Tribal Behavioral Health Coverage

Behavioral health looks at a person's emotional, psychological, social, and spiritual well-being.

• Emotional health – How we are able to control our thoughts, feelings, and behaviors
• Psychological health – How we think, feel, behave, and cope
• Social well-being – How we build relationships and interact with others
• Spiritual health – How we balance our physical and emotional health

Behavioral health services include treatment for mental health and substance use disorders. The four health factors that make up behavioral health, listed above, are considered as equally important as our physical health when it comes to our overall health.

There are two overall types of behavioral health disorders.

• Mental health disorders – Changes in how we think, our moods, and our behaviors
• Substance use disorders – The use of alcohol and/or drugs (such as opioids, prescription drugs, heroin, and other illicit drugs) in a way that causes health problems and interferes with our ability to handle responsibilities at home, school, or work

Behavioral health services coverage

This section reviews four types of health care coverage for behavioral health services:

• Indian Health Service (IHS)
• Medicaid and CHIP
• Medicare
• The Marketplace

Indian Health Service

IHS, an agency within the Department of Health and Human Services, is responsible for providing federal health services to American Indians and Alaska Natives (AI/ANs). The provision of health services to members of federally recognized tribes grew out of the special government-to-government relationship between the federal government and AI/AN tribes.

IHS is the principal federal health care provider and health advocate for AI/AN communities. Its goal is to raise their health status to the highest possible level.

IHS provides a comprehensive health service delivery system for AI/AN communities. IHS operates a Division of Behavioral Health and administers the following programs:

• Suicide Prevention and Care Program
• Zero Suicide Initiative
• Alcohol and Substance Abuse Program
• Substance Abuse and Suicide Prevention Program
• Youth Regional Treatment Centers
• Community Health Aide Program
• Native Youth Program
• Domestic Violence Prevention Program
• Telebehavioral Health Center of Excellence
• Indian Children's Program
• Tele-Education

Learn more about IHS behavioral health

For more information, visit the IHS behavioral health programs website.

Check out fact sheets on behavioral health from IHS.

Medicaid and CHIP coverage

Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. The Children’s Health Insurance Program (CHIP) provides health coverage to eligible children, through Medicaid and separate CHIP programs. Both Medicaid and CHIP are administered by the states, according to federal requirements, and the programs are funded jointly by states and the federal government.

Medicaid is the single-largest payer for behavioral health services, including mental health and substance use disorders, in the United States. Ultimately, behavioral health is protected at a level equal to physical health. This means that behavioral health and physical health services:

• cost the same
• cover the same number of visits
• do not require additional authorizations for treatment

Behavioral health services that Medicaid typically covers include:

• Outpatient services, like counseling and case management
• Inpatient services, such as hospital visits and detoxification
• Medications for psychiatric or substance use disorder treatment
• Community-based supports, like supportive housing and employment assistance

Learn more about behavioral health under Medicaid and CHIP

• Find an overview of what your state Medicaid or CHIP program covers and who is eligible
• Contact your state if you have questions about what your state Medicaid program covers
• Find coverage for your family through your state’s CHIP program

Medicare

Medicare provides coverage for people ages 65 or older, people with disabilities, or people with end-stage renal (kidney) disease.  Medicare provides coverage for behavioral health care under Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).

Medicare Part A (Hospital Insurance)

Medicare Part A helps pay for inpatient mental health services.

It covers medically necessary services, such as blood tests, provided to people who are admitted to a general or psychiatric hospital to receive mental health care.

Medicare Part B (Medical Insurance)

Medicare Part B helps pay for the following outpatient services:

• Evaluations and screening
• Psychiatric evaluations – a psychiatrist meets with a patient to diagnose any emotional or behavioral conditions
• Depression screening (1 per year) – designed to diagnose depression
• Alcohol misuse screening – (1 per year) to identify patients who use alcohol in a way that may be harmful (Learn more about coverage for alcohol misuse screening and counseling)
• Psychotherapy and counseling
• Individual and group psychotherapy – when a mental health care worker talks with a patient or group and uses research-based practices to collaboratively help them resolve problems
• Family counseling – when its main purpose is to help family members address conflicts in support of the patient's mental health treatment
• Opioid use disorder treatment services provided by opioid treatment programs, such as medication-assisted treatment for opioid use disorders
• Outpatient lab and diagnostic tests that are medically necessary and ordered by a physician
• Medication services
• Medication management – includes determining what medications a patient may need, prescribing those medications, and monitoring the patient's use of them
• Prescription medications for treatment of mental health issues
• Partial hospital stays – structured care programs that patients complete instead of being admitted to a hospital for inpatient mental health care

Learn more about behavioral health under Medicare

• Read more about Medicare's mental health benefits
• Learn more about Medicare coverage and see if a specific service is covered
• Learn about state requirements for behavioral health providers to be able to bill for their services under Medicare mental health (PDF) (4 MB, 35 pp).

The Marketplace

Through the Health Insurance Marketplace you can enroll in a health care coverage plan that meets your needs. It is a resource where individuals, families, and small businesses can:

• Compare health care coverage plans for services covered and affordability
• Get answers to questions about your health care coverage
• Find out if you are eligible for tax credits for private health care coverage or health programs like Medicaid or the Children's Health Insurance Program (CHIP)

Though health care benefits vary by state and health care plan, 10 essential health benefits must be covered by plans in the Marketplace. These benefits include behavioral health treatment (such as counseling with a psychologist to address your emotional concerns and helps you function well) and rehabilitative and habilitative services. Generally, health plans cover:

• Behavioral health providers, like psychiatrists, psychologists, social workers, advanced practice registered nurses, and counselors
• Behavioral health treatment, like counseling, medication, and alcohol/drug detox
• Inpatient services provided in settings like a hospital or emergency room
• Preventive services, like alcohol misuse and depression screenings, which most health care plans cover at no cost

Additionally, Marketplace plans must cover these services at a level equal to coverage provided for other medical and surgical services.

Contact the Marketplace

The Marketplace is available online at Healthcare.gov

Or call the Health Insurance Marketplace anytime, 24 hours a day, 7 days a week, at:
1-800-318-2596 (TTY: 1-855-889-4325)

Learn more about behavioral health under the Marketplace

For more information, visit the Mental Health and Addiction Insurance Help page.

Service Locator: Locating services by state

Looking for service providers in your area? Use CMS's Service Locator to find behavioral health service locations, contact information, and websites by state.