State Title V agencies facilitate access to behavioral health services for CYSHCN and support pediatric behavioral health providers in a variety of ways. Many state Title V programs are working to increase pediatric mental and primary health care integration via two federal grant programs, the Pediatric Mental Health Care Access (PMHCA) program and the Integrated Care for Kids (InCK) Model. PMHCA is administered by the Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau (MCHB) and began in 2018. Forty-three states and territories have participated or continue to participate in the program. The InCK Model, administered by the Centers for Medicare and Medicaid Services, began in 2020 and will continue to 2027. Seven states are participating in this project. Learn more about PMHCA here and InCK here.
Facilitating Access to Providers
Connecticut Medicaid has a behavioral health phone line run by the Connecticut Behavioral Health Partnership to help Medicaid-enrollees locate a behavioral health provider. The state’s 211 line can help individuals with both public and private insurance or who are uninsured locate providers.
Family Voices Hawaii worked with an Independent Physician’s Association to create a directory of behavioral health providers and the insurance plans they accept to enable physicians to make the best referrals.
Arizona’s Title V agency maintains, annually updates, and publishes a list of primary care, dental, and behavioral health providers in Arizona that offer a sliding fee schedule to under- or uninsured individuals. As of 2019, over 400 sites in the state were included in this list.
New Hampshire designates $30,000 in Title V funds to contract with the Dartmouth Hitchcock Medical Center. The funds are used to pay for psychiatry referrals for CYSHCN in order to bypass long wait times for pediatric psychiatric services.
Title V Maternal and Child Health in Nevada partially funds the 211 number which provides information on health and human service programs throughout the state, including mental and behavioral health resources for CYSHCN. All Title V MCH subrecipients in Nevada are contractually obligated to update agency information with 211 resources and promote 211 services. Title V paid for an MCH page to be developed on the site.
Title V Providing Direct Services
The Office for Children with Special Health Care Needs in Kentucky holds autism spectrum disorder clinics in areas of the state where services are not readily available in order to fill gaps in services. Psychiatrists and psychologists are part of the clinic teams.
Title V funded CYSHCN clinics in Louisiana have social workers on staff who focus on the behavioral health needs of patients. The social workers provide behavioral health assessments, care coordination, youth health transition, brief individual and family therapy, and referrals for more intensive therapy.
Title V-funded staff in Alaska support in-state pediatric autism diagnostic centers. The clinics serve rural populations in the state and provide neurodevelopmental diagnosis and treatment recommendations. Title V funds a parent navigator as part of the clinic team.
The Community Health Aide Program in Alaska is a network of Community Health Aides/Practitioners (CHAPs) who work in rural Alaska villages to provide basic health care services and referrals. The CHAP program has a specific Behavioral Health Aide Project aiming to develop village-based behavioral health service capacity, focusing on prevention, early intervention, and case management.
North Dakota Title V funds autism clinics throughout the state as well as a Developmental Assessment Clinic that provides gap-filling for pediatric behavioral health services that are not easily accessible or available.
Title V Paying for Services
The CYSHCN Program in North Dakota covers limited mental health conditions, including mental health disorders that are the direct result of a primary condition that was already covered. They also added Attention Deficit Hyperactivity Disorder (ADHD) as a covered condition.
Florida Children’s Medical Services (CMS) collaborates with a state-wide behavioral health program that provides services to non-Medicaid eligible children ages 5 to 19 years with mental health or substance use disorders who are determined eligible for CHIP. CMS conducts outreach and works to increase awareness of the program.
Expanding Medicaid Eligibility, Benefits, and Coverage
In 2015, Minnesota’s Medicaid agency began implementing their Early Intensive Developmental and Behavioral Intervention benefit, which provides medically necessary services and supports to people under the age of 21 with autism spectrum disorder (ASD) or related conditions. Included in this benefit are education and training for parents and family members and services that promote independence and participation in family, school, and community life. Children and youth who have ASD or a related condition and are enrolled in Minnesota’s medical assistance programs, including TEFRA, may be eligible for the benefit.
Texas Medicaid has a Youth Empowerment Services (YES) 1915(c) waiver that provides Wraparound services to children and youth with serious mental, emotional and behavioral difficulties. The YES Waiver provides intensive services delivered within a strengths-based team planning process that builds on family and community support. South Carolina’s 1915(c) waiver that supports the state’s Palmetto Coordinated Systems of Care (PCSC) program, operates similarly to Texas’s YES Waiver.
In 2019, West Virginia’s 1915(c) Home and Community Based Services Waiver for Children with Serious Emotional Disorders was approved. This waiver uses the National Wraparound Initiative model to provide services to children and youth ages 3 to 21 with serious mental, behavioral, or emotional needs and their families. Covered services include training needed to perform activities for daily living, assistance in finding and creating opportunities for work, support for individuals ages 18 to 21 as they move from living in a facility to living in a house or apartment with others, and short-term respite.
Cross Agency Partnerships
Children’s Medical Services, the Title V Program in Georgia, collaborates with Early Intervention to provide services for children dually enrolled in the CYSHCN program and the Early Intervention Babies Can’t Wait Program. These children receive their chronic illness support from Children’s Medical Services and behavioral health support through Early Intervention.
Kentucky Title V participates in the State Interagency Council for Services and Supports to Children and Transition-age Youth (SIAC), focused specifically on mental and behavioral health. The council meets monthly and includes representatives from the Departments of Education, Public Health, Behavioral Health, Developmental and Intellectual Disabilities, Medicaid, Community-Based Services, and Juvenile Justice, as well as the Kentucky Housing Corporation, Administrative Offices of the Courts, and youth and family organizations and representatives. The council chair rotates every two years. Kentucky’s CYSHCN Director was the SIAC chair in 2021 and 2022.
The Rhode Island Title V Program is a collaborative partner on PCMH-Kids, the State’s Medical Home initiative for CYSHCN. PCMH-Kids has integrated a clinical component within practices to meet the mental and behavioral health needs of children and youth.
A staff member from the Rhode Island Title V Special Needs Program sits on the Advisory for the Managed Care Insurer that covers most of the state’s CYSHCN. One of the key focuses of this Advisory is ensuring adequate access to mental and behavioral health services for CYSHCN.
Title V in Ohio has served on the Ohio Interagency Council for Youth (OICY) which supports the creation and maintenance of a comprehensive continuum of care to facilitate timely access to appropriate services among youth with behavioral health needs. OYIC’s purpose is to make recommendations to state and local entities to increase access to behavioral services for children and youth and to reduce behavioral health disparities.
Alaska has a Medicaid 1115 demonstration waiver creating an integrated behavioral health system for people who experience serious mental illness, severe emotional disturbance, substance use disorder (SUD), co-occurring substance use and mental illness. The Alaska Title V program advocated for children to be covered under the waiver.
Minnesota Title V staff participate on advisory councils for pediatric behavioral health and participate in grants aiming to improve systems of care for behavioral health. While they do not directly fund mental or behavioral health programs, the coordination role that Title V serves ensures collaboration between providers and local public health departments to promote team-based mental health care for children.
Building Primary Care Provider Capacity
New Jersey, Rhode Island, Colorado, and Florida operate psychiatric consult lines for primary care providers. For example, SPAN, the Parent Advocacy Network in New Jersey managed a pilot grant to fund the consult line in one county of New Jersey. The program was later expanded to other counties through an American Academy of Pediatrics grant. Primary care providers can contact a child or adolescent psychiatrist at one of the hubs throughout the state to seek consultation on a patient’s behavioral health needs.
The University of Kansas Medical Center, Montana Access to Pediatric Psychiatry Network, and the University of Alaska Anchorage contract with their state Title V agencies to host Project ECHO groups on topics such as pediatric behavioral health, pediatric psychiatry, autism, and other neurodevelopmental disorders. These sessions provide opportunities for community clinicians to consult with and learn from pediatric behavioral health specialists who serve as mentors.
Idaho’s Title V Block Grant funding was used to support an 8-session, ECHO tele-mentoring program on Pediatric Behavioral Health series for primary care providers and other clinicians throughout the state of Idaho. These sessions were led by a panel of subject matter experts and provided best practices, assessment tools, and treatment recommendations for addressing common pediatric mental health conditions including depression, anxiety, trauma, suicide, comorbidity, attention deficit disorders, substance use disorders, and crisis management resources. Participants from all seven of Idaho’s public health districts (PHDs) attended the series, and 73% of the participants were practicing healthcare providers. Approximately 92% of post-series survey respondents indicated their knowledge, competency, or practice changed because of their participation and 96% reported that they were more effective at treating pediatric patients with behavioral health concerns.
Behavioral Health Managed Care Organizations (MCOs)
Some states’ Medicaid programs provide behavioral health services through specialized MCOs. Potential benefits of this approach include opportunities to provide tailored benefits and services and use behavioral health-specific quality measures. When a state is exploring using a specialized MCO for behavioral health, Title V can be involved in many parts of the process, including providing feedback on contracts, assisting in selecting quality measures, and helping in the oversight process to ensure the MCO is providing quality care for children. Potential drawbacks of these plans include greater difficulty for families in accessing services due to the need to navigate an additional health plan with a different provider network and the potential that behavioral health becomes less integrated with primary and other healthcare.
Building Behavioral Health System Infrastructure
Within the Kansas Title V agency, a Behavioral Health Consultant oversees grants that focus on behavioral health. One of these programs, KSKidsMAP Pediatric Mental Health, supports primary care providers in caring for their pediatric patients’ mental health needs.
Staff members from the Illinois Department of Public Health serve on the executive board of the Illinois Children’s Mental Health Partnership (ICMHP). In 2019, four county public health departments participated in a pilot program with ICMHP testing a model for infant and early childhood mental health consultation. Two infant and early childhood mental health professionals served as consultants to the public health departments to build capacity and ensure that connections were made between appropriate systems and resources. During the pilot, services were focused on families participating in WIC and Family Case Management programs, but were available to anyone at the public health department.
Mississippi’s Title V agency provides funding to the organization Mississippi Families as Allies, which supports families raising children with behavioral health challenges. Families as Allies provides direct support to families, training for families in leadership and navigating systems, training for providers in systems advocacy and family-driven care, and technical assistance regarding policy change and family-driven care.
PTI Nebraska, Nebraska’s Family Voices affiliate organization, works closely with the National Alliance on Mental Illness to provide support for children’s mental health. PTI also utilizes the Nebraska Resource and Referral system, a provider database managed by Answers4Families, to connect families to resources for childcare for children with behavioral health needs. The database of licensed daycare providers is updated daily.
The Vermont Federation of Families for Children’s Mental Health provides funding to the Vermont Family Voices affiliate for a family support position specific to mental and behavioral supports for children and youth. This partnership has allowed the Family Voices affiliate to serve families more holistically.
Family Navigation Network (FNN), located within the Nevada Center for Excellence in Disabilities at the University of Nevada, Reno, is Nevada’s Family to Family Healthcare Information and Education Center. Through Title V MCH funding, FNN employs family navigators who provide families of CYSHCN with needed mental and behavioral resources and supports as part of overall care coordination.
Gap Filling Services
In Puerto Rico, if a child with the Government Insurance Plan (Medicaid/CHIP eligible) screens positive for Autism Spectrum Disorder (ASD), they receive six months of a provisional ASD coverage while confirming the diagnosis. Once the diagnosis is confirmed, the child qualifies for permanent autism coverage, up to age 21 years, that allows access to certain services without a referral. Two Title V-funded Autism Centers provide early identification and diagnostic services. When a child is diagnosed with ASD at one of the Autism Centers, a Certification of ASD diagnosis is provided to the family, which can be used to apply for the Government Insurance Plan (Medicaid/CHIP) Autism Special Coverage and in the eligibility determination for the IDEA Part C or Part B programs.
Mississippi’s Title V agency collaborates with an organization that supports families who have adopted children with behavioral health needs. This organization offers family engagement events, training for families, and respite care services.
School-Based Services and Initiatives
In the District of Columbia (DC), Title V provides support for staff overseeing the school-based health center (SBHC) program. Seven public high schools have SBHC programs, in which a mental health clinician provides behavioral health services on-site at least one day per week at each school. SBHCs collaborate with the school district, DC Health, and the Department of Behavioral Health to establish referral mechanisms to resources within the school and in the community. In addition, a Federally Qualified Health Center, Mary’s Center, is conducting a school-based transition program focused on mental health in seven schools. Two transition tools created as part of this program are a transition readiness assessment focusing on mental health self-care skills and a discharge wellness plan given to senior students.
New York’s School-Based Health Centers (SBHCs) are required to provide behavioral health screening for all patients as part of ongoing primary care. Two-hundred fifty-two (252) of these SBHCs also provide on-site mental health services including assessments, crisis intervention and counseling, and the remaining SBHCs provide referral to mental health services. In the 2020-2021 reporting year, New York SBHCs provided 76,288 mental health visits.
The Colorado Department of Public Health and Environment provides grants to SBHCs, prioritizing centers that serve a disproportionate number of uninsured or underinsured children and youth up to age 21 or low-income populations. These grants can be used for a variety of capacity-building purposes, including expanding behavioral health services.
The Kansas CYSHCN program has partnered with the Kansas Chapter of the National Alliance on Mental Illness (NAMI) to provide Ending the Silence training in schools for adolescents experiencing mental health needs. This training supports adolescents in understanding the importance of taking care of their mental health needs, when to seek help, and resources and tools to respond in a positive manner to those experiencing a mental health crisis.
Kentucky’s Title V agency collaborates with the state’s Department for Behavioral Health, Developmental and Intellectual Disabilities around suicide prevention and bullying. They work together on the Family Thrive program, a framework that supports youth resilience, social connection, knowledge of adolescent development, concrete support in times of need, and cognitive and social-emotional competence.