Parents

There are multiple ways for a youth to get a mental health assessment.

• If the youth has Medicaid, contact the Idaho Behavioral Health Plan managed care provider to find a provider in your area. You can call them directly to schedule an assessment.
• If the youth has Medicaid and you would like to receive respite services, call the Independent Assessor to schedule an assessment.
• If the youth does not have Medicaid, but you would like to apply, call the Independent Assessor to schedule an assessment.
• If the youth does not have Medicaid, and you do not think your child is eligible, contact Magellan Healthcare by calling 1-855-202-0973 or visiting magellanofidaho.com. They will help your child find a provider to complete a mental health assessment.

During the assessment appointment, the provider performs a full mental health assessment, and uses the Child and Adolescent Needs and Strengths (CANS) tool to determine if your child has serious emotional disturbance (SED).

If the youth has private insurance, call the number on your insurance card, or visit their website to find a provider in your area. Then call to schedule an assessment. If your private provider does not participate in the YES system of care, they may not complete a CANS as part of the mental health assessment process.

Mental health services come from different providers and agencies. Denials of service are determined by the organization responsible for access to the service, which is frequently the insurance company or the state agency sponsoring the program. Each organization has a slightly different process to follow once a service has been denied.

When an insurance agency or a program within the state of Idaho denies a service, a letter is written explaining why the service was denied. The letter includes the steps you can take to try to reverse the decision. It is important to follow the provided directions, including submitting your request for an appeal within the deadline.

Sometimes services are denied because your child does not meet the criteria for a service, or the evidence to prove that they do meet the criteria is missing. It is possible to work with your provider and the denying agency to resolve those issues, but it is important to meet all deadlines to file an appeal.

When a family or youth is unhappy with any part of the YES system of care, they may submit a concern or complaint by phone (208-364-1910 or toll free 1-800-352-6044), by email to yes@dhw.idaho.gov, or online by using the concern and complaint form.

Once the complaint is received:

• It is logged and forwarded to the person or agency best able to resolve the concern.
• The person who submitted the concern or complaint is contacted, usually within 5 business days, to acknowledge their information was received and to gather any additional information needed to resolve the concern.
• Information is reviewed by staff members before action is taken to resolve the concern.
• A letter explaining the resolution of the concern or complaint is sent to the person who submitted it, usually within 30 days.
• Appeals to the resolution may be filed by mail or fax.

Some agencies, like Medicaid, also have a specific internal complaint resolution process that is followed once a complaint is received.

Division of Medicaid
MedicaidAppeals@dhw.idaho.gov
Phone: 208-334-5747
Fax: 208-364-1811
Mail: Medicaid Appeals – IDHW, PO Box 83720, Boise, ID 83720-0009
In Person: Your Local Health & Welfare Office
Web link for processes: https://publicdocuments.dhw.idaho.gov/WebLink/Browse.aspx?id=17618&dbid=0&repo=PUBLIC-DOCUMENTS

Division of Behavioral Health
Email: APS@dhw.idaho.gov
Mail: 450 West State Street 10th floor P.O. Box 83720, Boise, ID 83720-0036
Fax: (208) 639-5741
An appeal can be requested verbally by calling 855-643-7233 and must be followed up with a written request
using one of the options listed above.

Division of Welfare/Self-Reliance (Medicaid and other benefit eligibility):
MyBenefits@dhw.idaho.gov
Phone: 877-456-1233
Fax: 866-434-8278
Mail: Self-Reliance Programs, PO Box 83720, Boise, ID 83720-0026
In Person: Your Local Health & Welfare Office
Web link for processes: https://healthandwelfare.idaho.gov/appeals-and-fair-hearings

Idaho Behavioral Health Plan – Magellan Healthcare
Phone: 1-855-202-0973 (TTY 711)
Email: IDAC@magellanhealth.com
Fax: 1-888-656-9795
Mail:
Magellan HealthCare, Inc.
Attn: Idaho Quality Department
P.O. Box 2188
Maryland Heights, MO 63043

Idaho Department of Education (IDE)
info@sde.idaho.gov
Mail: Special Education Dispute Resolution Idaho State Dept. of Education P.O. Box 83720  Boise, ID 83720-0027
Phone: (208) 332-6914 or (800) 432-4601
TT:  (800) 377-3529
Fax: (208) 334-2228
Dispute Resolution Process: https://www.sde.idaho.gov/sped/dispute/

For more information, visit the Appeals page.

Crisis and Safety Planning – Video
Cómo crear un plan eficaz de crisis y seguridad – Video
CANS for Families: CANS 3.0 – Video

Links to more resources

Serious emotional disturbance (SED) is a legal term used when youth under the age of 18 have both a mental health diagnosis and a functional impairment as identified by the Child and Adolescent Needs and Strengths (CANS) tool.

Idaho’s legal code* uses this definition:
“Serious emotional disturbance” means an emotional or behavioral disorder, or a neuropsychiatric condition which results in a serious disability, and which requires sustained treatment interventions, and causes the child’s functioning to be impaired in thought, perception, affect or behavior. A disorder shall be considered to “result in a serious disability” if it causes substantial impairment of functioning in family, school or community…”

A person has SED if they have both a DSM diagnosis and a functional impairment as identified by the Child and Adolescent Needs and Strengths (CANS) tool.

* Idaho Code,16-2403(13)

The YES system of care prioritizes the following values throughout treatment planning, implementation, and evaluation:

• Family-Centered – Emphasizes each family’s strengths and resources.
• Family and Youth Voice and Choice – Prioritizes the preferences of youth and their families in all stages of care.
• Strengths-Based – Identifies and builds on strengths to improve functioning.
• Individualized Care – Customizes care specifically for each youth and family.
• Team-Based – Brings families together with professionals and others to create a coordinated care plan.
• Community-Based Service Array – Provides local services to help families reach the goals identified in their coordinated care plan.
• Collaboration – Partners families, informal supports, providers, and agencies together to meet identified goals.
• Unconditional – Commits to achieving the goals of the coordinated care plan.
• Culturally Competent – Considers the family’s unique cultural needs and preferences.
• Early Identification and Intervention – Assesses mental health and provides access to services and supports.
• Outcome-Based – Contains measurable goals to assess change.

• Engagement – Youth and families are actively involved in the creation and implementation of their coordinated care plan.
• Assessment – Information about the youth and family is gathered to create a meaningful coordinated care plan.
• Care Planning & Implementation – The coordinated care plan identifies appropriate services and supports and how families and youth access them.
• Teaming – Youth and families are able to collaborate with providers and community partners to create their coordinated care plan.
• Monitoring & Adapting – The services and supports in the coordinated care plan are evaluated and updated as needed.
• Transition – Type of services, frequency of use, and levels of care change as the youth and family’s needs change.

There are multiple tools available to help you determine if your child may benefit from a full mental health assessment.

• Mental Health Checklist for Youth — Designed to be used by families.
• Youth Mental Health Checklist— Designed to be used by the youth.
• Child and Adolescent Needs and Strengths (CANS) screener — Designed for use by medical professionals and families.
• Speak with your child’s medical provider.

A mental health assessment, sometimes called a comprehensive diagnostic assessment (CDA), is a process where a licensed clinician reviews the history of the person seeking care, conducts a clinical interview, and evaluates any available data to identify mental health issues and service needs. A completed CDA includes background information, the results of a mental status exam, and a mental health diagnosis, if appropriate.

The Child and Adolescent Needs and Strengths (CANS) tool is often used at the same time as a CDA, as it helps the family share their story with the mental health provider. While the CDA identifies a mental health diagnosis, the CANS helps to identify specific needs that may benefit from treatment.

Not everyone who has a mental health concern has serious emotional disturbance (SED), but other types of mental health issues can also benefit from treatment. Completing a mental health assessment can help you decide if mental health care could help your child.

Contact the Idaho Behavioral Health Plan Managed Care Contractor, Magellan Healthcare, www.magellanofIdaho.com (if your child is currently eligible for Medicaid), or your private insurance company for local resources.

Access to the YES system of care is available to all Idaho youth under the age of 18 who have a mental health diagnosis and a functional impairment. For Medicaid eligible youth, Medicaid covers many of the services that are part of the YES system of care. For youth who do not qualify for Medicaid, services may be accessed for a fee through Idaho Behavioral Health Plan Managed Care Organization Magellan Healthcare.

Beginning January 1, 2018, the Idaho Legislature raised the qualifying federal poverty guideline (FPG) for Medicaid to 300% for children with serious emotional disturbance (SED). This means there are higher household income limits for children with SED to qualify for Medicaid coverage.

To see if your family may be eligible under these new limits, please take a look at the current Federal Health and Human Services Poverty Guidelines.

Please note: The information provided on this site represents 100% of the FPG and does not take into account allowable income exceptions. The only way to know if a child with SED will qualify for Medicaid under these higher income limits is to apply. Because of the increased income eligibility, the automated system may issue a preliminary denial. A final Medicaid eligibility determination is manually reviewed and a letter is sent in the mail.

Before you apply for Medicaid under the 300% FPG, your child will need to have an independent assessment. Please call the Independent Assessor to schedule an in-home appointment.

Youth who have SED and qualify for Medicaid with a household income over 185% and below 300% of the FPG are responsible for paying a monthly premium of $15.00.

If a youth is eligible for Medicaid and/or respite coverage after visiting the Independent Assessor, annual independent assessments and eligibility redeterminations are required to maintain Medicaid eligibility. In addition to annual reviews, youth who visit the Independent Assessor will complete a person-centered service plan as part of their coordinated care planning process.

The Child and Adolescent Needs and Strengths (CANS) tool is used in Idaho to identify a youth’s strengths and needs, including a functional impairment. The CANS uses the youth and families story to recognize strengths that can help during treatment, as well as needs that may require intervention. The results of the CANS are used to help identify appropriate services and then help monitor progress towards goals.

The CANS looks at different areas of your child’s life, such as:

• Their past experiences.
• Individual strengths.
• Social and family interactions.
• Their emotional needs.
• Their activities.

The CANS results provide a common language for everyone working with your child to communicate about their treatment goals. The CANS also considers the family’s needs and strengths as an important part of developing the treatment plan.

Along with a diagnosis from the current version of the Diagnostic & Statistical Manual of Mental Disorders (DSM), the CANS helps to determine if a youth has serious emotional disturbance (SED) and meets the criteria for YES services and supports.

If you would like to learn more about the CANS, visit the Praed Foundation website.

A Child and Family Team (CFT) is a group of caring and invested people who are invited by the youth and family to work together to help create a coordinated care plan. Members of the CFT include the youth, the family, and the mental health provider, but may also include extended family, friends, individuals from child-serving agencies, and community members.

The youth and family are essential Child and Family Team members, and a CFT may not meet without them. Families and youth are supported, valued, and respected by other members of the team. They lead the team in identifying short and long-term goals for the coordinated care plan.

Child and Family Teams meet as needed to create the coordinated care plan and then update it as treatment progresses and the needs of the youth and family change. The length of time that a CFT may meet depends on the needs of the youth and family. Members of the CFT may change over time.

Coordinated care plans are created by Child and Family Teams (CFT) and identify services and supports in the community that may help the youth and family reach their treatment goals.

If a youth has gone to the Independent Assessor and they are eligible for Medicaid, they will create a coordinated care plan that includes a person-centered service plan.

Treatment goals in coordinated care plans are measurable, assess change (but not compliance) and encourage the youth and family to work towards wellness and self-sufficiency. All types of coordinated care plans also include mental health crisis and safety plans.

Coordinated care plans are created by the Child and Family Team (CFT) to coordinate the care being given by all providers. Treatment plans explain only the service or support being offered by that specific provider.

Each provider creates an individualized treatment plan to explain how they plan to help the youth reach the goals identified in the coordinated care plan. They also identify the strength being built or the need being addressed with measurable goals.

Most schools do not directly provide services as part of the YES system of care, but school staff may participate on a Child and Family Team (CFT), help a family complete the CANS with the family’s mental health provider, support the goals identified on the coordinated care plan, or provide in-school supports. How schools choose to get involved and the resources available vary between districts, and families are encouraged to discuss involvement with their local school staff.

The YES system of care looks a little different when a youth is in the custody of a county detention facility or the Idaho Department of Juvenile Corrections. In those cases, the Child and Family Team (CFT), which may be called a treatment team, has members from county or state child-serving agencies, and the services and supports may not be community-based or voluntary. While every effort is made to include families on these teams, court orders must be followed, and that may impact the ability for the family to participate. The services identified by the treatment team reflect the services available in the facility and may include different services than are available in the community.

The answer to that question depends on how your child accesses the YES system of care.

If your child needs a service that isn’t available in your community, you may contact the Idaho Behavioral Health Plan managed care organization, Magellan Healthcare,  and ask them to find a provider in your area. If the service you need (or the requested amount of the service) is not a part of the Idaho Behavioral Health Plan (IBHP) you may apply for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services to help your child access the service. Families will still be responsible for the cost of premiums and co-pays up to 5% of the household’s modified adjusted gross income (MAGI).