Paying for Services
There are various ways to pay for mental healthcare services in Chittenden County. These are explained below:
Private/Group Insurance may be provided by your employer through a benefits package or you may purchase it independently if you do not qualify for a public funding source. If you are unsure if your health insurance provides mental health services, call the customer service number on the back of your insurance card and ask how many mental health counseling sessions your child is eligible for and what (if any) the co-pay is for these appointments. You will need to have your member identification number which is generally located on the front of your insurance card. If you do not have an insurance card but know that you have insurance through your employers, contact the Human Resources Department of the company you work for and request an insurance card and/or the customer service phone number of your health insurance company.
Employee Assistance Programs (EAPs) are employee benefit programs offered by many employers, typically in conjunction with a health insurance plan. EAPs are intended ot help employees deal with personal problems that might adversely impact their work performance, health, and well-being. EAPs generally include assessment, short-term counseling and referral services for employees and their household members. An EAP’s services are usually free to the employee or household member, having been pre-paid by the employer. EAPs are generally accessed through a toll free number, which you can acquire from the Human Resources Department of your employer.
Out of pocket – If your child does not have health insurance, you can request a “sliding scale fee” from mental health counselors for counseling sessions. Sliding scales offer the option of a reduced payment. Sliding scales are generally based on your income, but you can also advocate for a fee and/or payment schedule that is affordable for your family.
Public Funding Sources
Medicaid is a jointly funded state and federal program for payment of medically necessary services for people who meet certain income and resource guidelines. There are six primary ways for children and families to access Medicaid. These are briefly described below:
- Dr. Dynosaur is the name Vermont uses to refer to the Medicaid program for children under 18 and pregnant women. Eligibility for Dr. Dynosaur is based on household income and family size. A small monthly premium may be required. To apply, contact the Health Access Member’s Services Unit at 1-800-250-8427 to have an application mailed to you or visit http://www.greenmountaincare.org/application_forms.html to download an application.
- Katie Beckett Waiver/Disabled Children’s Home Care is a program that provides health care coverage to a child (under 19) with a disability that requires a level of care typically provided in hospitals or in-patient care facilities. In order to receive this funding, it must be determined that it is medically appropriate to care for the child in their home setting. Parents’ income is not a factor in the application process. Only the child’s income and resources are considered. To apply, call Health Access Member Services Unit at 800-250-8427. The Katie Beckett forms are complicated. The Vermont Family Network provides assistance to families in filling out these forms. They can be reached at 802-728-2263.
- ReachUp helps families with children by providing cash assistance for basic needs and services that support work and self-sufficiency. Families who are eligible for Reach Up are also eligible for health coverage through Medicaid, state subsidized child care, and may receive fuel assistance, food stamps, and job training. In order to quality for Reach Up, a family’s earned and unearned income and resources are assessed and the parent(s) agrees to work with a case manager. Applications can be obtained by calling Chittenden County’s Economic Services Division office at 802-863-7365 or 1-800-775-0506. For more information on the program or to download an application, visit http://dcf.vermont.gov/esd/reach_up.
- The Mental Health Waiver (Home and Community Based Waiver) provides coverage for children with a mental health condition or mental illness who are at risk of being hospitalized, who do not otherwise qualify for medicaid or if they do qualify for Medicaid, the Mental Health Waiver may provided needed additional mental health services. To apply, call the Vermont State Department of Mental Health at 802-241-2601.
- Supplemental Security Income (SSI) is a federal program for individuals who are disabled. SSI is administered by the Social Security Administration. A child is eligible based on their disability determination (which may be primarily mental health related) and the family’s income, resources, and assets. If eligible, the child will receive a monthly check based on the family’s income and is almost always eligible for Medicaid. To apply, families are encouraged to call their local SSA office (in Chittenden County 802-951-6753) or the Federal SSA office at 800-772-1213.
- Medically Needy Program – Spend Down is designed to assist families with large out-of-pocket medical expenses which are subtracted from their monthly income so that they can meet financial eligibility for Medicaid health coverage. This is a very individualized process. Contact Health Access Member’s Services Unit at 800-250-8427 for an application.
Special Education – If your child receives Special Education services through an IEP (Individualized Education Plan) and the IEP team believes that counseling is needed to assist your child in benefiting from their educational program, counseling services can be included in the IEP under “related services”. This is further clarified in the Special Education Guide (2010) on page 23 that can be accessed at http://education.vermont.gov/new/pdfdoc/pgm_sped/laws/educ_sped_guide.pdf.
Victim Compensation Fund provides limited financial assistance to Vermont’s victims of violent crime who have experienced a financial loss as a direct result of that crime as long as that loss is not reimbursable through other sources, such as insurance. Victim Compensation Fund covers a host of crime related expenses, including mental health care counseling. For more information on this funding and an application, visit the Vermont Center for Crime Services website at http://www.ccvs.state.vt.us or call 1-800-750-1213.
*Free Services – Many schools and/or organizations offer mental health services that are free to children and their families (i.e. First Call Child and Family Crisis Services, Women Helping Battered Women, Student Assistance Programs at school.) If you want to know if a provider or organization offers any services free of charge, call the provider/organization directly to inquire.