Understanding Behavioral Health Care

Handbook Content

Terms and Meanings

Some terms that we use in this chapter may not be familiar. These terms and their meanings are listed below.

  • Approved/Authorization: The decision Medicaid makes to pay for a service.
  • Facility: A health care building or practice.
  • Inpatient Care: Health care that you get when you're admitted as an inpatient to a health care facility, like a hospital.
  • Individual: Single person.
  • Prescription: An order from your provider for medications, equipment, testing, or supplies.
  • Primary Care Provider: Your main health care professional who maintains your good health and cares for your basic health needs by giving vaccines, finding disease, and offering medication or treatment for conditions or symptoms.
  • Provider: A doctor, nurse, therapist, or another qualified health care professional.
  • Referral: A written order from your primary care doctor for you to see a specialist or get certain medical services.
  • Respite: Relief for the primary caregiver of a person who is ill or disabled.
  • Screening: To look for serious health concerns.
  • Services: Care, treatments, testing, checkups, equipment, supplies, and other ways your health care providers help you stay healthy.
  • Specialist: A provider that focuses on a specific area of medicine, or a group of patients, to diagnose, manage, prevent, or treat certain types of symptoms and conditions.
  • Substance Use: The use of alcohol or drugs causing impairment, health problems, or failure to meet responsibilities at work, school, or home.
  • Targeted Case
  • Management: Planning of care for members with special needs or conditions to gain access to medical, social, educational, and other services.
  • Transportation: Being given a ride.
  • TTY: The number you can call to connect with someone when you have a hearing impairment.

Understanding Behavioral Health Care

Behavioral health is the state of your emotions, your thoughts, and lifestyle or behavior choices. Behavioral health care can help you when you feel sad, overwhelmed, or anxious. You can get help when you experience emotions that negatively affect your daily life.  

Behavioral health services help you with mental health and substance use disorders (SUD). Mental health services may include treatment for anxiety, depression, or behavior problems. Substance use disorders involve alcohol or drug misuse. Some people have what’s called co-occurring (meaning having both) mental health and substance use disorders. 

Providers who may work with you include social workers, counselors, therapists, doctors, psychologists, psychiatrists, and technicians. Mental health and SUD treatment is available for members of all ages. Some treatments need a referral or an authorization. 

ND Medicaid covers a wide range of supportive mental health and substance use disorder treatments, medications, and services. We cover individual, family, and group counseling and psychotherapy. Your treatment may occur in an outpatient, inpatient, or residential treatment setting. We also cover services like behavioral and crisis interventions and home and community-based services (HCBS) to support members living successfully in their communities.

Specialized Behavioral Health Services

Specialized behavioral health services offer diagnostic testing, psychological testing, psychotherapy, partial hospitalization, and more. You can learn about some of these services available to you below.

Applied Behavioral Analysis

Youth with autism may qualify for Applied Behavior Analysis (ABA) services. ABA services are a form of behavioral therapy. The goal of ABA services is to assist with the youth’s independence and successful home and community living. It uses positive reinforcement to teach and promote the following skills: social, communication, learning and academic, and self-care.  ABA services include a comprehensive assessment, care plan development, referral, monitoring, and follow-up, as well as skills training for youth and their families. 
Youth with autism may qualify for services through the Autism Spectrum Disorder Waiver. You can learn more about the Autism Waiver in the Medicaid Waivers chapter of this handbook.

Behavioral Health Rehabilitative Services

Behavioral health rehabilitative services are short-term services meant to reduce, change, or eliminate undesirable behaviors and introduce new skills to develop positive behaviors. Services are for members of all ages needing mental health help or behavioral interventions who are:

  • At risk of entering or reentering a mental health facility or hospital with a qualifying World Health Organization Disability Assessment Schedule (WHODAS 2.0) score of 25 or higher or a Daily Living Activities (DLA-20) score of 5 or less; and/or
  • In need of substance use disorder treatment services; and/or
  • Diagnosed with a mental health disorder and:
    • From a household that is in crisis and at risk of major dysfunction that could lead to disruption of the current family makeup; and/or
    • In a family that has experienced dysfunction that caused disruption of the family.

These services help restore you to your best functional level with interventions, assessments, screenings, skills training, and individual or group counseling. Referrals are needed for these services.

Substance Use Disorder Services

Substance Use Disorder (SUD) services support your recovery from the use of alcohol, harmful substances, illegal drugs, or misuse of prescriptions. A team of professionals work together with you to stabilize your health. 

Your SUD treatment will start with an assessment and a plan for treatment will be developed. Your treatment plan may include counseling, individual or group therapy, interventions, and more. Medicaid covers treatment for youth and adults including non-intensive and intensive outpatient services, partial hospitalization services, clinically managed low and high-intensity residential care, clinically managed residential withdrawal, and medically monitored intensive inpatient services.

SUD treatment offers a wide range of services. Medicaid covers many SUD services. You can find out more about your SUD coverage in our Substance Use Disorder Treatment Services Policy.

We also cover Medication for Opioid Use Disorder (MOUD). MOUD is a treatment that uses medication to treat opioid use disorders. MOUD treatment is offered through Opioid Treatment Programs and office-based Opioid Treatments. These services are for members with diagnosed moderate or severe opioid use disorder who are determined eligible for and agree to MOUD treatment. 

Targeted Case Management

Targeted Case Management is available for adults with serious mental illness (SMI) and youth with serious emotional disturbance (SED), A case manager will help you access medical, social, educational, and other services for your care and treatment.
An adult is considered to have SMI if they have: 

  • A diagnosed mental disorder expected to last a year or longer; and
  • A moderate level of functional limitation; and
  • One of the following:
    • Psychiatric treatment that was more intensive than outpatient services. These services must have occurred more than once and was related to their mental illness; or
    • A history of documented problems resulting from mental illness for at least one year. The documented problems must be verified by family or a local health care provider; or
    • Had a single episode of continuous structured supportive residential care. This does not include hospitalization. The episode must have lasted for at least two months.

A child is considered to have SED if they are younger than 21 years old and have: 

  • A diagnosed mental disorder expected to last a year or longer; and
  • A moderate level of difficulty functioning in school, at home, and/or in community activities. This is measured by a WHODAS 2.0 score of 25 or higher or a DLA-20 score of 5 or less; and
  • One of the following:
    • A psychiatric crisis or emergency that needed emergency intervention to prevent institutional placement; or
    • Need for long-term mental health services.

Temporary or expected functional limitations caused by stressful events in the member’s environment does not make them eligible for targeted case management.

1915(i) Behavioral Health Supports and Services

1915(i) behavioral health supports and services are non-traditional Medicaid services to support qualifying people of all ages with certain behavioral health conditions to live successfully in their homes and communities. Some 1915(i) services are Home and Community Based Services (HCBS) such as peer support, non-medical transportation, housing support, supported education and employment, and more.

Every member receiving 1915(i) services and supports will have a care coordinator. Their care coordinator will work with them to develop a person-centered plan of care. They will work together to choose service providers for needed services. 

Members must complete a separate application for the 1915(i) program and meet eligibility criteria. 

You can find a full list of covered 1915(i) services:

You can apply for 1915(i) services by completing an application. You will need to be assessed by a provider to see if you qualify for these services. 

Coverage Limits

Generally, North Dakota Medicaid cannot pay for residential or in-patient care at residential mental health or SUD treatment facilities with more than 16 beds. Out-patient care may be covered at these facilities. This is called an Institutions for Mental Disease (IMD) exclusion and is a federal Medicaid rule. You can find a list of IMDs in North Dakota here.

Where to Get Treatment

You can make an appointment with your primary provider to talk about your mental health or use of substances. You can also talk to your provider about these concerns at your annual wellness visit. Your primary provider can help you plan for treatment and next steps.

Your behavioral health provider may offer telehealth appointments. You can learn more about this in the Telehealth chapter of this handbook.

You can see the Coverage 2 Care (C2C) Road Map to Behavioral Health to better understand behavioral health care.

The following sections offer more ways to find help.

Mental Health

Substance Use Disorder

  • Visit the Find Treatment Website to enter your zip code or city and state for a list of treatment facilities near you and access nation helplines. 

1915(i) Behavioral Health Services and Supports

If you have questions about 1915(i) services, please reach out to a 1915(i) Navigator.

Crisis Services

Contact 988 by call, text, or online chat. 988 is always available if you are having thoughts of suicide, a mental health or SUD crisis, or are in emotional distress.
You can call or visit your local human service center and ask to be seen for your concern. Human service centers have Open Access clinic hours where you can be seen as a walk-in, without making an appointment. 

  • Visit our website to find a local human service center.
  • Visit the Find Treatment Website to enter your zip code or city and state for a list of treatment facilities near you and access nation helplines. 
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