MinnesotaCare is a public health coverage program for eligible Minnesota residents. Most members receive care through a managed health plan.[1]
MinnesotaCare mental health coverage for teens can include a range of behavioral and psychiatric services, from outpatient therapy and medication management to inpatient mental health treatment when necessary. The exact amount that a family pays, which providers are in network, and whether a service requires prior authorization can all depend on the teen’s plan and level of treatment.
Families may need to confirm coverage through medical necessity, network participation, referrals, and other requirements before treatment starts in order to avoid unexpected costs. However, this process can feel confusing and daunting for many, especially when already trying to manage a teen’s mental health needs. To help you better understand what MinnesotaCare covers for teens, this page explores:
MinnesotaCare is a state health coverage program for eligible Minnesota residents who meet certain program requirements.
Most people enrolled in MinnesotaCare receive resources and support within Minnesota through a managed health plan available in their specific county. However, some people may also receive services through a fee-for-service arrangement where the provider bills the state directly.[1]
In general, teen therapy can be covered by MinnesotaCare as long as the service meets program requirements and is delivered by an eligible provider. But the exact process for accessing these services may depend on the teen’s managed care plan.
MinnesotaCare therapy coverage for teens may include:[2]
Services like coaching may not qualify for reimbursement. Families should ask the health plan what provider credentials and billing codes are covered under MinnesotaCare counseling.
A provider saying that they accept MinnesotaCare is not always enough. Therefore, a parent should confirm whether:
It may also help to understand the specifics of teen medication management coverage under MinnesotaCare.
MinnesotaCare psychiatric treatment can include assessment and medication management for symptoms that involve:
The prescriber may be a psychiatrist or other qualified professional depending on the setting. Therefore, parents should ask questions to ensure coverage, such as whether:
MinnesotaCare members younger than 21 are exempt from cost sharing, even with prescription medications. However, families may still need to confirm that a medication is covered and whether it requires prior authorization.
MinnesotaCare behavioral health benefits can cover more than just weekly therapy and medication management.
Possible covered services can include:[2]
However, a teen does not necessarily qualify for every service simply because they have MinnesotaCare. There are specialized services and Minnesota resources that have their own eligibility criteria and screening processes that may impact coverage.
MinnesotaCare includes coverage for medically necessary inpatient hospital services.[3] However, this does not mean that inpatient services will be covered simply because a family member requests it.
Inpatient treatment coverage requires clinical justification, medical-necessity certification, and authorizations.[3] Coverage may be considered when a teen is:
Families should inquire with the hospital and the teen’s MinnesotaCare health plan about what approval requirements are needed in these situations.
MinnesotaCare residential treatment coverage depends on what type of residential service is being considered and how the service is funded.
One specialized level of care for Minnesota youth is a psychiatric residential treatment facility, or PRTF. PRTFs provide inpatient-level psychiatric care in a residential setting for those under 21 years old with complex mental health conditions. But medical necessity must be established before admission.[4]
Eligibility criteria for a PRTF can include:[4]
Minnesota’s children’s mental health system includes crisis response services for young people experiencing mental health emergencies.[2] Crisis care can involve:
However, if a teen is in immediate danger, then the first step is to ensure safety before figuring out every insurance detail. Parents can call 911, 988, or go to their nearest emergency room.
Mission Prep is here to help you or your loved one take the next steps towards an improved mental well-being.
Those under the age of 21 typically do not pay MinnesotaCare premiums, copays, coinsurance, or deductibles.[5][6] But families should always verify that a provider is in-network with the teen’s specific health plan and that any prior authorization or medical necessity requirements have been met before starting services. Just because a service is covered by insurance does not mean it does not require prior approval before treatment begins.
Below, we consider some terms you may come across when trying to ensure that MinnesotaCare covers teen mental health treatment.
Minnesota DHS states that some MinnesotaCare services and prescriptions require prior approval.[1]
This means that the health plan or state program reviews the requested service before agreeing to cover it. This may be most relevant for services like:
Authorization is not the same as clinical recommendations, and sometimes the two do not align. A therapist may believe a certain treatment would help, while the health plan may require additional documentation or justification before agreeing to pay for it.
When more intensive care is recommended, it may be helpful to ask the provider if authorization has already been submitted and, if the service has been approved, how long it is approved for. Getting both questions answered can help decrease confusion about whether both clinical acceptance and insurance approval have actually occurred.
Insurance coverage usually depends on whether a service is determined to be medically necessary. This means that the treatment must be clinically appropriate for the teen’s condition and level of functioning.
For example, weekly outpatient therapy may be appropriate for one teenager. But another teenager may need intensive outpatient care or residential psychiatric treatment.
Parents should ask the treatment provider to explain exactly why the recommended level of care is necessary and what documentation is being submitted to the insurer.
You might find that a therapist accepts one MinnesotaCare plan but not another. This can be a common source of frustration for families.
Before scheduling, ask the provider if they are in-network with your teen’s exact MinnesotaCare plan. Then call member services and verify that the provider is listed as participating.
Insurance can be overwhelming, and sometimes contacting member services can feel like it adds to that overwhelm. But a few targeted questions can help clarify most situations.
For instance, you could start off by writing down the representative you speak to’s name and the date of the phone call, and then asking:
If a treatment facility is involved, you can compare what the facility tells you against what the health plan confirms so that you can reduce the chances of any unexpected charges.
A denial for a mental health service does not necessarily mean that the service cannot be covered.
It may be helpful to start by determining why the claim or authorization was denied. Common reasons may include:
If a service is denied, then there are a number of things that you can do. You can start by asking for the denial in writing so you can keep it for your records. Then speak with the provider and health plan to see if the provider can submit additional records or request reconsideration.
Minnesota managed care members also have appeal rights, and your plan member materials should explain the process.[7] So, aim to keep copies of:
Take a tour of our teen residential mental health facilities located in Minnetonka, MN. Our locations offer peace & comfort within a residential environment where teenagers, aged 12-17, can relax and focus on themselves.
Our well-appointed facilities are located in on the west side of the Metro area and serve teens from across Minnesota.
MinnesotaCare mental health coverage for teens provides coverage for outpatient therapy, psychiatric treatment, prescriptions, and other behavioral health care when program and medical-necessity requirements are met.[1][2][6]
However, just because a mental health service is covered does not mean it fits the teen’s needs clinically. And coverage should not become the only driving factor in clinical decisions. Parents who are trying to choose the right level of care for their teen can use the health plan and the teen’s existing treatment team to help determine next steps.
At Mission Prep Teen Treatment, we offer residential treatment programs that include evidence-based therapy services to support teens navigating anxiety, depression, trauma, stress, and other mental health concerns.
Our Minnesota locations are an important part of the treatment process at Mission Prep Teen Treatment. We believe it’s critical for teens to have a safe and welcoming environment to build the tools they need to facilitate healing. We maintain modern, well-appointed homes where teens are able to develop and practice strategies that help lay the foundation for sustainable healing.
Mission Prep Teen Treatment accepts insurance and is in-network with most major providers. We are happy to help you check your insurance coverage for mental health care.
Start the admissions process online or call 866-901-4047 to speak with a caring member of our team who can answer any questions you might have. Reach out for a free, no-obligation conversation. Our team is also happy to talk you through whether MinnesotaCare could cover your teen’s treatment.
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