Medicaid Behavioral Health Services: Psychosocial Rehabilitation (e.g. "Clubhouse model")

Medicaid Behavioral Health Services: Psychosocial Rehabilitation (e.g. “Clubhouse model”)

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2022

Location	Service Covered?	Copayment Required?	Limits on Services?
United States	Yes - 34; No - 11; NR - 6	Yes - 3	Yes - 9
Alabama	No
Alaska	Yes	No	NR
Arizona	Yes	NR	No
Arkansas	NR	NR	NR
California	No
Colorado	Yes	No	No
Connecticut	No
Delaware	NR	NR	NR
District of Columbia	Yes	No	No
Florida	Yes	$2	Limit of 1,920 quarter-hour units (480 hours) per state fiscal year
Georgia	NR	NR	NR
Hawaii	Yes	No	No
Idaho	No
Illinois	Yes	No	No
Indiana	Yes	No	Varies by level of need; Medicaid Rehabilitation Option package of services is required
Iowa	Yes	No	No
Kansas	No
Kentucky	No
Louisiana	Yes	No	For mental health rehabilitation, requires a certain score on the standardized assessment tool
Maine	Yes	$.50 to $2 per day, depending on payment amount, up to $20 per month	No
Maryland	No
Massachusetts	No
Michigan	Yes	No	No
Minnesota	NR	NR	NR
Mississippi	Yes	No	For community mental health centers only, limit of 20 per day, 15 minute units, no annual limits; prior authorization is required
Missouri	Yes	No	No
Montana	No
Nebraska	Yes	No	No
Nevada	Yes	No	Prior authorization is required; limits vary by level of care
New Hampshire	NR	NR	NR
New Jersey	Yes	No	No
New Mexico	Yes	No	No
New York	Yes	No	No
North Carolina	Yes	No	Prior authorization is required
North Dakota	No
Ohio	Yes	No	No
Oklahoma	Yes	$3	No
Oregon	Yes	No	NR
Pennsylvania	No
Rhode Island	Yes	No	No
South Carolina	Yes	No	Limit of 24 units per day; 1 unit is 15 minutes
South Dakota	Yes	No	NR
Tennessee	Yes	No	No
Texas	Yes	No	NR
Utah	NR	NR	NR
Vermont	Yes	No	No
Virginia	Yes	No	Service authorization is required
Washington	Yes	No	No
West Virginia	Yes	No	NR
Wisconsin	Yes	No	Functional eligibility requirements
Wyoming	Yes	No	No

2018

Location	Service Covered?	Copayment Required?	Limits on Services?
United States	Yes - 29 No - 17 NR - 5	Yes - 3	Yes - 10
Alabama	No
Alaska	No
Arizona	Yes	No	No
Arkansas	Yes	NR	NR
California	No
Colorado	Yes	No	No
Connecticut	No
Delaware	Yes	No	Medically necessary and part of a treatment plan
District of Columbia	No
Florida	Yes	$2.00 copayment per visit	Up to 3,840 15 minute units per recipient, per fiscal year.
Georgia	Yes	No	No
Hawaii	Yes	No	No
Idaho	No
Illinois	NR	NR	NR
Indiana	Yes	No	Medicaid Rehab Option package of services required
Iowa	NR	NR	NR
Kansas	Yes	No	NR
Kentucky	No
Louisiana	Yes	No	Yes - Not Specified
Maine	Yes	$.50 to $2/day depending on payment amount, up to $20/month	No
Maryland	No
Massachusetts	No
Michigan	Yes	No	No
Minnesota	No
Mississippi	Yes	No	Requires prior authorization and Limited to 20 Daily, No Yearly Limit.
Missouri	Yes	No	No
Montana	No
Nebraska	Yes	No	No
Nevada	Yes	No	PA required. LOC 3, max 2 hours per day; LOC 4 & 5, max 3 hrs per day; LOC 6, max 4 hrs per day.
New Hampshire	NR	NR	NR
New Jersey	Yes	No	5 hrs per day, 5 days per week
New Mexico	Yes	No	No
New York	NR	NR	NR
North Carolina	Yes	No	Prior authorization required on the first day of service
North Dakota	No
Ohio	Yes	No	No
Oklahoma	Yes	$4 per visit	PSR services for adults are limited to members who have a history of psychiatric hospitalization or admission to crisis centers, have been disabled by the SSA for mental health reasons, are residing in residential care facilities or are receiving services through a specialty court program.
Oregon	Yes	No	No
Pennsylvania	No
Rhode Island	No
South Carolina	NR	NR	NR
South Dakota	No
Tennessee	Yes	No	No
Texas	Yes	NR	NR
Utah	Yes	No	No
Vermont	Yes	No	No
Virginia	Yes	No	NR
Washington	No
West Virginia	No
Wisconsin	Yes	No	No
Wyoming	Yes	No	Prior authorization is required after the first 20 visits to confirm ongoing medical necessity

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Medicaid Behavioral Health Services: Psychosocial Rehabilitation (e.g. “Clubhouse model”)

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Medicaid Behavioral Health Services: Psychosocial Rehabilitation (e.g. “Clubhouse model”)

2022

2018

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