HOME
ABOUT &
INTRODUCTION
TABLE OF
CONTENTS
  SECTION 1  
Applying for
Health Insurance
  SECTION 2 
Eligibility in
Special Situations
  SECTION 3 
After Application
Approval
  SECTION 4 
Accessing
Health Care
  SECTION 5 
Low Cost
Health Care
  SECTION 6 
APPENDIX A
  SECTION 6 
APPENDIX B
  SECTION 6 
APPENDIX C



HOME
ABOUT & INTRODUCTION
TABLE OF CONTENTS
SECTION 1
Applying for Health Insurance
SECTION 2
Eligibility in Special Situations
SECTION 3
After Application Approval
SECTION 4
Accessing Health Care
SECTION 5
Low Cost Health Care
SECTION 6 • APPENDIX A
SECTION 6 • APPENDIX B
SECTION 6 • APPENDIX C

A Manual for School Nurses and Counselors

5TH EDITION • 2022

SECTION 4

ACCESSING HEALTH CARE

Behavioral/Mental Health Care, and Drug and Alcohol Treatment

Behavioral/mental health care, and drug and alcohol treatment are covered benefits for children with Medical Assistance and CHIP.

Children Covered by Medical Assistance (MA)

Children enrolled in Medical Assistance are entitled to all medically necessary mental health and drug/alcohol treatment services, and this includes emergency, inpatient, and outpatient care, and Intensive Behavioral Health Services or IBHS (which has replaced Behavioral Health Rehabilitative Services).

Children are enrolled in a separate behavioral health managed care plan which contracts with providers and facilities.  Children are assigned to a behavioral health managed care plan based on their county of residence.

To find a provider, a parent can:

Consent for Treatment

For behavioral/mental health treatment, the permission of a parent or legal guardian is required for children under the age of 14. For minors ages 14 to 18, they may consent for treatment without parental consent. For drug and alcohol treatment, children and youth of all ages do not need their parent’s permission to obtain treatment.

Children Covered by CHIP

Children enrolled in CHIP are covered for mental health and drug and alcohol treatment. Covered services include outpatient, inpatient, partial hospitalization and drug and alcohol substance use disorder treatment.

CHIP does not cover Intensive Behavioral Health Services (IBHS) and family-based Mental Health Services. A child in need of these services may qualify for Medical Assistance in the Children with Special Needs category. (For more information about this category, see Section 2). Behavioral health services are included in the CHIP health plans with no limits on the number of visits or days in a hospital or outpatient care setting.

CHIP uses a distinctly different network of behavioral health providers from the Medical Assistance providers.

To find a provider, a parent can:

  • Parents can call their CHIP plan to find a provider in their network. Families can also discuss any questions regarding CHIP benefits. The CHIP plans and their phone numbers are listed below.
    • Aetna Better Health: 800-822-2447
    • KIDZ Partners: 888-888-1211
    • Keystone Health Plan East: 800-464-5437
    • UnitedHealthcare Community Plan: 855-383-8604

Children Who Have Private Insurance

For children with private insurance, the package of benefits is dependent on the contract between the insurance company and the employer (or another purchaser, such as the parent).  If a child does not have adequate coverage for mental/behavioral health issues, the family can apply for Medical Assistance in the Children with Special Needs program or PH-95. For more information about this program, see Section 2.

To find a provider, a parent can:

  • Call an agency they are already familiar with or one recommended by their child’s school, their childcare, or health care provider.
  • Call member services on the back of their insurance ID card to ask for a list of providers who accept their insurance.

 

Children Who Are Uninsured

To find a list of agencies that provide free or low-cost care in your county, see Section 6 of this guide – County-Based Free and Low-Cost Health Care Services.

You can also call Children First’s Helpline 215-563-5848 x 17 to find free or low-cost behavioral health care services and to get help applying for health insurance (MA or CHIP). Children First Helpline services are free and available in any language.

The managed care behavioral health plans in each county will refer families to free and low-cost care.

Encourage parents to use one of the resources above – and consider offering to do a three-way phone call with the parent and the  agency to help get the child connected to care.

What types of services are available?

Outpatient Services:

Services usually occur at a mental health provider’s office. The outpatient system offers a wide range of clinical services including individual, group and family therapy, psychiatric evaluations, and medication management.

Community-Based Services:

Some children require more intensive support in their home, school and community. Intensive Behavioral Health Services (IBHS) and Family Based Services (FBS) are available to youth ages 0-21. Services include a range of behavioral health services to better manage their symptoms within their community.

Residential Treatment Facility (RTF):

When a youth cannot be safely maintained within their community, they may require a highly structured setting like a psychiatric RTF. This setting offers a safe, therapeutic environment where youth can stabilize their symptoms with a more intensive level of treatment support. 

Acute Services:

If a youth is at imminent risk for harming themselves or others, or requires more intensive support to stabilize their psychiatric symptoms, they may require acute inpatient or partial hospitalization. Services are provided in a hospital setting. Both settings include a wide range of clinical services including individual, group and family therapy, psychiatric evaluations, and medication management. 

Substance Abuse Treatment:

Outpatient and/or inpatient treatment for alcohol and drug abuse that can include detoxification, rehabilitation, medication management, and individual, group, and family therapy.

Behavioral Health Crisis Services

In the event of a psychiatric emergency, parents can bring their child to the nearest hospital, but they also have the option of taking their child to the nearest children’s mental health emergency center. At a mental health emergency center, the child will be evaluated by a psychiatrist and connected to appropriate treatment. There are crisis centers like these in each county. 

Bucks County:

Lenape Valley Foundation Adult and Children’s Mobile Crisis:
Call 1-877-435-7709 and a Telephone Crisis Worker will gather preliminary information, determine if Mobile Services are appropriate, and dispatch a Mobile Crisis Intervention Service team to your location.

Lower Bucks County (24/7 access):
Lenape Valley Foundation Crisis Center
Lower Bucks Hospital ER
501 Bath Road, Bristol, PA 19007
(215) 785-9765

Central Bucks County (24/7 access):
Doylestown Hospital ER, home to Lenape Valley Foundation Crisis Center
595 West State Street, Doylestown, PA 18901
(215) 345-5327

Bristol:
Lenape Valley Foundation
499 Bath Road,
Bristol, PA 19007
(215) 785-9765
M-F (7am-10pm) 

Chester County:

Valley Creek Crisis Center Warm Line
866-846-2722
M-F 2-8pm, Sat-Sun 12-6pm

Valley Creek Crisis Center Hotline (24/7 access):
469 Creamery Way, Exton, PA 19341
Walk-in or call: 610-280-3270

Delaware County:

Mobile Crisis (24/7 access):
Elwyn Delaware County Crisis Connects Team
855-889-7827 

DelCo Warm Line (24/7 access):
855-464-9342 

Mercy Fitzgerald Hospital Mental Health Crisis Services (24/7 access):
1500 Lansdowne Avenue, Darby, PA 19023
610-237-4210

Crozer Chester Medical Center- Mental Health Crisis Services (24/7 Access):
1 Medical Center Blvd, Chester, PA 19013
610-447-7600

Montgomery County:

Montgomery County Teen Talk Line
Call 866-825-5856 or Text 215-703-8411
M-F 3:00pm-9:00pm 

Montgomery County Children’s Crisis Support (24/7 Access):
Call 888-HELP-414

Montgomery County Emergency Service (MCES) (24/7 Access):
50 Beech Drive, Norristown, PA
610-279-6100 or 844-455-7455

Philadelphia County:

Philadelphia Crisis Line/Mental Health Delegate Hotline (24/7 Access):
215-685-6440
Get phone support or request a Children’s Mobile Crisis Team (CMCT)

Philadelphia Children’s Crisis Response Center (PCCRC) (24/7 Access):
3300 Henry Avenue Falls Center 2, Suite 3N, Philadelphia, PA 19129
215-878-2600

Concerns about Behavioral Health

If you are working with a family that is concerned about the care their child is receiving, about an inability to obtain care, or dissatisfaction with treatment, there are a number of steps parents can take to resolve their concerns.

Remind families that they can always ask to speak to a supervisor or request a change in their child’s therapist. If things cannot be resolved within that agency, families can switch agencies. It is important for a family to talk with their child’s therapist about their concerns because sometimes difficult issues come up in therapy. 

If there is a more serious problem, families should first file a complaint with the behavioral health provider. 

If the family’s problem is not resolved, they should then file a complaint with their child’s behavioral health insurance company.  (For more information on how to do this, see Section 6, Appendix C – Denial of Health Care Services).

Vision and Hearing Services

Medical Assistance must provide all medically necessary vision and hearing services including eye exams, eyeglasses, hearing evaluations, and hearing aids to children under 21. Children on Medical Assistance can receive as many replacement pairs of glasses and hearing aids as they need.

CHIP provides routine and specialty vision and hearing services including eye exams, eyeglasses, hearing evaluations, and hearing aids. Children on CHIP are limited to two pairs of eyeglasses in a coverage year and one hearing aid for each ear every two years.

(Note: A child with serious vision or hearing issues that exceeds the limits on these benefits in CHIP may qualify for the Children with Special Needs category in Medical Assistance. For more information see Section 2 – Eligibility in Special Situations)

For a comprehensive list of vision and hearing providers who participate in vision and hearing services, parents should call their plan’s member services. The phone numbers are found on the back of the member ID card and below:

Medical Assistance

  • Aetna Better Health: 866-638-1232
  • Health Partners: 800-553-0784
  • Keystone First: 800-521-6860
  • UnitedHealthcare Community Plan: 800-414-9025 

Children’s Health Insurance Program (CHIP)

  • Aetna Better Health: 800-822-2447
  • Keystone Health Plan East: 800-464-5437
  • KIDZ Partners: 888-888-1211
  • UnitedHealthCare Community Plan: 855-383-8604 

For children who are uninsured or whose private health care coverage through their parent’s job does not cover vision and/or hearing services, see Section 5 for free or discounted health care services.

Dental Care

Medical Assistance covers all medically necessary oral health care services.  CHIP covers preventative and routine dental care services, such as cleanings, dental x-rays, fillings, and other restorations.

Specialty Services: Braces

Medical Assistance and CHIP will cover braces if they are medically necessary.  An orthodontist has to submit evidence of medical necessity and obtain authorization to give a child braces.  To be considered medically necessary, the misalignment of teeth must interfere with eating, breathing, or other day to day function, not just cosmetic problems.

For a comprehensive list of dentists who participate in Medical Assistance and CHIP, parents should call their plan’s member services.  The phone numbers are found on the back of the member ID card and below:

Medical Assistance

  • Aetna Better Health: 866-638-1232
  • Health Partners: 800-553-0784
  • Keystone First: 800-521-6860
  • UnitedHealthcare Community Plan: 800-414-9025

Children’s Health Insurance Program (CHIP)

  • Aetna Better Health: 800-822-2447
  • Keystone Health Plan East: 800-464-5437
  • KIDZ Partners: 888-888-1211
  • UnitedHealthCare Community Plan: 855-383-8604 

For a list of dentists who provide free or low-cost care to children without insurance or without dental coverage in private insurance, see Section 5 of this manual.

Family Planning Services

Children and youth of all ages can access family planning services without parental consent

Services include:

  • Birth control – including IUDs and implants or long-acting reversible contraceptives (LARCs)
  • Emergency contraception
  • Pregnancy tests and pregnancy options counseling
  • Testing and treatment for sexually transmitted infections – including HIV
  • Pelvic, breast, testicular, and medical exams
  • Health education and counseling on a wide variety of issues

Children with Medical Assistance and CHIP

Medical Assistance and CHIP provide comprehensive coverage for family planning services. Children can use the member services number on the back of their card to find a family planning provider.

Children with Private Insurance

The preventive health services benefit in the Affordable Care Act (ACA) requires that most insurance plans cover evidence-based preventive services including annual exams, Pap smears, and contraception without cost-sharing.  Children can use the Member Services number on the back of their ID card to find a provider.

Children Without Insurance

Designated family planning providers provide comprehensive services for free. Find a list of providers in Section 6 of the guide – County-Based Free and Low-Cost Health Care Services.

LGBTQ+ Services

Youth who are lesbian, gay, bisexual, transgender, or queer (LGBTQ) are diverse, come from all walks of life and include students of all races, ethnicities, and socioeconomic statuses.

There are a number of organizations that provide inclusive, specialized health and support services for youth who are LGBTQ+ including:

  • physical health care
  • behavioral health care
  • case management services

Find contact information for these organizations in Section 5 of the guide – County-Based Free and Low-Cost Health Care Services.