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How can I pay for my child's mental health services?

HOW CAN I PAY FOR MY CHILD’S MENTAL HEALTH SERVICES?

Once you have made the decision that your child needs mental health services it is time to begin the process of finding a provider. It is important that the mental health providers you work with are a good fit for your child and your family. But it is also important that you are able to afford those services.

Payment for mental health services is a complex system that depends on many variables – which can make first entering services a confusing and frustrating task at a time when families need straight answers. We hope the information below can get you started.  

FUNDING SOURCES

Employee Assistance Program (EAP)

Some employers offer their staff an Employee Assistance Program (EAP). These programs typically allow the staff person to have several visits with a therapist over a year’s time period. Usually, those appointments can be used by the staff person or a member of their immediate family.

Ask your employer if they have an EAP and which mental health providers are part of it. Most EAPs will have a list of providers and some guidance about what types of mental health concerns they are qualified to address.

Because EAPs typically only cover a few appointments, it is important to plan ahead if continued services will be needed past the EAP coverage.

Indiana Department of Child Services and Juvenile Justice

Indiana’s Department of Child Services (DCS) and the Juvenile Justice system have the ability to pay for the cost of some mental health services for children and youth. Most of the time, this requires that the child be involved in those systems, in addition to other eligibility criteria.

An exception to that is the Children’s Mental Health Initiative which provides access to Wraparound services for eligible youth. The youth must have a high level of mental health need (determined by a threshold set by the state of Indiana), no Medicaid coverage and not formally involved with DCS or probation. Once in the program, it covers the cost of Wraparound services and other needed mental health services. The Elkhart County Access Site for Wraparound can be reached at (574) 246-9102.

Medicaid

Medicaid is a health insurance program funded by state and federal government. It pays for necessary medical coverage for low income citizens and citizens with certain disabilities. You can find out if you or your child qualifies for Indiana Medicaid coverage by visiting their website, the local office of the Division of Family Resources or by meeting with a local healthcare navigator. 

There is more than one type of Medicaid, so it is important to know the details of your child’s coverage. If you call the insurance provider directly, using the phone number on your child’s Medicaid card, they can answer questions about which mental health services are covered and which providers accept that coverage. The Indiana Medicaid website also has information about how to find providers under each plan.

Most Medicaid plans will cover therapy and psychiatric services for children and youth. Other services, such as case management, skills training or Wraparound, might be covered. Part of what determines if specialized or intensive mental health services will be covered by Medicaid is your child’s level of need. That level of need is determined through completion of a CANS (Child and Adolescent Needs and Strengths) assessment, which is done by mental health providers.

Medicaid sometimes covers the cost of residential treatment for eligible youth through their PRTF (Psychiatric Residential Treatment Facility) program. Not all residential treatment centers have PRTF available and not all children qualify for it.

Private or Commercial Insurance

Private insurance may be available to you through your employer or through the Affordable Care Act (ACA). Indiana has mental health parity meaning that most health insurance plans are required to provide coverage for mental health treatment that is equal to coverage for physical illness. However, there is an exemption for group plans with fewer than 50 members. It is important to pay attention to the details of your insurance plan because mental health appointments may be covered differently than typical doctor appointments.

Many private insurance plans will pay for part of the cost of therapy and psychiatric appointments after you have reached your annual deductible. There is a wide variation between different insurance plans, so spend some time looking into what yours will cover. If you have insurance through your employer, they will be able to give you an explanation of your benefits. You can also call the phone number on your insurance card to speak with someone directly from your insurance company.

When you look into the details of your plan’s mental health coverage, pay attention to key information such as annual deductibles, co-pays, co-insurance and which specific services are covered. In addition, some services may only be covered if you get pre-authorization from the insurance company. 

Private insurance plans do not cover every type of mental health service available in our community. If your child needs more intensive or specialized services, such as case management, skills training, Wraparound or residential treatment, other sources of support will be needed.

Self Pay

Paying for mental health services without the help of insurance coverage can be expensive. Community mental health centers, such as Oaklawn and Bowen Center, must provide sliding scales for those with no insurance coverage at all. A sliding scale is like giving a discount on services, so that the family is not charged the full cost of the service. Some private practice mental health providers also offer a sliding scale. Our Resources page has contact information for some local providers. When you call and ask about sliding scales, the provider will need to gather some information about your family’s income.

CHOOSING A PROVIDER

When choosing a mental health provider, there are many factors to consider. 

Location and Hours

After school hours are often in high demand, so be sure that the provider you choose has availability at the time of day that you need it. Also check and see how frequently your child will be able to meet with the provider. Find out where the provider is able to meet. Some providers work only in their office – others are able to meet you at home or in the community. 

Cost

Find out how much it will cost to see a particular mental health provider. Different types of providers charge different fees, accept different insurances, and have different payment expectations. Some will expect payment on the date of services and others will bill you later. 

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Services

There are a variety of mental health services – therapy, medication, skills training, etc. – and picking one can be confusing. A good place to start is by talking with your child’s primary care doctor or with a therapist who can do an initial assessment and then make recommendations. 

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Specialty

Mental health providers often develop specialties. Some focus on working with adults, others with children. Some have additional training in certain techniques or methods. Find out what type of mental health concerns a provider typically works with and if they have special certifications or training. 

Recommendations

Talk with family, friends or others that you trust and find out if they know a provider who has been helpful to them. Your family doctor or your child’s school counselor may also have suggestions.

Fit

Not every provider will fit well with every child, youth or family. Providers have different personalities, experiences, backgrounds, cultures, philosophies and approaches. Finding someone that your family likes and feels comfortable talking with is one of the most important factors when choosing a provider. Many providers have profiles set up with their photograph and information about themselves and their work. Looking at that information can help you choose who to reach out to. 

TYPES OF MENTAL HEALTH SERVICES

Therapy

Possible Funding Sources: Employee Assistance Programs, Medicaid, Private Insurance, Self-Pay, Indiana DCS and Juvenile Justice*

Psychotherapy is a way of treating mental health concerns by talking with a mental health provider. During sessions, clients learn about their thoughts, feelings, behaviors and moods, as well as healthy ways to cope with related challenges. Individual sessions include just the client. Family sessions include the client and at least one family member. Group therapy includes several clients and sometimes family members as well. 

Therapy is usually provided by therapists (LMHC, LMFT and others), clinical social workers (LCSW) and psychologists (PhD or PsyD). However, some psychiatrists incorporate therapy into their practice as well. 

There are many types of therapy: solution-focused, cognitive behavioral, dialectical behavior, relational, play, behavioral, etc. The type of therapy clients receive depends on their specific mental health needs and the training of the provider. 

Medication

Possible Funding Sources: Medicaid, Private Insurance, Self-Pay, Indiana DCS or Juvenile Justice*

Medication for mental health concerns is usually prescribed by a psychiatrist (MD or DO) or advanced practiced nurse (APN, MSN, CNS, FNP). The type and amount of medication prescribed for a client will depend on the client’s age, diagnosis, health history and many other factors.

Prescribing medication for children and teenagers is a highly specialized task and there is a shortage of psychiatrists overall across the United States. However, not all children and youth with mental health concerns need to see a psychiatrist. Some will improve with therapy or another service while others may have a family doctor who is able to prescribe medication for a mental health concern.  

The cost of medication can sometimes be a barrier for families. Mental Health America has some tips and resources to get prescriptions at reduced cost. 

Case Management

Possible Funding Sources: Medicaid, Indiana DCS or Juvenile Justice*

Case management services focus on helping a client get linked to services and supports so that there is a positive impact on the client’s mental health. These services may be called by different names, depending on the provider.

Case management is a recognition that child and youth mental health is impacted by family environment, living situation, physical health, friends, teachers and the broader community. When a child or youth receives case management services, it may include helping the family find resources for housing, food, insurance, child care, sports, tutoring, school supports and more.

Case managers often work to ensure that all members of the client’s treatment team are connected and working toward the same goals. The services are generally provided by a person with a bachelor’s degree in a mental health related field. 

Skills Training

Possible Funding Sources: Medicaid, Indiana DCS or Juvenile Justice*

Skills training services help clients and families learn and practice skills that will have a positive impact on the client’s mental and behavioral health. These services may be called by different names, depending on the provider.

Skills to learn may include anger management, communication, nutrition, conflict resolution, sleep hygiene, problem solving and more. Although therapy often involves learning healthy coping skills, skills training focuses in on those skills and how to put them into practice.

Skills trainers typically have a bachelor’s degree in a mental health related field and are able to meet with clients and families at home, school and in the community. 

 

Psychological Testing

Possible Funding Sources: Medicaid, Private Insurance, Self-Pay, Indiana DCS or Juvenile Justice*

Psychological testing is a process by which a psychologist works with a child, youth, parent and others to complete psychological instruments in order to better understand the symptoms that are being experienced. The process results in a diagnostic formulation and recommendations. Many times, psychological testing is completed by schools when a student is being assessed for special education needs. However, there are also psychologists who take referrals from other sources, such as family doctors, therapists and psychiatrists. 

Pharmacogenomics Testing

Possible Funding Sources: Check with your insurance company

Pharmacogenomics is the study of how genes effect the body’s response to certain types of medications. Although pharmacogenomics is very helpful to some patients, it is not the only factor to consider when selecting the best medication which is why it’s essential to speak with your health care professional about all concerns. Some doctors are hesitant to give their consumers pharmacogenomic testing due to an opinion that there is not enough empirical evidence to support beneficial results. Other physicians and hospitals have begun using it.

Depending on your insurance policy and reasons for testing, some insurance companies may cover pharmacogenomic testing. Contact your insurance provider about coverage prior to testing. If you don’t have insurance and cannot afford to pay for the test, some companies may offer financial assistance if you qualify. 

Wraparound

Possible Funding Sources: Medicaid, Indiana DCS*

According to the National Wraparound Implementation Center (NWIC), Wraparound is “an ecologically based process and approach to care planning that builds on the collective action of a committed group of family, friends, community, professional, and cross-system supports mobilizing resources and talents from a variety of sources resulting in the creation of a plan of care that is the best fit between the family vision and story, team mission, strengths, needs, and strategies.” There are key elements to the process. 

Inpatient Hospitalization

Possible Funding Sources: Medicaid, Private Insurance, Indiana DCS or Juvenile Justice*

If a child or teenager is a danger to self or others, inpatient hospitalization may be necessary. In a mental health crisis, the fastest way to get help is to call 9-1-1 or go to the nearest emergency room. Both Elkhart General and Goshen Hospital are able to arrange for crisis mental health assessments to determine if an inpatient stay is recommended. Memorial Epworth in South Bend and Michiana Behavioral in Plymouth are the closest inpatient units. Each unit will have different age requirements. 

Residential

Possible Funding Sources: Medicaid, Private Insurance, Indiana DCS or Juvenile Justice*

Residential treatment is one of the most intensive mental health services and involves the child or youth going to live at a treatment center for a period of time. Some residential programs are designed to be shorter term – just a few months long. Other programs can last six months to a year. Residential treatment would typically be recommended only after other, less intensive mental health services have been attempted without a relief of serious symptoms. To be accepted into a residential placement, a child or youth must meet the entrance criteria and have a way to pay for the service. Medicaid will pay for residential stays within its PRTF program. Child welfare, juvenile justice and school corporations sometimes refer for residential as well. 

While a child or youth is in a residential program, that program will most likely ask that the family participate in the mental health services – sometimes in person. This can be burdensome to families because residential treatment facilities are often far from the family’s home and the cost of travel and lodging is not covered by the residential program. When a child or youth is ready to be discharged from a residential program, it is very important for families to participate in careful discharge planning so that the child or youth will have mental health supports ready to start as soon as she returns home. 

*Note that a child/youth will need to be involved with Indiana DCS or Juvenile Justice, as well as meet certain criteria, in order to receive funding for mental health services from them. 

It’s OK to Ask for Help

We have a complicated mental health system. It can be confusing and frustrating to try to find the right services for a child or youth. But there are people who know the system and can help you navigate it. Here are some points of entry…

 

Child or Youth’s Doctor

Mental Health Provider

School Counselor/Social Worker

Clergy/Faith Leader

Probation Officer

Contact Us Form (below)

The Source • Youth Mental Health Network

MORE RESOURCES

There are a lot of places in your city that can help, too.
Here is a list of some community resources.

IF THIS IS AN EMERGENCY CALL 911 or GO TO NEAREST EMERGENCY ROOM

For the National Suicide Prevention Lifeline call 1-800-273-8255 or text the word ‘home’ to 741741 for Crisis Text Line.

IF THIS IS AN EMERGENCY CALL 911 or GO TO NEAREST EMERGENCY ROOM

For the National Suicide Prevention Lifeline call 1-800-273-8255 or text the word ‘home’ to 741741 for Crisis Text Line.

CONTACT US

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If you need someone to talk to, text “Help” to 741741, or call 1-800-273-8255.