Access Care, Eligibility, and Payment
At West Michigan CMH, ensuring that community members are able to access the care they need is essential.
How to Access Care
Your health and wellness matter to us. And when you need care, we’re here.
You can access care 24 hours a day, 7 days a week. Simply call any of our locations:
Mason County: (231) 845-6294
Lake County: (231) 745-4659
Oceana County: (231) 873-2108
If you prefer to talk to someone in person, you may walk in to any office location during business hours (8am-5pm, Monday-Friday). A licensed and highly-qualified professional will be glad to meet with you and discuss your needs and potential service options.
Eligibility for Services
West Michigan CMH determines an individual’s eligibility for services using the Community Mental Health Medical Necessity and Therapeutic Appropriateness criteria. These criteria are based on national standards and accepted professional practice.
West Michigan CMH serves people who have a mental illness, developmental disability, emotional impairment, and/or a substance use disorder, and also show a medical need for services. Individuals who qualify for services will be able to receive care regardless of their insurance, or their county of residence. Please see the section “Payment for Services” below for more information.
If you are unsure of your eligibility for services through West Michigan CMH, we’d be glad to help you determine if you are eligible for our services and care.
If you do not qualify for West Michigan CMH services, our staff can assist you in finding other services available to you.
Payment for Services/Non-Discrimination Clause
It is important to us that your ability to pay not be a barrier to receiving the services you need.
We’ll help you to determine your needs and conclude whether your treatment will be covered.
To start, it’s important that you inform West Michigan CMH staff of all the insurance coverage you currently have. Also include any recent changes to your insurance. If all insurance information is not provided, you may be at risk of being charged for services that should be covered for you.
WMCMH offers a discounted sliding fee schedule for all seeking services based on income and family size. Services will not be denied because of inability to pay. In addition, WMCMH does not discriminate based on race, color, sex, national origin, disability, religion, age, sexual orientation, gender identity, inability to pay or Medicaid/Medicare CHIP status.
General Payment Guidelines
- If you are enrolled in Medicaid and meet criteria for specialty behavioral health and/or substance use disorder services, the total cost of your treatment will be covered.
- If you are a Medicaid beneficiary with a deductible (“spend-down”) as determined by DHHS (Department of Health and Human Services), you may be responsible for the cost of some of your services. In this case, there is an amount that must be paid before the services you receive can be covered by Medicaid. For this (and for those with private insurance and gaps in coverage), West Michigan CMH offers a sliding fee scale (see below). Our staff can discuss the sliding fee scale with you and answer any questions you may have.
- If you do not have Medicaid or any type of insurance, West Michigan CMH staff will work with you through our DHHS (Department of Health and Human Services) staff to help determine if you are eligible for Medicaid or Healthy Michigan.
- If you do not qualify for Medicaid or Healthy Michigan, Payment is then based on what you can afford. Our staff will work with you to determine what your costs will be. If necessary, we can even help you set up a payment schedule that works for you.
- If you are uninsured or underinsured and are enrolled and identified as a CCBHC Consumer (Certified Community Behavioral Health Clinic) you will be eligible for financial assistance under the Federal Poverty Guidelines (FPG). Please refer to this chart. This scale is based on gross income and family size. Depending on where you fall on the scale, you may be eligible for a $0 per visit copay, a $5 per visit copay or you may remain responsible for the full cost of all services. Proof of gross income is required to be on file to determine eligibility for a sliding fee scale.
- If you are uninsured or underinsured and are a consumer with only a DD Diagnosis, you will be eligible for financial assistance under the Public Mental Health System sliding fee scale. Please refer to this chart. This is based on household State Taxable Income. Depending on where you fall on the scale you may be eligible for a monthly ability-to-pay. Proof of taxable income is required to be on file to determine eligibility for a sliding fee scale.