Children who qualify for Medicaid as part of an adoption assistance agreement receive their Medicaid mental health services from community mental health centers as part of a Prepaid Mental Health Plan (PMHP).

In 2001, the Utah State Legislature passed Senate Bill 97. The Subsidized Adoption Exemption Bill created an option for children with an adoption assistance agreement to receive Medicaid mental health services from providers who are not part of the PMHP. This can be done through an exemption process called carve out. The Medicaid agency and the Division of Child and Family Services (DCFS) have worked together to implement this process.

There are some important things for you to understand and check into before requesting an exemption:

• There may be little or no continuity of care services from a private mental health provider. Services such as medication evaluations, psychological evaluations, after school programs, or day treatment programs may need to be sought out separately.
• A limited number of mental health providers outside of the PMHP are enrolled as Medicaid providers. Most private mental health providers are not enrolled as Medicaid providers. Medicaid qualified outpatient mental health providers are either private psychiatrists or psychologists. Also, mental health providers who have a contract to provide mental health services for children in foster care can qualify as Medicaid providers.
• Some mental health providers have waiting lists.

The steps below outline the process to receive the Medicaid exemption for an adopted child to receive mental health services from a provider who is not part of the PMHP.

1. The parent must call the DCFS post-adoption worker to ask for the PMHP exemption for outpatient mental health services.
2. The DCFS post-adoption worker and parent will discuss the child’s treatment needs. The post adoption worker will help the parent select a provider that provides the appropriate level of treatment.
3. The DCFS post-adoption worker will send Medicaid information regarding the exemption request.
4. Medicaid grants the exemption based on written justification and notifies the DCFS post-adoption worker, DCFS administration, and the PMHP.
5. The DCFS post-adoption worker notifies the parent of the approval and assists the parent to obtain services.

If the mental health provider selected is a residential provider, be aware that you are responsible to pay the facility for room, board and educational cost. Medicaid does not pay room, board or educational costs. If the room, board and educational cost would cause a hardship for your family, your DCFS post adoption worker may be able to help you request supplemental assistance through DCFS to help pay these costs, if funding is available.

If after receiving an exemption, your child returns to the community mental health center for all outpatient mental health services, your child should be re-enrolled in the PMHP the first of the next month.

Northern Region:
Jeanna O'Conner 801-395-5973
Anna Whisler 801-776-7404

Salt Lake Region:
April Bennett 801-300-8135
Jennie Robinson 801-300-8135

Western Region:
Springville South Peter Johansson 801-358-3236
Provo North Danielle Blauer 801-874-6011

Southwest Region:
Shandra Powell (SW Region) 435-865-5669
Richfield/South Angie Morrill 435-896-1263
St. George Gwen Fund 435-668-1852

Eastern Region:
Price/Castledale Greg Daniels 435-636-2367
Vernal/Roosevelt Fred Butterfield 435-722-6446
Moab/Blanding Katie Eberling 435-678-1491