Young people’s mental health has been a pressing issue in recent years. With Medicaid as the country’s largest payer for mental health services, the program’s role is all the more essential.
The National Academy for State Health Policy evaluated state Medicaid coverage across the U.S. in its Jan. 5 report by looking specifically at procedure codes, beneficiary eligibility, medical necessity criteria, service limits and prior authorization.
Here are four takeaways:
1. Thirty-one of the 50 states and the District of Columbia cover therapy through at least one benefit for youth regardless of a behavioral disorder. Twelve states cover therapy without a diagnosis as long as the child presents with symptoms or meets criteria indicating risk of a disorder.
2. At least 20 states permit providers to bill for this therapy using diagnostic codes for symptoms and/or factors that shape health.
2. Twenty-eight states do not limit the scope and duration of therapy.
3. However, 23 do require prior authorization or have a “soft limit” on access for at least one service type.
4. Five states require prior authorization for access to any therapy, with two of those states requiring prior authorization under specific circumstances. In Arkansas, the prior authorization requirement only applies to children under 4 years old. In Connecticut, only certain providers, such as medical clinics, must follow this requirement.
