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Medicaid and the BPHC program

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A special program is available to assist in coordinating healthcare services for persons with mental health issues. The Behavioral & Primary Healthcare Coordination program has a higher income limit and no asset limit.

The BPHC program can include coordinating logistical support, advocacy and education to assist individuals in navigating the healthcare system and activities that help recipients gain access necessary to manage their physical and behavioral health conditions.

This is not meant to serve all needs, but is geared to offer assistance to those who are eligible. Those who are deemed clinically eligible for BPHC may become eligible for Medicaid due to BPHC financial eligibility standards and therefore eligible to receive all Medicaid covered services for which they qualify to meet their complex needs.

Working along side community mental health centers, the BPHC program will provide eligible individuals with help in managing their physical and behavioral health, such as help in scheduling appointments with doctors, coaching on communicating more effectively with doctors and following instructions on medications or other doctor recommendations.

BPHC service activities may include support in adhering to health regimens, scheduling and keeping medical appointments, obtaining and maintaining a primary medical provider and facilitating communication across providers. In addition, BPHC includes: direct assistance in gaining access to services, coordination of care within and across systems, oversight of the entire case, and linkage to appropriate services: needs based assessment of the eligible recipient to identify service needs; development of an individualized integrated care plan (IICP); referral and related activities to help the recipient obtain needed services; monitoring and follow-up; and evaluation.

For more information on eligibility and program criteria, visit the FSSA's site by clicking here.


Need help with long-term care planning? Looking for a way to cover nursing home expenses without dissolving all your assets?

Schedule a complimentary consultation with one of our attorneys to discuss how we can help you apply for Medicaid benefits.

Call us at 260-969-1177 or email info@grundenlaw.com.

April Grunden