FAQ in the Mental Health System

Frequently Asked Questions (FAQ) for the Mental Health System

Q. My child needs help…What do I do…Who do I call?

A. There are many different routes that a parent or caregiver can follow to get “help” for their child.  A great place to begin is to speak with your family doctor or health care provider and explain your concerns about the behaviors or developmental issues you are seeing in your child. Below are other people you can call to get the help for your child .They can also provide support for you, your child and your family.

  • Mental health specialists, such as psychiatrists, psychologists, social workers, case managers, school guidance counselors.
  • Your medical insurance company or managed care organization (MCO)
  • Community mental health centers or family centers, outpatient clinics , Mental health programs at universities, colleges or medical schools, County Department of Human Services, hospital psychiatry department, family services, social agencies, local mental health provider organizations or faith based organizations
  • Peer support groups, advocacy groups , employee assistance programs

Q. How will I pay for the expensive treatment my child may need?

A. With private insurance, you contact them (the number for behavioral health will be on the back of your insurance card) and request a list of mental health professionals in your area that are covered by your insurance plan. They can tell you how to obtain an evaluation and the number of visits that your insurance will cover. If your child has medical assistance (MA), you will have access to many programs that private insurance will not cover.

Q. What is MA or Medical Assistance?

A. Medical Assistance covers both the health care needs and mental health needs for children and youth under the age of 21. Medical Assistance is administered by the Department of Public Welfare (DPW).Medical Assistance can be a child’s only insurance or it can be a secondary to other coverage, covering those services or equipment not covered by the child’s primary insurance. It also covers services rarely covered by employer provided insurance such as Behavioral Health Rehabilitation Services (also commonly known as “wraparound”), shift nursing (8 hours or more per day), in-home personal care services, diapers, nutritional supplements, prescriptions and transportation to and from medical appointments. It will pay for services, like in-home nursing, physical, speech or occupational therapy, without annual or lifetime caps often imposed by other insurance plans.

More information can be found at: The Health law Project: http://www.phlp.org/
How to Get Medical Assistance for a child under 18 under PD-95 “loophole”

Q. Will my child/youth qualify?  

A.  Many children and youth qualify for Medical Assistance (MA) regardless of their parent’s income. Pennsylvania has what is commonly referred to as a “loophole” for qualifying for MA. CERTAIN DISABILITIES qualify your child for this coverage. Your income does NOT count.

  • A child can qualify for Medical Assistance even if she or he has other health insurance (although the other insurance usually needs to be billed first).
  • The assets of the parent(s), guardians, and the child (money in the bank, stocks, bonds, etc.) don’t count in determining eligibility for Medical Assistance.
  • The income of caregivers and guardians other than the parents don’t count.
  • The income of the parent(s) doesn’t count if the child’s condition meets certain disability standards.
  • Some of the diagnoses that qualify may be mental health or behavioral.

Q. How can I get Medical Assistance for my son/daughter?

A. The Health Law Project and you will see all the information you need to apply for this insurance or call Social Security at 1-800-772-1213 or your County Assistance Office.

Q. If Medication is Suggested, What Do I Need to Know?

A. Sometimes it is suggested that perhaps you should consider medication for your child. Much of the time caregivers will feel worried about side effects or possible addiction to the medication. These concerns are understandable and need to be addressed. The following questions should be asked when you are considering medication for a child/adolescent:

  • Will medical tests have to be done before my son/daughter begins the medication? If so, why?
  • Will my child become addicted to the medication?
  • How long will my child be on this medication—months, years, etc.?
  • What are the side effects to this medication? What are the long-term side effects if my child has to take this medication for a long period of time?
  • How does this medication work?
  • Will my child’s personality change because of this medication?
  • What will this medication cost? Is there a generic form of this medication?
  • How soon will we know if the medication is working?
  • How do you know when to stop the medication or change the medication if it does not seem to be working?
  • Has this medication worked for other children with similar problems?

Include your older son or daughter in the discussion with your doctor may be helpful for your family. Often, older children are embarrassed and not comfortable with taking medications.