Behavioral Health

Resources for a Mental Health or Substance Use Disorder Crisis

For a life-threatening emergency, such as a suicide attempt, risk of a suicide attempt, or a possible drug overdose call 988, call 911, or go to the nearest emergency care facility.

988 Crisis Line: If you or a loved one is experiencing a mental health or suicidal crisis, you can call, text or chat 988 to talk to a trained crisis counselor. The 988 line is confidential, free and available 24/7/365. Learn more at 988lifeline.org

Molina will cover a member’s emergency behavioral health services provided by an emergency behavioral health provider, without prior authorization, regardless of the providers in-network status. Emergency behavioral health services include mobile crisis response teams, crisis stabilization units, withdrawal management, behavioral health triage facilities, and evaluation and treatment facilities.

Non-emergency behavioral health services and finding a provider:

Molina covers preventive and routine outpatient and inpatient behavioral health treatment services with licensed mental health and substance use disorder specialists. For details on what is covered, please refer to the “Agreement and Combined Evidence of Coverage and Disclosure Form” for your plan here.

Your health care contacts:

Find a participating behavioral health specialist:

Visit the Find a Doctor page, enter your ZIP code, and search for behavioral health provider by type, including Psychiatry, Autism/Applied Behavioral Analysis (ABA), Substance Use Disorder, Psychology, Social Worker, Counseling, Mental Health Clinic/Center

For help finding a provider, you can contact your PCP. You can also call Member Services or the 24/7 Nurse Advice Line.

Virtual Office Visits

For routine or preventive office visits by telehealth, use Teladoc any time 24/7 to visit with a licensed behavioral health doctor without having to leave home.

After-Hours Access

For after-hours care, non-emergency physician services are available 24/7 by Teladoc. Registered nurses are available at the 24-hour Nurse Advise Line.

Prescription Drugs

Molina covers behavioral health prescription drugs listed on the Molina Formulary when ordered by providers and filled through a pharmacy in the Molina pharmacy network.

Questions

If you have questions about how to obtain behavioral health services or you are having difficulty obtaining services, call Member Services or the 24-hour Nurse Advice Line. For questions about your coverage, call Member Services.

Care access standards and getting help finding care 

Molina does not require members to have a referral when seeking behavioral health services. Some provider systems may require a referral for an appointment. Services must be made available within 10 business days of making a request for an appointment with a behavioral health provider. If you are unable to schedule an appointment within these timeframes, please call Molina Member Services. For more detail on accessing care, visit the Guide to Getting Quality Healthcare.

Other non-emergency behavioral health resources: 

AL-Anon & ALA-Teen: 888-4AL-ANON (888-425-2666)

• Support for people whose loved ones have alcohol and drug-related problems.

  Substance Abuse and Mental Health National Health Line: (800) 662-HELP (4357).

• Free and confidential, non-emergency assistance for people dealing with substance use disorders or mental health challenges.

Covered Services

Mental Health/Substance Use Disorder (MH/SUD) Services: Molina covers the full range of levels of care required by State Law and does not limit benefits or coverage for behavioral health to short-term or acute treatment. Mental health and substance use disorder utilization review determination criteria and education program materials are available at no cost at www.MolinaMarketplace.com.

You have a right to receive timely and geographically accessible Mental Health/Substance Use Disorder (MH/SUD) services when you need them. If Molina fails to arrange those services for you with an appropriate provider who is in the health plan's network, the health plan must cover and arrange needed services for you from an out-of-network provider. If that happens, you do not have to pay anything other than your ordinary in-network cost-sharing.

If you do not need the services urgently, your health plan must offer an appointment for you that is no more than 10 business days from when you requested the services from the health plan. If you urgently need the services, your health plan must offer you an appointment within 48 hours of your request (if the health plan does not require prior authorization for the appointment) or within 96 hours (if the health plan does require prior authorization).

If your health plan does not arrange for you to receive services within these timeframes and within geographic access standards, you can arrange to receive services from any licensed provider, even if the provider is not in your health plan's network. To be covered by your health plan, your first appointment with the provider must be within 90 calendar days of the date you first asked the plan for the MH/SUD services.

If you have questions about how to obtain MH/SUD services or are having difficulty obtaining services you can: 1) call your health plan at the telephone number on the back of your health plan identification card: 2) call the California Department of Managed Care's Help Center at 1-888-466-2219: or 3) contact the California Department of Managed Health Care through its website at www.healthhelp.ca.gov to request assistance in obtaining MH/SUD services.

Mental Health Services: To the extent required by federal or State Law, Molina covers medically necessary treatment of a mental health or substance use disorder, only when that disorder is listed in the mental and behavioral disorders chapter of the most recent edition of the International Classification of Diseases or is listed in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Molina covers medically necessary treatment of gender dysphoria.

“Medically necessary treatment of a mental health or substance use disorder” means a service or product addressing the specific needs of that patient, for the purpose of preventing, diagnosing, or treating an illness, injury, condition, or its symptoms, including minimizing the progression of that illness, injury, condition, or its symptoms, in a manner that is all of the following:

• In accordance with the state-required non-profit professional association standards of mental health and substance use disorder care.
• Clinically appropriate in terms of type, frequency, extent, site, and duration.
• Not primarily for the economic benefit of the health care service plan and subscribers or for the convenience of the patient, treating physician, or other health care provider.

Outpatient care for treatment of mental health disorder does not include therapy or counseling for primary diagnosis of any of the following: career, marriage, divorce, parental, or job counseling or therapy.

Molina generally covers the following Medically Necessary Mental Health Services: 

• Inpatient care
• Crisis stabilization
• Short-term residential treatment services
• Partial hospitalization programs for mental health
• Intensive outpatient programs for adults and day treatment for children
• Psychological and neuropsychological testing
• Behavioral health procedures
• Individual and group psychological therapy

Early Screening: Behavioral health and wellness screenings for children and adolescents (ages 8-18) can identify early signs of behavioral health issues, such as depression and anxiety, for improved outcomes. We encourage you to take advantage of these screenings at your child's doctor visit or when talking to one of our Case Managers to support your child's mental health and overall well-being.

Autism Spectrum Disorder (ASD): Molina covers the diagnosis and treatment of autism spectrum disorders including autistic disorder, Asperger’s disorder, and pervasive developmental disorder not otherwise specified, as defined by the most recent version of the DSM. Molina covers treatment for autism spectrum disorders, including Applied Behavioral Analysis (ABA), prescribed or ordered by a Provider.

Mental Health Parity and Addiction Equity Act: Molina complies with the federal Mental Health Parity and Addiction Equity Act.  Molina ensures that the financial requirements and treatment limitations on Mental Health Services or Substance Use Disorder benefits provided are no more restrictive than those on medical or surgical benefits. However, if federal or State law prohibits treatment or payment for certain Mental Health Services, no coverage is available under this Policy.

Court-Ordered Community Assistance, Recovery, and Empowerment (CARE): Molina covers the cost for developing evaluations and for provision of all health care services for a Member when required or recommended for the Member pursuant to CARE agreements or CARE plans approved by a court, whether provided by a Participating Provider or a Non-Participating Provider. For services other than prescription drugs, Cost Sharing is waived and Prior Authorization is not required.

Substance Use Disorder (Inpatient and Outpatient): Molina covers Medically Necessary inpatient and outpatient treatment for substance use disorder based upon non-profit professional association criteria. Inpatient coverage, in a Participating Provider hospital, is covered for medical management of withdrawal symptoms. Molina may require authorization for coverage of services, including inpatient and certain outpatient services. Molina covers the following outpatient care for treatment of substance use disorder:

• Short-term residential programs
• Day-treatment/partial programs
• Individual and group substance use disorder counseling
• Individual substance use disorder evaluation and treatment
• Intensive outpatient programs
• Medical treatment for withdrawal symptoms
• Medication-Assisted Treatment (MAT)
• Opioid Treatment Programs (OTPs)

Outpatient care for treatment of substance use disorder does not include therapy or counseling for primary diagnosis of any of the following: career, marriage, divorce, parental, job, learning disabilities, and intellectual disability.