Who is eligible for public mental health services?
Medicaid recipients are automatically enrolled in a local
mental health managed care plan with the Behavioral Health
Organization (BHO). In order to receive services through the
Thurston Mason BHO you must
meet eligibility criteria. Eligibility requires that you:
- Live in Thurston or Mason County; and
- Have a medical identification card showing enrollment in a
Medicaid program; and
- Meet criteria for “medical necessity” for mental healthcare
- Meet “access to care standards”
What is Medical Necessity?
Medical necessity is a term for describing a requested
service which is reasonably calculated to prevent, diagnose,
correct, cure, alleviate, or prevent the worsening of
conditions in the recipient that endanger life, or cause
suffering or pain, or result in illness or infirmity or
threaten to cause or aggravate a handicap or cause physical
deformity or malfunction, and there is no other equally
effective, more conservative or substantially less costly
course of treatment available or suitable for the person
requesting service. For the purpose of this section, “course
of treatment” may include observation or, where appropriate,
no treatment at all.
What is Access to Care?
Access to Care means the minimum eligibility requirements
for Medicaid eligible adults and children to access mental
health services through the publicly funded system.
Who pays for the services?
People who have a medical identification card, also known as
Medicaid coupons are eligible for medically necessary mental
health services at no cost to the person. Any person needing
mental health crisis services is eligible to receive them.
All services must be authorized by the Thurston Mason BHO. The Thurston Mason
and contracted providers will handle this
part of the process.
What if I get a bill?
If you received services from a provider
that is not a Thurston Mason BHO
Network Provider, you may be responsible for any and all
costs for services received. If your coupon was not active
at the time of services, you may have to pay. If you had a
coupon and receive a bill from a provider for services in
error, contact the agency billing office. If you need
further help, contact the Thurston Mason BHO at (360)
What services are available?
Inpatient and outpatient mental health services are
available to you and your family if they are needed. Some of
those services include:
- Case Management;
- Individual therapy;
- Group therapy;
- Medication evaluation, prescription, and management; and
- Crisis Services
For more information, see Outpatient Programs.
You may also receive employment support services,
residential support, and other services through the Thurston Mason
Interpreter services are available upon request. Written materials
such as brochures, client rights, Enrollee Handbook, intake
forms, Notice Letters, etc. are translated into Spanish.
Materials available through the
Department of Social and
Health Services may be available in additional
If you need mental health services, an individual service
plan will be developed with you. Your plan will consider
your age and your culture. You may receive one or more of
the services listed above. The plan will fit your treatment
goals, according to your strengths and needs. Your mental
health care provider will decide with you which services are
most appropriate for you and for how long.
Your mental health care provider may also ask your
permission to work with people who provide you other
services such as housing, healthcare, and employment.
Who provides services?
The Thurston Mason BHO contracts with local licensed Community Mental
Health Agencies (CMHA) which form the Thurston Mason BHO
Provider Network. For a list of Thurston and Mason County
CMHA’s go to the TMBHO
Network Provider List.
You may only go to these authorized agencies for covered
services. You may be responsible for costs if you receive
mental health services through other providers.
What choices do I have?
You may choose a mental health care provider at the agency
from which you receive services. If you don't choose a
mental health care provider, one will be assigned. You have
the right to change mental health care providers during the
first 30 days. You can also ask for a change once a year for
any reason. If you think you have a good reason, you can ask
for more changes. The change may or may not be granted.
What if I need crisis services?
If there is a life-threatening emergency,
please dial 911. When the situation is not life threatening,
you should first use your personalized crisis plan and then,
if necessary contact your Mental Health Care Providers
on-call service or call the crisis line at 1-800-627-2211. You can also go to the
Evaluation and Treatment Facility (E&T) for crisis services
or call (360) 754-1338 or (360) 528-2590.
Mental Health Crisis when NOT
enrolled with a TMBHO Network Provider: Individuals residing in either Thurston or Mason
County without a Thurston Mason BHO Network Provider who are involved in
a situation which is NOT life threatening should contact
the Evaluation and Treatment Facility at (360) 754-1338.
How can I get outpatient services?
If you think you need services, call the toll-free or local
telephone numbers on the
Network Provider list.
Public mental health services are designed to keep you well
in your own community. All efforts will be made to keep you
from requiring inpatient care.
What if I needed to be in an inpatient facility for my
Psychiatric inpatient services are available to Medicaid
enrollees. These services are at no cost, but must be
approved in advance. If you think you need to be
hospitalized, contact your mental health care provider. Your
provider will help you with inpatient services if they are
What can I do if I am unhappy or unsatisfied with my
There are two types of
formal concerns and one
that you may make. You can make an informal complaint by
expressing your dissatisfaction to your provider or with the Thurston Mason
BHO. It's a good idea to try to resolve
your complaint with the person directly involved or ask the
Ombuds to assist you, before you
try other things. You can also contact the Thurston Mason
BHO directly at (360) 876-2602.
For more information, see
Additional Questions and Answers