Bill Medicaid for Hours of Employment Specialists

Mental health agencies can now bill hours for employment specialists in supported employment situations to Medicaid.

Employment specialists are like case managers and help their clients to get a job and then hang onto the job. They stay with a client as long as services are needed. Ideally they have some good connections in the business community to help land the job, and they also have good people skills to job coach their clients over any rocky roads that come up. Typically, an employment specialist carries a work load of 25 clients. The cost of supportive employment per client runs in the $1000-$4000 a year range.

Medicaid comes under Title XIX of the Social Security Act and is a Federal/State entitlement program that pays medical assistance for people with low income. It is a joint venture between the Federal and State governments. Each state varies in what it will reimburse. The feds provide matching dollars for state outlays. Medicaid doesn’t provide assistance to all poor people; there are select criteria in each state delineating what is covered.

Among this criteria are community-based services for the mentally ill. This population is deemed disabled and would be institutionalized without certain helping measures. For at least some states, this includes the services of employment specialists performing supported employment services.

Because Medicaid operates under broad federal guidelines and each state is given latitude on who will be covered, you find a lot of variation from state to state. Each state administers its own program. In general, Federal matching funds are available when a state determines a certain group eligible. Among others, Supplemental Security Income recipients are eligible in most states. Many of the mentally ill qualify under this rubric. Under broader guidelines, the feds will also match state dollars to “medically needy” persons. People with mental illness can qualify here as well. An example is the ticket to work recipients who get benefits to work despite their being disabled.

Due to the large degree of flexibility the feds allow with Medicaid payments, in at least some states, mental health agencies have billed the hours of employment specialists to Medicaid. Figuring out the billing process is complicated and will vary from state to state. To get started go to the website for Medicaid and then to your own state’s listing and look for a Provider’s Manual which should give the details about billing.

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