Medicaid Benefits for Mental Health or Substance Abuse Providers

The Diamond State Health Care Plan (Medicaid) assures that children are able to  get behavioral health services that are clinically necessary. DPBHS provides all Medicaid behavioral health services with the exception of routine outpatient services.

Each Delaware Medicaid eligible child has an annual (July 1 through June 30) outpatient benefit of 30-units. This benefit is usually provided by one of the three Managed Care Organizations (MCO) contracted by the State

  • Delaware Physicians Care, Inc. 
  • Diamond State Partners
  • Unison Health Plan of Delaware, Inc.

To assure continuity of care, DPBHS provides supplementary funding for additional units per year if they are deemed clinically necessary.

Any outpatient MCO provider who wishes to apply for extended benefits beyond the 30-unit annual outpatient benefit before the end of the benefit year (June 30) should contact a DPBHS system administrator to begin the process for continuing the clinically necessary service. The DPBHS administrator will need specific business information and an estimate of how many units are being requested through the end of the benefit year.  Retroactive requests will not be processed. Providers must accept current DPBHS outpatient rates.

For more information pertaining to the Delaware Medicaid Plan, please refer to the website: Delaware Medicaid Assistance Program (DMAP)