The Child Mental Health Treatment Act (CMHTA) authorizes the State (through the Office of Behavioral Health) to assist families with the costs of care for children who are not categorically eligible for Medicaid and who are eligible for community, residential, or transitional treatment services. Families are also required to participate in the costs of care for their children. The following information outlines the potential costs for families at various stages of the program:
Local Behavioral Health Organizations (BHOs) serve as the point of access for children who are categorically eligible for Medicaid. Families interested in accessing residential treatment for their Medicaid eligible child should contact their local BHO. The BHO will provide an assessment to determine the need for services including, but not limited to residential treatment services. If the assessment determines that the child is in need of residential treatment, the BHO will be financially responsible for the cost of care.
Note: The following pertains to children who are not categorically eligible for Medicaid:
Local Community Mental Health Centers (CMHCs) serve as the point of access for children who are not categorically eligible for Medicaid and are at-risk of out-of-home placement as defined in the Act. The CMHC will conduct an evaluation to determine if treatment is necessary. Families may be assessed a fee, based on a sliding scale, for this evaluation. If private insurance is not available to pay the fee, the family may be responsible for this cost. The local CMHC will provide specific information about the cost for this service.
Community based services include, but are not limited to, therapeutic foster care, intensive in-home treatment, intensive case management, and day treatment. The CMHC will determine the parental fee based on reported income. This fee is not to exceed 50% of what the residential fee would be. The remainder of the treatment costs would be covered by CMHTA.
Note: The following pertains to residential treatment only:
A monthly Child Support Payment will be determined for each child, based on the family's gross monthly income and the "Schedule of Basic Child Support Obligations" in Section 14-1-115, C.R.S. The residential facility determines the support payment based on this schedule, and the family pays the Child Support Payment directly to the residential facility to cover Room and Board (also called Child Maintenance) costs. Families who do not cooperate in making income information available may be billed for the full cost of care.
Subject to available appropriations, the State will pay for the first 30 days of Room and Board (Child Maintenance) and Treatment for eligible children, minus any private insurance available and the monthly Child Support Payment. The residential facility will submit an invoice to the Division of Behavioral Health for reimbursement of these costs. The invoice must identify the amount billed to the family for the monthly Child Support Payment and any amount paid by private insurance. Families who do not make income information or insurance benefits available may be billed for the full cost of care.
A child who is not categorically eligible for Medicaid at the time that placement in a residential facility is required, must become SSI eligible in order to qualify for State funding through the Act, beyond the first 30 days of residential treatment. The SSI application is essential because if the child qualifies for SSI, the child will also be eligible for Medicaid. SSI and Medicaid eligibility are necessary for the State to contribute to the residential costs beyond the first 30 days.
If SSI eligibility is determined, benefits will be assigned on behalf of the child. Although these benefits will likely be assigned to the family as the representative payee for the child, the monthly benefit payments (minus a $30 needs allowance that should be held for the child's needs) must be given to the residential facility to cover the Room and Board costs. In addition to providing the residential facility with the monthly SSI benefits, the family must continue to pay the monthly Child Support Payment that was determined.
If SSI eligibility is denied, the family will be financially responsible for all costs (Room and Board and Treatment) beyond the first 30 days of residential treatment.
Once SSI eligibility is determined, Medicaid will pay for the residential treatment costs retroactive to the first day of the second calendar month of care, until the completion of the residential treatment. Subject to available appropriations, the State will continue to participate in the remaining costs of care, if necessary. The State's share of the ongoing costs of care is the portion of the expenses not covered by private insurance, Medicaid, the monthly Child Support Payment, and the SSI award, minus the personal needs allowance. The residential facility will submit monthly invoices to the Office of Behavioral Health for reimbursement of costs not covered by these other sources. The invoice must completely identify the amount paid by Medicaid, private insurance, the SSI award, and the amount billed to the family for the Child Support Payment.