Health Update: Insurance Coverage and Behavioral Health Services
By Pat Nemia, Project Director
Massachusetts Family Voices
Private insurance coverage of behavioral health services for children and adolescents has changed in Massachusetts.
As of July 1, 2019, Massachusetts fully-funded or fully-insured private health insurance plans are required to pay for certain behavioral health services for children and adolescents. Self-insured or self-funded health plans are not required to cover these services.
What is Fully-Funded vs. Self-Funded plan?
Fully-funded plans are purchased by your employer from an insurance company. You and/or your employer pay premiums and the insurance company pays claims for covered services. A plan purchased through the Health Connector or directly from a Massachusetts’s health insurance company is also a fully-funded plan.
In a self-funded plan, employers collect premiums and employers pay employee claims. Self-funded health plans often look the same as fully-funded plans because employers usually hire an insurance company to manage or administer the self-funded health plan.
What behavioral health services are now covered by Fully-Funded private insurance plans?
As of July 1, 2019, the following behavioral services were covered:
- In-home behavioral services.
- Behavior management monitoring.
- Behavior management therapy.
- In-home therapy or Family Stabilization Treatment.
- Therapeutic clinical intervention.
- Ongoing therapeutic training and support.
- Mobile crisis intervention.
- Intensive care coordination.
- Community-based acute treatment (CBAT).
- Intensive community-based acute treatment (ICBAT).
As of July 1, 2020, the following behavioral health services will be covered:
- Therapeutic mentoring services.
- Family Support and training / Family Partner support.
What if I have a Self-Funded plan?
Self-Funded plans do not have to comply with the regulation. Check with your plan to determine if they have decided to include behavioral services as a benefit. If you have a self-funded plan and MassHealth has been paying for your behavioral health services there will be no change in coverage.
What if I have MassHealth?
MassHealth already covers behavioral health services through the Children’s Behavioral Health Initiative (CBHI): https://www.mass.gov/childrens-behavioral-health-initiative-cbhi. There is no change to Mass Health coverage of these services.
If this change applies to your child, follow these steps to insure continuity of care.
- Call your plan and say that you are calling about the Behavioral Health for Children and Adolescents (BHCA) benefit that went into effect July 1, 2019.
- Talk with your health plan to see if they will continue to cover your child’s current provider(s) and services. If not, request a list of providers that will be in your network or work with your health plan to find providers.
- Talk with your child’s current behavioral health provider(s). Share your insurance information and ask if there will be any impact to your child’s services.
For more information about private insurance coverage for Behavioral health services visit:
https://childrensmentalhealthcampaign.org/resources or contact Mass Family Voices 800-331-0688.