Medicaid behavioral health
Applies to:
All Priority Health Choice, Inc., members: Medicaid, Healthy Michigan Plan
Mild to moderate conditions
Priority Health provides outpatient behavioral health therapy services for Medicaid members with mild to moderate mental health needs. This includes members experiencing or demonstrating mild to moderate psychiatric symptoms or signs of sufficient intensity to cause subjective distress or mildly disordered behavior, with minor or temporary functional limitations or impairments (self-care/daily living skills, social/interpersonal relations, educational/vocational role performance, etc.) and minimal clinical (self/other harm risk) instability.
Severe conditions, substance use disorders, specialized behavioral health services
Medicaid members with severe mental illness (adults), severe emotional disturbance (children), substance use disorders or developmental disabilities, as defined in the Michigan Mental Health Code, should be directed to their local pre-paid inpatient health plan (PIHP) for evaluation and treatment.
Providers are responsible for referring members to their PIHP if they require specialized behavioral health services.
Members who are being served through the PIHP system of care are generally not eligible to receive mental health outpatient services through Priority Health.
Helpful tools
- Priority Health is here to collaborate with you. Download this document to know who to contact for your needs.
Contact information for Behavioral Health Medicaid collaboration
- Download this chart to help you better understand who's responsible for authorizations and payments:
Mental Health & Substance Use Disorder Authorization and Payment Responsibility Grid
- Find the correct PIHP and Community Mental Health information and contacts here. (Bill the PIHP in the member's county of residence.)
Coding help
- Review MDHHS's site to review behavioral health code charts and provider qualifications.
Medicaid resource
Below is the link to the MDHHS Medicaid Provider Manual for more information.
- Medicaid Provider Manual - Go to the "Behavioral Health and Intellectual & Developmental Disability Support and Services" section, then Section 1.6, Beneficiary Eligibility
PHI consent tool
To reduce confusion about when an individuals' consent is necessary to share health information, the Michigan Department of Health and Human Services (MDHHS) has additional resources available, to help clinicians and providers navigate the laws surrounding protected health information (PHI).
There are multiple state and federal laws that address what health information can be shared, when it can be shared and with whom. These resources are intended to increase the flow of patient information from clinician to clinician, particularly in the case of behavioral health information.
Medicaid eligibility questions
Questions about Medicaid/Healthy Michigan Plan members' service eligibility should be directed to our Behavioral Health department. You can reach us at 616.464.8500 during business hours to verify eligibility.