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Health and Behavioral Health Programs

Medicaid

Medicaid is authorized under Section 1902 of the Social Security Act, which provides that a state plan for medical assistance must “provide for making medical assistance available, including at least the care and services listed in paragraphs (1) through (5), (17), (21) and (28) of section 1905(a).”

Mandatory appropriations are authorized under Section 1901 of the Social Security Act “for the purpose of enabling each state, as far as practicable under the conditions in such State, to furnish (1) medical assistance on behalf of families with dependent children and of aged, blind, or disabled individuals, whose income and resources are insufficient to meet the costs of medical services, and (2) rehabilitation and other services to help such families and individuals attain or retain capability for independence and self-care, there is hereby authorized to be appropriated for each fiscal year a sum sufficient to carry out the purposes of this title. The sums made available under this section shall be used for making payments to States which have submitted, and has approved by the Secretary, state plans for medical assistance.”

Reimbursement for medical assistance services is provided to states under the Federal Medical Assistance Percentage (FMAP) system, and is based on claims from participating healthcare providers. Providers enroll in the state’s Medicaid system, and directly bill the state Medicaid agency for the cost of services, based on the state’s Medicaid provider reimbursement rates. The state tracks claims through their state claims management system (built through MMIS) which is then used to request reimbursement from the federal government for its share of the costs.

Mental Health and Substance Use Disorder Programs

There are three major substance abuse and mental health block grants allocated to states and territories by the Substance Abuse and Mental health Services Administration (SAMHSA): the Substance Abuse Prevention and Treatment Block Grant, the Community Mental Health Services Block Grant, and the State Targeted Response to the Opioid Crisis Grants.

Besides these, state governments, local governments, and non-governmental organizations (NGOs) can also apply for a variety of discretionary grants administered by SAMHSA that are targeted towards specific populations.

In general, low-income individuals may also receive public assistance for substance use disorder and mental health services through: state-funded programs, locally funded programs, SAMHSA grants, Medicaid, Medicare, Department of Veterans Affairs, and the Affordable Care Act marketplace.