Magellan Healthcare is implementing a new process to meet the cost share requirements outlined in HB 220. This process applies to individuals seeking non-Medicaid covered behavioral health services and is designed to ensure compliance with the statutory cap that limits member contributions to no more than 5% of their household’s annual adjusted gross income (AGI).
Key elements of the process include:

• Eligibility Screening: During initial screening for Other State Funded (OSF) services (those not covered by Medicaid or for individuals without Medicaid), members will verbally attest to their household income. Magellan will calculate their AGI and determine the maximum out-of-pocket responsibility (AGI × 5%).
• Cost Share Requirement: Members must have incurred behavioral health costs equal to or exceeding 5% of their AGI before qualifying for OSF services. This requirement does not apply to individuals receiving services under SUD-specific funding sources.
• Hardship Exceptions: A financial hardship pathway is available for members unable to meet the cost share without compromising basic needs (e.g., housing, food, childcare). Magellan may reduce or waive the cost share based on the member’s attested ability to pay. Approved hardship exemptions will remain valid for one year.
• Implementation Timing: The new process will apply to all new screenings starting on July 1, 2025, Current members will remain eligible under existing terms until their next annual renewal, at which time the cost share requirement will be introduced.

Magellan will provide a separate, detailed provider notice prior to implementation. Providers are encouraged to review these materials and direct any member questions to Magellan’s Member Helpline.