Eligibility for SMCN programs is based on the Public Mental Health System. 

The goals of the Public Mental Health System (PMHS) are to:

• Help individuals get the care they need
• Make sure the care is appropriate
• Improve the quality of care
• Pay for the care received and learn what services help people

The public mental health system serves three main groups of people:

1. Medical Assistance recipients enrolled in Managed Care Organizations
2. Medical Assistance recipients who are also eligible for Medicare and remain in the Medicaid fee-for-service system.
3. Individuals for whom (because of their medical and financial need) the cost of mental health services is subsidized in whole or part by State and local funds.

Special Populations

Eligible Uninsured:

People without Medicaid may be served in the PMHS if the following conditions are met:

• The person needs treatment for a mental health problem
• Their income and family size meets the set scale
• They have a Social Security Number
• The person has applied for benefits (MA, SSI, SSDI) or they applied and have been found not to be eligible
• The person’s mental health insurance does not cover a particular level of service or benefits are all used up
• The person must be a citizen of the United States and reside in Maryland
• An alien lawfully in the Country or one who has met certain legal conditions for permanent or temporary residency

Veterans:

Medical care, including psychiatric care, is one of the benefits veterans may be entitled to receive.  In order to determine eligibility and to get these benefits, it is necessary to apply to the Department of Veterans Affairs.  The Disable American Veterans organization may help veterans to complete the application process.  Call 202-554-3506 for more information.

There is a Maryland Department of Veterans Affairs to assist Maryland Veterans to get help; call 410-333-4428.  In addition, there are VA Regional Offices where a person can get benefit information and where to go; call 1-800-827-1000.

Homeless:

The Mental Hygiene Administration receives federal money to provide mental health services to homeless people in shelters and on the streets.  MHA transfers the money to the Core Service Agencies who then contract with providers to provide outreach, case management, eviction prevention, security deposits, crisis intervention, housing subsidies, emergency purchases (food, medication, etc.) and assist people in getting treatment.  For information on local homeless programs contact the Core Service Agency in the County you reside in.

Priority Population – Adults (Rehab and Residential Programs)

SEVERELY MENTALLY ILL

PRIORITY POPULATION DEFINITION - ADULTS (SMI)

Revised 9/1/03, 3/10/14

Reviewed 05/10/07, 1/25/10

INCLUDED DIAGNOSES (DSM-5 – including ICD-9 and ICD-10 diagnosis codes):

295.90/F20.9 Schizophrenia

295.40/F20.81 Schizophreniform Disorder

295.70/F25.0 Schizoaffective Disorder, Bipolar Type

295.70/F25.1 Schizoaffective Disorder, Depressive Type

298.8/F28 Other Specified Schizophrenia Spectrum and Other Psychotic Disorder

298.9/F29 Unspecified Schizophrenia Spectrum and Other Psychotic Disorder

297.1/F22 Delusional Disorder

296.33/F33.2 Major Depressive Disorder, Recurrent Episode, Severe

296.34/F33.3 Major Depressive Disorder, Recurrent Episode, With Psychotic Features

296.43/F31.13 Bipolar I Disorder, Current or Most Recent Episode Manic, Severe

296.44/F31.2 Bipolar I Disorder, Current or Most Recent Episode Manic, With Psychotic Features

296.53/F31.4 Bipolar I Disorder, Current or Most Recent Episode Depressed, Severe

296.54/F31.5 Bipolar I Disorder, Most Recent Episode Depressed, With Psychotic Features

296.40/F31.0 Bipolar I Disorder, Current or Most Recent Episode Hypomanic

296.40/F31.9 Bipolar I Disorder, Current or Most Recent Episode Hypomanic, Unspecified

296.7/F31.9 Bipolar I Disorder, Unspecified

296.89/F31.81 Bipolar II Disorder

301.22/F21 Schizotypal Personality Disorder

301.83/F60.3 Borderline Personality Disorder

INCLUDED DIAGNOSES (DSM-IV):

295.10 Schizophrenia, Disorganized Type

295.20 Schizophrenia, Catatonic Type

295.30 Schizophrenia, Paranoid Type

295.40 Schizophreniform Disorder

295.60 Schizophrenia, Residual Type

295.70 Schizoaffective Disorder

295.90 Schizophrenia, Undifferentiated Type (*includes ICD-9 diagnoses 295.10-295.95) 

296.33 Major Depressive Disorder, Recurrent, Severe Without Psychotic Features

296.34 Major Depressive Disorder, Recurrent, Severe With Psychotic Features

297.1 Delusional Disorder

298.9 Psychotic Disorder, NOS

301.22 Schizotypal Personality Disorder

301.83 Borderline Personality Disorder

296.43 Bipolar I Disorder, Most Recent Episode, Manic, Severe Without Psychotic Features

296.44 Bipolar I Disorder, Most Recent Episode, Manic, Severe With Psychotic Features

296.53 Bipolar I Disorder, Most Recent Episode, Depressed, Severe Without Psychotic Features

296.54 Bipolar I Disorder, Most Recent Episode, Depressed, Severe With Psychotic Features

296.63 Bipolar I Disorder, Most Recent Episode, Mixed, Severe Without Psychotic Features

296.64 Bipolar I Disorder, Most Recent Episode, Mixed, Severe With Psychotic Features

296.80 Bipolar Disorder, NOS

296.89 Bipolar II Disorder

-and-

In order to be included in the PRIORITY POPULATION, individuals must meet the target diagnostic criteria and meet the following functional limitations:

Serious mental illness is characterized by impaired role functioning, on a continuing or intermittent basis, for at least two years, including at least three of the following:

 Inability to maintain independent employment,

 Social behavior that results in interventions by the mental health system,

 Inability, due to cognitive disorganization, to procure financial assistance to support living in the community,

 Severe inability to establish or maintain a personal support system, or

 Need for assistance with basic living skills.

The diagnostic criteria may be waived for the following two conditions:

1. An individual committed as not criminally responsible who is conditionally released from a Mental Hygiene Administration facility, according to the provisions of Health General Article, Title 12, Annotated Code of Maryland. Or 

2. An individual in a Mental Hygiene Administration facility with a length of stay of more than 6 months who requires RRP services, but who does not have a target diagnosis. This excludes individuals eligible for Developmental Disabilities services.