Financial Responsibility for Mental Health Services
County residents who are Medicaid enrolled, Medicaid eligible or who are uninsured, can receive services which are medically necessary as determined by clinical assessment.
At the time of your first scheduled visit to LCMHA you will meet with one of our client accounts representatives who will review with you the financial information you have been requested to bring and will establish your ability to pay. This is done to be sure our services are affordable. Your ability to pay is determined based on you income and family size. Fees are assessed on a sliding fee scale established by the Michigan Department of Community Health. Any deductible or co-pay you may be responsible for will not exceed your Ability to Pay.
- No one will be denied access to services due to inability to pay
- There is a discounted/sliding fee schedule available
If you are a Medicaid recipient, the client accounts representative will verify the type of Medicaid you have. If a “spend down” amount must be satisfied before Medicaid pays, the client accounts representative will be able to discuss this and answer any questions you may have. In some cases you amy be asked to contact your HMO directly for service authorization.
If you have private insurance, LCMHA can assist in coordinating your mental health benefits with your insurance carrier. Questions about deductible and co-pays can be answered by the client accounts representative.
Redetermination of Ability To Pay
You have the right to contest an Ability to Pay determination that has been made by LCMHA. You can notify LCMHA in writing of your desire for a re-determination and a meeting will be held concerning your request. If you are dissatisfied with the outcome of the meeting, you may appeal the re-determination of the Ability To Pay to the Probate Court in the county where you reside.
Annual Determination of Insurance Coverage and Ability To Pay
LCMHA will annually determine your insurance coverage and Ability To Pay if you continue to receive services. A new determination will be completed if LCMHA is informed of a significant change which may affect your Ability To Pay and/or insurance coverage.
Frequently Asked Questions
How are you protected?
You can ask for a new determination if your finances change and you feel that you cannot make payments. You also can ask for a review of your determination if you do not agree with the amount you are asked to pay. The law requires that we recalculate the amount you must pay each year if you or family members are receiving services. You can discuss you situation with a CMH Fiscal Services Accounts Specialist if you are having problems with your payments.
What if I still feel I can’t pay the amount you say I must pay?
After finding out how much we determine you can pay, you can ask for an administrative hearing. This request for a hearing must be a written request and must be sent, within 30 days of the original fee determination, to CMH’s Fiscal Services Department. If you still believe this amount is more than you can pay, you can take your case to the probate court in the county where you live.
Is the information I provide confidential?
Yes, all information will be held in the strictest confidence. You may be asked to sign a release of information form that will allow us to provide information to your insurance company.
What if I still have questions about making payments or how my ability to pay was figured?
You can contact CMH’s Fiscal Services Department at 517.263.8905.