American Indians and Alaska Natives (AI/AN)
American Indians/Alaska Natives receiving Washington Apple Health (Medicaid) coverage have the choice to receive their treatment of mental health and substance use disorder (together, known as “behavioral health”) either through the managed care program or through the Apple Health fee-for-service (FFS) program.
Providers treating clients in the Apple Health FFS program will bill the state directly through the ProviderOne claims system and be paid according to the published rate schedule:
To find out what coverage an AI/AN client has selected, providers need to check the ProviderOne Benefit Inquiry screen, which will show:
- The name of the Behavioral Health Organization (if the enrollee has BHO coverage); and/or
- The name of the Fully Integrated Managed Care Plan (if the enrollee has FIMC coverage); and/or
- The name of the managed care plan (if the enrollee has Behavioral Health Services Only (BHSO) benefit package.
If the enrollee has active Medicaid coverage but no BHO, FIMC, or BHSO plan is listed, that means that the enrollee has behavioral health fee-for-service coverage.
- Providers will not be able to see if a client is AI/AN.
Note: If AI/AN Apple Health clients are eligible to receive care at an Indian Health Service (IHS) facility, Tribal health program, or urban Indian health program, this change will not affect their ability to receive care at those programs. In addition, those programs may be able to help AI/AN clients make their choice for Apple Health coverage for behavioral health services.