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Recent regulations issued by CMS allow children with serious emotional disturbances, individuals with disabling mental disorders, and individuals with mental disabilities that prevent them from performing tasks of daily living to be exempted from enrolling in Medicaid benchmark plans. While most individuals who are newly eligible for Medicaid under health reform will be enrolled in benchmark coverage, these individuals with severe needs may instead be enrolled in standard comprehensive Medicaid.

The National Council fact sheet, “Medicaid Benchmark Benefits in Health Reform: Improvements and Exemptions,” describes the differences between benchmark and standard coverage, the improvements to benchmark coverage under health reform, and the implications of these changes for individuals with disabilities. States will need to develop processes to identify which individuals meet the criteria of having a disabling mental disorder or functional impairment. These processes will have to incorporate both those applying for Medicaid for the first time as well as those who are currently enrolled.

The National Council encourages community behavioral health organizations to work with their state Medicaid departments to ensure that the needs of individuals with mental illness and substance use disorders are addressed throughout this process.
Fact Sheet
The National Council
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A program of the U.S. Department of Health and Human Services Substance Abuse & Mental Health Services Administration, Center for Mental Health Services