Department of Mental Health:

Eligibility Criteria and Application Process

 

To be approved for continuing care services from the Department of Mental Health (DMH), the applicant has to go through a multiple stage process.

The applicant must:

Then the applicant is assigned a priority status.

Clinical Criteria: An applicant must have a qualifying mental disorder (lists available on the DMH website) as the primary disorder requiring treatment, and meet functional impairment and illness duration criteria. The qualifying mental, behavioral, or emotional disorder must have lasted for, or be expected to last for, at least one year. There are specific functional impairment criteria that vary by age.

Continuing Care Services: If the applicant meets the clinical criteria , then DMH asks if the applicant requires continuing care services and assesses what kind of access to appropriate community services are available to the applicant ? .

Other Means of Obtaining Needed Services: If the applicant requires DMH continuing care services, DMH will then determine s s whether the applicant is able to obtain those services through insurance (e.g. HMO, indemnity plan), medical entitlement (e.g. Medicaid, Medicare), or from another entity, such as the Massachusetts Rehabilitation Commission, Department of Social Services, the Veterans Administration or a local education agency, etc.

Priority Status: Following a determination that an individual is eligible for and needs DMH continuing care services, DMH will assign the individual a priority status. The decision will be based on the review and on the availability of services. An individual's priority status may be redetermined at any time. Priority status levels:

Client Status: the individual has a high priority rank and some or all of the needed services are available immediately.

Pending Services Status: the individual has a high priority rank; none of the needed services is available immediately, but it is expected that at least one of the needed services will be available in less than one year. DMH will contact the applicant at least monthly regarding his or her status until some or all of the needed services become available.

Low Priority Status: the individual has a low priority rank and it is anticipated that none of the needed services will be available for a year or more. DMH will notify the individual of his or her "low-priority status."

Six-Month Rule: If an applicant reapplies within six (6) months from the date eligibility was denied, the finding that the applicant met clinical criteria would remain in effect.

If Eligible Under “Client Status”

DMH will assign an individual on "client status" to a DMH case manager within five (5) days of the assignment determination. The notification letter will serve as an introduction to the client's assigned case manager. It will contain the case manager's name, an address and phone number where he or she may be reached and a date when the case manager will contact the client to arrange for a personal interview to begin service planning.

If some or all of the services are available, but a case manager is not available, the notification letter will identify the services that have been approved and specify who will be contacting the client regarding the initiation of the services.

When an individual is either assigned to a case manager or is receiving DMH continuing care services, he or she will be considered a DMH client.

-Adapted from the DMH website. A detailed description of the eligibility criteria and application process is available at http://mass.gov/portal/index.jsp?pageID=eohhs2terminal&L=5&L0=Home&L1=Consumer&L2=Behavioral+Health&L3=Mental++Health&L4=Determining+Eligibility+for+Mental+Health+Services&sid=Eeohhs2&b=terminalcontent&f=dmh_c_eligibility_continue_care&csid=Eeohhs2.

Applications are available on our website under the community resource center area, Health & Illness > Mental Health > DMH, and at http://mass.gov/portal/index.jsp?pageID=eohhs2terminal&L=4&L0=Home&L1=Consumer&L2=Behavioral+Health&L3=Mental++Health&sid=Eeohhs2&b=terminalcontent&f=dmh_c_application_forms&csid=Eeohhs2.)

06/2005