Description
Used to see if you have a substance use concern. It helps providers know the best way to help you.

• What it is: A conversation with a provider to see if alcohol or drug use may be affecting your health
• Who this may help: People who are unsure if they have a substance use concern or want help deciding next steps
• What to know: Helps guide treatment choices

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: No

Description
Tests to see if your hair, urine, or saliva shows that there is alcohol or drugs in your body.

• What it is: Tests of urine, hair, or saliva to check for alcohol or drugs in your system
• Who this may help: People in treatment or monitoring programs
• What to know: Often used to support recovery or treatment planning

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: No, until the 24 unit threshold is met.

Description
If you live in Enhanced Safe and Sober Housing, you can get basic housing essentials like bedding, towels, soap, toothpaste, etc.

• What it is: Basic items like bedding and hygiene supplies
• Who this may help: People living in ESSH
• What to know: Prior approval required

Member Eligibility

• Medicaid: Not covered
• Other State Funds: Covered
• Pre-Auth Required: Yes

Description
Case management is a collaborative process with a behavioral health professional. A case manager helps facilitate and advocate for options and services to meet your needs. If you have mental health concerns, a trained mental health expert can help you access and coordinate care for your physical and mental health. They can also help you with community-living needs.

• What it is: Support from a professional who helps coordinate services
• Who this may help: People who need help navigating care or community resources
• What to know: Focuses on mental and physical health needs

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: No

Description
Case management is a collaborative process with a behavioral health professional. A case manager helps facilitate and advocate for options and services to meet your needs.

If you have substance use concerns, a trained expert can help you access and coordinate your care for your physical and mental health. They can also help you with community-living needs.

• What it is: Support to coordinate care for substance use recovery
• Who this may help: People needing help managing treatment and recovery services
• What to know: Can also help with housing and daily living needs

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: No

If you have substance use concerns and need to go to an appointment or a treatment facility, you could get free or low-cost childcare while you are there.

• What it is: Help paying for childcare during treatment visits
• Who this may help: Parents receiving substance use treatment
• What to know: Available through Other State Funds

Member Eligibility

• Medicaid: Not covered
• Other State Funds: Covered
• Pre-Auth Required: Yes

The CDA helps providers understand your mental health and substance use concerns and develop a care plan. It includes a review of your health history and any family-related issues. A CDA needs to be completed every twelve (12) months. It can be updated more often if needed.

• What it is: A detailed review of your mental health and substance use needs
• Who this may help: People starting services or whose needs have changed
• What to know: Required at least once every 12 months

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: No

Description
Crisis* Centers offer you in-person help if you are having a mental health or substance use crisis. You may stay at a Center for up to 23 hours and 59 minutes. This is available for all Idahoans. 
*A crisis is when you or someone you know is having sudden and severe mental health concerns, and you are unsure of what to do. See Getting Care chapter for more information.

• What it is: In-person crisis support for up to 23 hours and 59 minutes
• Who this may help: People needing immediate, face-to-face help
• What to know: Available statewide

Member Eligibility
Coverage: This service is available to all Idahoans free of charge.

Description
With crisis* intervention services, you can talk to a behavioral health expert 24 hours a day, 7 days a week. The person will work with you to manage the crisis and make a plan to improve your situation. 
*A crisis is when you or someone you know is having sudden and severe mental health concerns, and you are unsure of what to do. See Getting Care chapter for more information.

• What it is: Immediate support from a behavioral health professional
• Who this may help: People needing help managing a crisis right away
• What to know: Available 24/7

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: No

Description
Crisis* psychotherapy is for when you have a behavioral health crisis but are not at risk of hurting yourself or others. You talk with a trained therapist to explore and address the issues that led to your crisis. The goal is to help you get stable quickly. 
*A crisis is when you or someone you know is having sudden and severe mental health concerns, and you are unsure of what to do. See Getting Care chapter for more information.

• What it is: Short-term therapy during a crisis
• Who this may help: People in crisis who are not at risk of harming themselves or others
• What to know: Focuses on quick stabilization

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: No

Description
You can call 988 24 hours a day, 7 days a week, if you are having a behavioral health crisis.* This service gives you immediate help over the phone, text, or chat with trained professionals. Staff will listen and connect callers to the right levels of care. The crisis call center is available for all Idahoans. 
*A crisis is when you or someone you know is having sudden and severe mental health concerns, and you are unsure of what to do. See Getting Care chapter for more information.

• What it is: 24/7 phone, text, or chat support during a crisis
• Who this may help: Anyone experiencing a mental health or substance use crisis
• What to know: Available to all Idahoans

Member Eligibility
Coverage: This service is available to all Idahoans free of charge.

Description
If you start to have signs of serious mental illness that interferes with your life, you may have ESMI.* The STAR program is for people who:

• Are between 15 and 30 years old
• Have experienced ESMI within the past two (2) years
• Have not received treatment
• Meet the criteria in the most recent version of The Diagnostic and Statistical Manual of Mental Disorders

Services include:

• Assessments
• Treatment plans
• Psychoeducation
• Crisis intervention
• Case management and coordination
• Psychotherapy (individual and group)
• Peer support**
• Medication management
• Education and career help

**Adult mental health peer support is not covered by Medicaid. Other state funding covers adult mental health peer support for Medicaid and non-Medicaid members enrolled in ESMI programs.

*ESMI is a condition that affects an individual, regardless of their age, and that is a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified within the current version of The Diagnostic and Statistical Manual of Mental Disorders as published by the American Psychiatric Association (APA). For a significant portion of the time since the onset of the disturbance, the individual has not achieved or is at risk for not achieving the expected level of interpersonal, academic, or occupational functioning. This definition is not intended to include conditions that are attributable to the psychologic effects of a substance, substance use disorder, are attributable to an intellectual developmental disorder or another medical condition. The term ESMI is intended for the initial period of onset of the symptoms.

• What it is: Early treatment for new serious mental illness symptoms
• Who this may help: People ages 15–30 with recent onset symptoms
• What to know: Focuses on recovery, education, and work goals

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: Yes

Description
If you are in recovery from substance use concerns and are leaving a psychiatric hospital or other facility, you might be able to get ESSH. ESSH provides a safe, clean and sober place where you can continue your recovery. Houses have a substance use disorder-qualified house manager who lives there 24 hours a day, 7 days a week. You get recovery coaching, medication monitoring, and extra support for SUD- and mental health-related issues.

ESSH is different than regular Safe and Sober Housing (SSH) in these ways:

• In ESSH, the house manager lives in the house all the time. In SSH, they do not.
• ESSH is for people who are leaving inpatient or residential treatment. SSH is for people in recovery and active treatment or waiting for active treatment.
   
• What it is: Sober housing with 24/7 on-site support
• Who this may help: People leaving inpatient or residential treatment
• What to know: Includes recovery coaching and medication monitoring

Medicaid Eligibility

• Medicaid: Not covered
• Other State Funds: Covered
• Pre-Auth Required: Yes

Description
If you have Serious Mental Illness (SMI)* or Serious and Persistent Mental Illness (SPMI)** you and your family can get information that can help you understand your needs and strengths. This service is to help you learn about and understand your condition, so you can manage and make decisions in an informed way. Depending on what you need help with, you can come to sessions with just your family or a group of families that share the same experiences.

*In order to be considered as having an SMI, a member must 1) have a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet the diagnostic criteria specified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and 2) have a functional impairment that substantially interferes with or limits one (1) or more major life activities.

**In order to be considered as having an SPMI, a member must 1) meet the criteria for SMI, 2) have at least one (1) additional functional impairment, and 3) have a diagnosis under DSM-5 with one (1) of the following: Schizophrenia, Schizoaffective Disorder, Bipolar I Disorder, Bipolar II Disorder, Major Depressive Disorder Recurrent Severe, Delusional Disorder, or Borderline Personality Disorder.

• What it is: Education for you and your family about serious mental illness
• Who this may help: People with SMI or SPMI and their families
• What to know: Helps families understand conditions and treatment options

Member Eligibility

• Medicaid: Covered
• Other State Funds: Not covered
• Pre-Auth Required: No

Description
If you have mental health concerns, you and your family can talk with a behavioral health expert who will help you and your family learn coping and other skills.

• What it is: Therapy sessions with family members
• Who this may help: People whose mental health affects family relationships
• What to know: Helps families learn coping and communication skills

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: No

Description
Functional assessments measure your ability to do things needed for daily living. It measures your strengths and needs.

• What it is: An evaluation of how you manage daily life tasks
• Who this may help: People who need help living independently or managing daily routines
• What to know: Looks at strengths and support needs

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: No

Description
After you have successfully completed treatment for a substance use concern, you can meet with a group of people on a regular basis. These people are going through the same kinds of things you are going through. The group members support each other in recovery.

• What it is: Ongoing group support after completing treatment
• Who this may help: People maintaining recovery after treatment
• What to know: Focuses on peer support

Member Eligibility

• Medicaid: Not covered
• Other State Funds: Covered
• Pre-Auth Required: No

Description
If you have a mental health or substance use concern, you can meet with a group of three or more people with similar concerns. You and the other group members will talk and support each other. You may practice coping skills to learn how to manage issues. The group is led by a behavioral health expert who helps you be safe.

• What it is: Therapy with others who have similar concerns
• Who this may help: People who benefit from peer support and shared learning
• What to know: Led by a trained provider

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: No

Description
If you have Serious and Persistent Mental Illness (SPMI)* or more than one mental health concern, you may be able to live in a HART home. HART is a program where people with the same conditions live together in the community. In a HART home, you will get medically necessary services that may include:

• Comprehensive diagnostic assessment
• Peer support
• Case management
• Crisis response and intervention
• Individualized skills building treatment plan
• Psychotherapy (individual and group)
• Medication management
• Skills building/CBRS
• Skills training and development
• Treatment planning

*In order to be considered as having an SPMI, a member must 1) meet the criteria for Serious Mental Illness, 2) have at least one (1) additional functional impairment, and 3) have a diagnosis under DSM-5 with one (1) of the following: Schizophrenia, Schizoaffective Disorder, Bipolar I Disorder, Bipolar II Disorder, Major Depressive Disorder Recurrent Severe, Delusional Disorder, or Borderline Personality Disorder.

• What it is: Community housing with treatment services
• Who this may help: People with serious and persistent mental illness
• What to know: Includes therapy, skills training, and medication support

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: Yes

Description
If you have a mental health or substance use concern, you can talk with a trained therapist to explore and address emotional, mental, and behavioral challenges. It provides a safe space to discuss concerns, understand feelings, and develop coping strategies to improve overall wellbeing.

• What it is: One-on-one therapy with a trained professional
• Who this may help: People with emotional, mental health, or substance use concerns
• What to know: Helps build coping skills and improve wellbeing

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: No

Description
A trained clinician and a skills helper work with you and your family to create a personalized treatment plan. The approach focuses on your strengths and helps you meet goals.

• What it is: A personalized plan focused on your strengths and goals
• Who this may help: People who need help building daily living or coping skills
• What to know: Created with a clinician and skills helper

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: No

If you have a mental health concern (with or without a co-occurring substance use concern), and your thoughts, mood, perception, or behavior is substantially impaired, you may need to be admitted to the hospital as inpatient. Inpatient care is when you get covered services in a hospital and stay there overnight for at least one day.

If you do not have Medicaid, other state funds will cover inpatient care only if you are involuntarily admitted.

• What it is: Overnight hospital care for serious mental health concerns
• Who this may help: People whose symptoms severely affect safety or functioning
• What to know: Requires prior approval

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: Yes

Description
If you have a substance use concern and need medically managed withdrawal treatment and related care, you may need to be admitted to the hospital as inpatient. Inpatient care is when you get covered services in a hospital and stay there overnight for at least one day.

• What it is: Hospital care for medically managed withdrawal
• Who this may help: People needing medical support during detox
• What to know: Requires prior approval

Member Eligibility

• Medicaid: Covered
• Other State Funds: Not covered
• Pre-Auth Required: Yes

This is a structured program for you if you have mental health or substance use symptoms that can be managed in a level of care that is less intensive than partial hospitalization but higher than basic outpatient care. Services include:

• Assessment and treatment planning
• Psychotherapy and/or psychoeducation
• Skill-building activities
• 24-hour crisis services
• Psychiatric evaluation
• Medication management
• Substance use screening and monitoring, and drug testing (as appropriate)
• Physical exam
• Care coordination/transition management/discharge planning
• For eating disorders:
• Health assessment and monitoring
• Dietary and nutrition services

You may also get these services outside the program:

• Separate case management
• Respite
• Peer support
• Recovery coaching
• Psychological/neuropsychological testing
                 
• What it is: Structured treatment several days a week while living at home
• Who this may help: People needing more support than weekly therapy
• What to know: Includes therapy, skill-building, and care coordination

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: No

Description
If you are in recovery from substance use concern, life skills can help you cope with the demands and challenges of life. Programs can help you enhance personal or family relationships, reduce work or family conflict, and adopt healthy, recovery-oriented behaviors.

• What it is: Training to manage daily responsibilities during recovery
• Who this may help: People recovering from substance use concerns
• What to know: Focuses on healthy, recovery-oriented behaviors

Member Eligibility

• Medicaid: Not covered
• Other State Funds: Covered
• Pre-Auth Required: No

Description
A doctor or nurse meets with you to discuss the medicines you take and order new ones you might need.

• What it is: Visits to review and manage medications
• Who this may help: People taking medications for mental health or substance use
• What to know: Helps ensure medications are safe and effective

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: No

Description
Medication-assisted treatment (MAT) is the use of medications, sometimes in combination with counseling and behavioral therapies, to treat substance use disorders. MAT helps treat opioid use disorder and alcohol use disorder and can help you to sustain recovery.

• What it is: Medication combined with counseling for substance use disorders
• Who this may help: People with opioid or alcohol use disorders
• What to know: Supports long-term recovery

Member Eligibility

• Medicaid: Covered
• Other State Funding: Covered
• Pre-Auth Required: No

Mobile response is a brief community-based intervention to help you if you are in a mental health crisis.* Teams identify your stressors and focus on your strengths and natural supports to de-escalate the crisis and prevent future crises. Mobile Response will be delivered in the community. This is available for all Idahoans.

*A crisis is when you or someone you know is having sudden and severe mental health concerns, and you are unsure of what to do. See Getting Care chapter for more information.

• What it is: Crisis help delivered in the community
• Who this may help: People who need in-person crisis support where they are
• What to know: Helps prevent hospitalization

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: No

Description
If you have a mental health concern, you and your family can meet with other families who face similar challenges. In a group setting with a trained professional, you and others discuss and work on emotional concerns. The goal is to help you and your family grow, handle your emotions better, and improve your daily life skills.

• What it is: Therapy with several families together
• Who this may help: Families facing similar mental health challenges
• What to know: Focuses on emotional growth and daily life skills

Member Eligibility

• Medicaid: Covered
• Other State Funds: Not covered
• Pre-Auth Required: No

Description
Formal sets of tests that help detect brain damage, injuries or other issues. They can reveal challenges in how the brain functions. These tests are given by a psychologist.

• What it is: Specialized testing to understand how the brain is working
• Who this may help: People with brain injuries, memory concerns, or complex conditions
• What to know: Helps guide treatment planning

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: No, until 14 hour threshold is met

Description
If you have a substance use concern, you can meet with a therapist for help. You will learn how to:

• Stop using substances and stay substance-free
• Change behaviors
• Repair relationships
• Make new friends who don’t use substances
• Create a recovery lifestyle

You can meet with a therapist by yourself or in a group.

• What it is: Therapy focused on stopping substance use and building recovery
• Who this may help: People working toward long-term recovery
• What to know: Can be individual or group-based

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: No

Description
This is a structured program for you if you have mental health or substance use symptoms that can be managed in a level of care that is less intensive hospitalization but higher than intensive outpatient care. You attend this structured program for 20 or more hours a week. You do not spend the night in the hospital. Services include:

• Assessment and treatment planning
• Psychotherapy and/or psychoeducation
• Skill-building activities
• 24-hour crisis services
• Psychiatric evaluation
• Medication management
• Substance use screening and monitoring, and drug testing (as appropriate)
• Physical exam
• Care coordination/transition management/discharge planning
• For eating disorders:
  • Health assessment and monitoring
  • Dietary and nutrition services
     
• What it is: Day-long treatment without overnight stays
• Who this may help: People needing intensive care but not hospitalization
• What to know: Typically 20+ hours per week

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: Yes

Description
Formal sets of written, visual or verbal tests that are given by a psychologist. They help providers understand how you think, feel and behave. They can also help determine your strengths, challenges, personality and how you handle situations.

• What it is: Tests that help providers understand how you think, feel, and behave
• Who this may help: People who need clarity about diagnoses, learning needs, or emotional concerns
• What to know: Given by a psychologist

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: No, until 14 hour threshold is met

Description
If you are recovering from a substance use concern, you can get support from a Certified Recovery Coach (CRC) or a Certified Peer Recovery Coach (CPRC).* These coaches are your advocate, guide, leader, and mentor. They help you get connected to services and connect you to the recovery community. They help you create a recovery and resiliency plan that meets your needs. If you have a relapse they, can help you re-engage in supports and treatments. If you work with a CRC/CPRC, you may have fewer and less severe relapses.

*The difference between a CRC and a CPRC is that a CRC is not required to be in recovery themselves. CPRCs are all in recovery themselves.

• What it is: Support from a certified recovery coach or peer
• Who this may help: People in recovery who want guidance and encouragement
• What to know: Helps connect you to recovery supports

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: No

Description
If you have a mental health and/or substance use concern and your psychiatric, behavioral, or cognitive problems are severe that you need 24-hour care, you could go to a residential treatment center. A residential treatment center is not a hospital. Services include:

• Psychiatric care
• Psychological care
• Therapeutic and behavior modification
• Psychotherapy
• Nursing care
• Family visits
• Psychoeducation
   
• What it is: 24-hour care in a non-hospital setting
• Who this may help: People with severe mental health or substance use needs
• What to know: Includes therapy, medical care, and education

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: Yes

Description
If you are in recovery from a substance use concern and in active treatment or waiting for active treatment, you may be able to live in an SSH. SSH provides a safe, clean and sober place for you to continue your recovery. A house manager who may or may not live in the house is available to support you 24 hours a day, 7 days a week. You would need to pay a fee for amenities and utilities.

SSH is different than Enhanced SSH in these ways:

• In SSH, the house manager does not live in the house all the time. In ESSH, they do.
• SSH is for people in recovery and active treatment or waiting for active treatment. ESSH is for people who are leaving inpatient or residential treatment.
   
• What it is: Sober housing while in treatment or waiting for treatment
• Who this may help: People in recovery needing stable housing
• What to know: Residents pay some living costs

Member Eligibility

• Medicaid: Not covered
• Other State Funds: Covered
• Pre-Auth Required: Yes

Description
If you have a mental health concern, you might be able to get CBRS at home or in the community. Providers use special techniques to help you improve behavior, social skills, communication, and daily living skills. It can help boost your abilities and confidence. It can help reduce mental health symptoms.

• What it is: Support to build social, communication, and daily living skills
• Who this may help: People whose mental health affects everyday functioning
• What to know: Can be provided at home or in the community

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: Yes

Description
A doctor or nurse may give you medicine you need in a shot form. Injections may help people with long-term conditions. They can lead to better results and consistent use. Sometimes injections are the best way to get certain medicines.

• What it is: Medication given by injection
• Who this may help: People who need long-acting medications
• What to know: Often improves consistency

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: No

Description
TMS uses a magnetic field to influence brain activity. It can help if you have depression, obsessive-compulsive disorder, or another condition that has not improved with treatment. It is not invasive. The side effects are usually mild and temporary. TMS takes place in an office, not a hospital, and does not involve anesthesia.

• What it is: Non-invasive treatment using magnetic pulses
• Who this may help: People with depression or OCD that has not improved with treatment
• What to know: Office-based, no anesthesia required

Member Eligibility

• Medicaid: Covered
• Other State Funds: Covered
• Pre-Auth Required: Yes

Description
If you have substance use concerns and do not have a way to get to treatment appointments, you can get free or low-cost travel. If you are in overnight care, you can also get free or low-cost travel for your child to visit you. To get transportation, call Magellan at 1-855-202-0973 (TTY 711) 24 hours a day, 7 days a week.

• What it is: Help getting to treatment appointments
• Who this may help: People without reliable transportation
• What to know: Call Magellan to arrange

Member Eligibility

• Medicaid: Not covered
• Other State Funds: Covered
• Pre-Auth Required: No