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Child Health Plus and Behavioral Health Services
Can I access mental health and substance use disorder
services with Child Health Plus?
If you or your child receives health insurance coverage through Child
Health Plus (CHP), you should be able to access mental health and
substance use disorder services with this coverage. If you are enrolled in
a managed care plan, you can contact your health plan or its Member
Services division to learn more about your coverage for these services.
If you need further help to confirm that you or your child is enrolled in
CHP, you can contact the New York State of Health or call 1-800-698-
4KIDS (1-800-698-4543) and ask about Child Health Plus. If you are
hearing impaired, you can call the TTY number, 1-877-898-5849.
New York State and federal laws require most comprehensive health
insurance plans to cover medically necessary mental health services and
manage your mental health or substance use benefits as they manage
medical and surgical benefits, without additional limitations. This is
called “mental health parity” and requires that rules about copayments,
number of visits and pre-authorizations should be similar for accessing
mental health and substance use disorder services as they are for
physical medical care. The NYS Office of Mental Health provides more
information on mental health parity for New Yorkers.
What type of mental health and substance disorder services
can I get with Child Health Plus?
Your managed care plan should provide you with a Summary of Benefits
and Coverage (SBC) in clear and accessible language that describes
what is covered under your specific health plan. An example of the SBC
is available on healthcare.gov. The SBC will show you the costs and
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services associated with your health plan, including information about
mental health and substance use disorder services in a section titled
“Types of Medical Events”. You can learn more about the SBC on
healthcare.gov.
If you do not have your SBC, you can request it from your health plan
using the phone number provided on the back of your health insurance
card or you can call 1-800-698-4KIDS (1-800-698-4543) to get more
information about how to get your SBC.
The managed care plans that provide CHP coverage must offer
prevention services that can help you address behavioral health issues,
such as behavioral assessments and screenings for autism,
developmental, and depression for both child and mother, which can
support health and wellbeing. You can learn more about the preventive
services that are required for most insurance coverage on
healthcare.gov.
Will I need a referral or prior authorization to get mental
health and substance use disorder services through Child
Health Plus?
Depending on your health plan, you may need to get prior authorization
or a referral from your primary care doctor before you can receive the
mental health or substance use disorder services you might need. You
should check your SBC or contact your health plan to confirm whether a
referral or prior authorization is required.
If you don’t need a referral from your primary care provider, you can use
the NYC Well website to find a mental health professional. Visit NYC Well
or call the NYC Well Hotline at1-888-NYC-WELL (1-888-692-9355) and
indicate that you need to find a mental health provider who accepts
Child Health Plus.
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Additional Resources Regarding Mental Health and
Substance Use Disorder Services
If you need help finding a mental or behavioral health
provider
Call 1-888-NYC-WELL (1-888-692-9355) or visit NYC Well Find Services
If you want to learn more about Child Health Plus benefits:
Call the New York State of Health at 1-855-355-5777 or TTY at 1-800-
662-1222 or visit NYS Department of Health Child Health Plus
Visit NYC Health Insurance Link
Download Child Health Plus at a Glance
Download CHP Benefits
If you have been denied mental health services
Depending on your insurance, you may be protected by Mental Health
and Addiction Insurance “Parity” law.
Health plan members are also entitled to request and receive a copy of
the most recent comparative analysis performed by their health
insurance plan to assess compliance with federal parity laws and
regulations. If your health insurance plan refuses to provide this
information to you, you can call the Consumer Assistance Unit of the NYS
Department of Financial Services at 1-800-342-3736 to get assistance.
The New York State Office of Mental Health (OMH) provides additional
information about mental health parity.
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If you need help navigating the health care system
Contact Community Health Advocates (CHA), a program of the
Community Service Society, for free help on how you access the health
care you need. You can call the CHA Helpline at 1-888-614-5400.
Important Note: This information is compiled from government
handbooks and webpages and relies on them for accuracy and is current
as of December 17, 2021. It is provided here for your assistance and
should not be taken as legal advice.
