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Medicaid and Behavioral Health Services
Can I access mental health and substance use disorder
services with my Medicaid coverage?
If you receive Medicaid, you should be able to access mental health and
substance use disorder services through your coverage. If you are
enrolled in a Medicaid managed care plan, you can contact your health
plan or its Member Services division to learn more about your coverage
these services. If you need help to confirm the type of Medicaid
coverage you are enrolled in, you can contact the New York State of
Health or call the New York State Department of Health Medicaid
Helpline at 1-800-541-2831
New York State and federal laws require most comprehensive health
insurance plans to cover medically necessary mental health services and
manage your mental health or substance use benefits as they manage
medical and surgical benefits, without additional limitations. This is
called “mental health parity” and requires that rules about copayments,
number of visits and pre-authorizations should be similar for accessing
mental health and substance use disorder services as they are for
physical medical care. The New York State Office of Mental Health
(OMH) provides more information on mental health parity for New
Yorkers.
What type of mental health and substance disorder services
can I get with Medicaid?
Your Medicaid managed care plan should provide you with a Summary
of Benefits and Coverage (SBC) in clear and accessible language that
describes what is covered under your specific health plan. An example
of the SBC is available on healthcare.gov. The SBC will show you the
costs and services associated with your health plan, including information
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about mental health and substance use disorder services in a section
titled “Types of Medical Events”. You can learn more about the SBC on
healthcare.gov.
If you do not have your SBC, you can request it from your health plan
using the phone number provided on the back of your health insurance
card or you can call the New York State Department of Health Medicaid
Helpline at 1-800-541-2831.
New York’s Medicaid program covers behavioral health-related
preventive services, such as alcohol misuse screening and counseling or
depression screening, which can support health and wellbeing. You can
learn more about the preventive services that must be covered through
Medicaid at healthcare.gov
Will I need a referral or prior authorization to get mental
health and substance use disorder services through
Medicaid?
Depending on your particular health plan, you may need to get prior
authorization or a referral from your primary care doctor before you can
receive the mental health or substance use disorder services you might
need. You should check your SBC or contact your health plan to confirm
whether a referral or prior authorization is required.
If you don’t need a referral from your primary care provider, you can use
the NYC Well website to find a mental health professional. Visit NYC Well
or call the NYC Well Hotline at 1-888-NYC-WELL (1-888-692-9355) and
indicate that you need to find a mental health provider who accepts
Medicaid.
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Additional Resources Regarding Mental Health and
Substance Use Disorder Services
If you need help finding a mental or behavioral health
provider
Call 1-888-NYC-WELL (888-692-9355) or visit NYC Well Find Services
If you want to learn more about Medicaid benefits:
Visit NYS Department of Health Medicaid
Visit NYC Health Insurance Link
To learn more Medicaid Coverage during the COVID-19 Emergency,
download
Medicaid Benefits Through Local DSS
Download Medicaid at a Glance
If you have been denied mental health services
Depending on your insurance, you may be protected by Mental Health
and Addiction Insurance “Parity” law.
Health plan members are also entitled to request and receive a copy of
the most recent comparative analysis performed by their health
insurance plan to assess compliance with federal parity laws and
regulations. If your health insurance plan refuses to provide this
information to you, you can call the Consumer Assistance Unit of the NYS
Department of Financial Services at 1-800-342-3736 to get assistance.
OMH provides additional information about mental health parity.
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If you need help navigating the health care system
Contact Community Health Advocates (CHA), a program of the
Community Service Society, for free help on how you access the health
care you need. You can call the CHA Helpline at 1-888-614-5400.
Important Note: This information is compiled from government
handbooks and webpages and relies on them for accuracy and is current
as of December 17, 2021. It is provided here for your assistance and
should not be taken as legal advice.
