Are physical and behavioral health services covered separately?
Fee-for-service MA covers physical and behavioral health services provided by any provider participating in the Medical Assistance program. In managed care, there are separate physical health and behavioral health providers. Each county chooses its own behavioral health managed care organization. However, DPW contracts with physical health managed care organizations to provide care over wider, pre-determined geographic areas. Physical health HMOs pay for all covered aspects of physical healthcare, and all pharmaceuticals including mental health drugs. What determines Medicaid eligibility? Eligibility is determined by being part of a particular group such as pregnant women, children, older adults, or disabled adults, and also by meeting financial and citizenship requirements. Some people are eligible because of a temporary disability, or because they are caring for a disabled family member. In this situation the physician plays an important role in helping the patient obtain MA. (see be
