP providers, except in an emergency.

For general information, see Massachusetts Behavioral Health Partnership
To find a provider, use the Provider Search tool
For a list of services, see Covered services

If you have questions, call the MBHP Clinical Access Line at 1-800-495-0086. This service is available 24 hours a day, every day of the year. You can also ask your primary care physician for a referral, or call MassHealth Customer Service at 1-800-841-2900 (TTY: 1-800-497-4648).

Managed Care Organization (MCO) members:

If you are enrolled in a MassHealth Managed Care Organization (MCO) health plan, you should call your MCO or visit their web site for information about mental health and substance abuse services. MassHealth will not pay for services from providers who are not part of your MCO plan.

For MCO contact information, see:

MassHealth MCO Managed Care Health Plans
Select your MCO plan at the top of the page, and then follow the "Find a Health Care Provider" link for your MCO

Each MassHealth MCO has an online search tool and a member services phone line to help you find approved mental health and substance abuse treatment service providers in your area.

Other MassHealth members:

If you are not enrolled in the MassHealth PCC Plan or an MCO managed care health plan, you can get mental health and substance abuse treatment services from any provider who accepts MassHealth and meets MassHealth provider requirements.

You can ask your primary care physician for a referral, or call MassHealth Customer Service at 1-800-841-2900 (TTY: 1-800-497-4648).

What is the Children's Behavioral Health Initiative (CBHI)?

The Children's Behavioral Health Initiative (CBHI) is a state plan to improve behavioral health care for children who have MassHealth coverage.

The CBHI resulted from a 2007 court case referred to as Rosie D., in which the court ruled that the state must change the way MassHealth provides mental health services for children with serious emotional disturbances. The new system gives parents more control over their children's care, provides care coordination, brings services to the child's home or community, and makes it possible for more children with severe mental health issues to remain at home rather than being institutionalized.

For more information about the CBHI and the Rosie D. case, see Children's Behavioral Health Initiative on the MassHealth web site, and Rosie D. from the Center for Public Representation.

What behavioral health services are available for children?

Children who meet the MassHealth eligibility requirements for mental health and/or substance abuse treatment services are covered for the behavioral health benefits described under What benefits will I get?

In addition, the Children's Behavioral Health Initiative (CBHI) added new benefits for MassHealth members under 21. Some of the new services are only available to MassHealth Standard and CommonHealth members. CBHI services must be medically necessary before MassHealth will pay for them.

Children's Behavioral Health Initiative services include:

Outreach: The state must educate MassHealth members and providers about the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. EPSDT is a federal Medicaid program for children under 21 that emphasizes prevention and early intervention. EPSDT includes periodic well-child visits and screenings.
Behavioral Screening: Health care providers must screen all MassHealth members under 21 for behavioral health as well as physical health during well-child visits. The behavioral health screening tool may be a short list of questions or a checklist that parents/caretakers discuss with the child's health care provider. If the screening shows areas of concern, the child can get further evaluation or treatment, as needed.
Assessment: Children needing further evaluation or treatment are referred to a behavioral health specialist. The behavioral health specialist assesses and diagnoses children using the Child and Adolescent Needs and Strengths (CANS) survey and other tools. Children diagnosed with severe emotional disturbances (SED) are referred to a Care Coordinator.
Intensive Care Coordination (ICC): The Care Coordinator works with family, friends, support service providers, and other team members to develop an Individual Care Plan (ICP). The ICP outlines the child's needs, the family's goals, the treatment schedule, and support services. A major goal of intensive care coordination is to make sure that all medically necessary services are provided in a manner that is sensitive to the child and family's background and needs.
Family Support and Training: Qualified Family Partners paraprofessionals give one-on-one support to parents/caregivers in their homes or other community settings.
Mobile Crisis Intervention: Mobile emergency services are available 24 hours a day, seven days a week, to help children and youth who are having a behavioral health crisis. A crisis team goes to the child/youth in crisis, stabilizes the situation, and helps the child and family get any services they need.
In-Home Behavioral Services: Children and youth with challenging problem behaviors that interfere with their daily lives can get individualized intensive at-home behavior therapy and monitoring.
Therapeutic Mentoring Services: Children who need help with social skills as part of their treatment plan can get one-on-one mentoring to learn how to interact with others in an age-appropriate way.
In-Home Therapy Services: In-home therapy services treat the behavioral health needs of the child, while also helping family members learn how to provide effective support at home. In-home therapy services can help children remain at home instead of being placed in residential treatment facilities or hospitals.

For detailed information about CBHI services, including specific admission criteria for each type of service, see Medical Necessity Criteria for CBHI Services on the MassHealth web site.

How do I get behavioral health services for my child?

If you have concerns about your child's behavior or emotional well-being, there are several ways to get help:

You can call your child's primary care doctor. Your child's doctor will discuss your concerns with you, tell you about the behavioral health services available to your child, and make a referral if needed.
If your child does not have a primary care doctor, you should call MassHealth Customer Service at 1-800-841-2900 for help.
If your child is enrolled in a managed care health plan, call the plan's customer service number. For phone numbers and other contact information, see Contact Information on the MassHealth web site.
You can also call a Community Service Agency (CSA) for information. The CSAs provide Intensive Care Coordination (ICC) and Family Partner services. See Community Service Agencies for a list of agencies and the areas and populations they serve.

For more information about getting behavioral health services for your child, see Notice to Parents or Caregivers About New Behavioral Health Services for Children and CBHI Information for Members.

Useful links

These links are external links to web sites that are not part of MassResources.org. When you click on these links, you will leave our site. Click "Back" on your browser to return.

Massachusetts Behavioral Health Partnership (MBHP)
Information about the MBHP, the organization that manages behavioral health services for many MassHealth members. Includes:
Children's Behavioral Health Initiative
Detailed information about the Children's Behavioral Health Initiative, including updates, member information, provider information, screening tools and training programs, medical necessity criteria, and other related material. From the Massachusetts Office of Health and Human Services.
Mental Health - MassLegalHelp
How to get MassHealth and other insurers to pay for mental health services, including how to appeal denials. From MassLegalHelp.
Rosie D.: Reforming the Mental Health System in Massachusetts
Information about the Rosie D. court case and mandated changes in the children's mental health system in Massachusetts. From the Center for Public Representation.
Parents' How-to Guide to Children's Mental Health Services in Massachusetts
A guide for Massachusetts parents with information about what kinds of mental health services are available for children, how to get mental health services, and how to pay for them. From the Boston Bar Association, 2009.

MassHealth Behavioral Health Services section last updated on 4/19/10

Top of Page | Home Page | Printer-friendly Version

MassHealth Mental Health and Substance Abuse Treatment: Behavioral Health Services

What are behavioral health services?