Medicaid Behavioral Health Services: ASAM Level 2.5 - Partial Hospitalization Services

Location	Service Covered?	Copayment Required?	Limits on Services?
United States	Yes - 34; No - 11; NR - 6	Yes - 4	Yes - 10
Alabama	Yes	Yes - not specified	No
Alaska	Yes	No	NR
Arizona	Yes	NR	No
Arkansas	NR	NR	NR
California	Yes	No	No
Colorado	No
Connecticut	Yes	No	No
Delaware	NR	NR	NR
District of Columbia	Yes	No	No
Florida	No
Georgia	NR	NR	NR
Hawaii	Yes	No	No
Idaho	Yes	No	No
Illinois	No
Indiana	Yes	No	Prior authorization is required
Iowa	Yes	No	No
Kansas	No
Kentucky	Yes	No	NR
Louisiana	No
Maine	Yes	$.50 to $2 per day, depending on payment amount, up to $20 per month	Minimum of 3 hours per day, 3 days per week
Maryland	Yes	No	NR
Massachusetts	No
Michigan	Yes	No	No
Minnesota	NR	NR	NR
Mississippi	Yes	$3 for non-community mental health center outpatient setting	Prior authorization is required
Missouri	Yes	No	No
Montana	Yes	No	No
Nebraska	No
Nevada	Yes	No	Prior authorization is required
New Hampshire	NR	NR	NR
New Jersey	Yes	No	No
New Mexico	Yes	No	No
New York	Yes	No	No
North Carolina	Yes	No	NR
North Dakota	Yes	No	No
Ohio	Yes	No	Prior authorization is required
Oklahoma	Yes	$3	No
Oregon	Yes	No	No
Pennsylvania	No
Rhode Island	Yes	No	Yes - not specified
South Carolina	Yes	No	Prior authorization is required
South Dakota	Yes	No	No
Tennessee	Yes	No	No
Texas	No
Utah	NR	NR	NR
Vermont	Yes	No	NR
Virginia	Yes	No	Service authorization is required
Washington	No
West Virginia	Yes	No	Based on medical necessity
Wisconsin	Yes	No	Subject to prior authorization
Wyoming	No

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