Inpatient Psychiatric Coverage for beneficiaries 65 or older

Effective for services provided on or after July 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will allow for coverage of inpatient psychiatric care for beneficiaries of Medicare and Medicaid who are 65 or older.

Medicaid regulations allow for the provision of inpatient psychiatric services in an Institution for Mental Disease (IMD) for persons under age 21 and age 65 or older. This service is currently covered for the under age 21 beneficiaries in our State Plan but not for the age 65 or older population. Even though this service is a covered Medicare benefit, coverage is not currently available for those dual eligibles that have exhausted their Medicare hospital benefit.

The provision of this service will promote better health outcomes for older persons with behavioral health needs that could be best addressed in an in-patient facility.

If you have questions about this bulletin, please contact the Division of Behavioral Health at (803) 898-2565. Thank you for your continued support of the South Carolina Medicaid Program.

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