If your teenager needs mental health care, North Carolina Medicaid can be a powerful resource. Below is a plain-English guide to what’s covered, how plans work, and how families can use benefits to pay for teen therapy, psychiatry, and (when appropriate) residential treatment.
Teens on Medicaid Have Extra Protections (EPSDT)
Federal law requires Medicaid to cover all medically necessary care for members under age 21, even if a specific service isn’t normally listed in the state plan. This is called EPSDT (Early and Periodic Screening, Diagnostic and Treatment). In practice, EPSDT is what ensures access to services like therapy, psychiatry, crisis care, and higher-level supports when a clinician says they’re medically necessary.
Also helpful: No copays for members under 21. That includes behavioral health visits.
Which Medicaid Plan Do Teens Use?
North Carolina Medicaid operates through managed care plans:
- Standard Plans (for most children and teens): AmeriHealth Caritas, Carolina Complete Health, Healthy Blue, UnitedHealthcare Community Plan, and WellCare (availability varies by county).
- Behavioral Health/I/DD Tailored Plans (since July 1, 2024): for people with more significant behavioral health needs or certain diagnoses; these plans include physical health, pharmacy, and enhanced behavioral health services plus care management.
Most teens are in a Standard Plan; teens with more complex needs may be enrolled in a Tailored Plan. Either way, EPSDT still applies. Read more here.
What Teen Mental Health Services Are Covered?
Coverage is broad under Medicaid and EPSDT when services are medically necessary. Common examples include:
- Outpatient therapy (individual, group, family) and diagnostic assessments, including telehealth options.
- Psychiatric evaluation and medication management.
- Mobile Crisis Management for urgent behavioral health needs.
- Enhanced youth services when indicated (varies by plan), such as Intensive In-Home, Multisystemic Therapy (MST), and other evidence-based interventions; requirements sit inside “8A” enhanced services policy and related youth service definitions.
- Residential levels of care (including Psychiatric Residential Treatment Facilities and Level II–IV youth residential services) when a physician and team determine this level is necessary—authorized under EPSDT.
Note: Specific prior authorization rules and service names differ slightly by plan, but the EPSDT standard (“medically necessary to correct or ameliorate”) is the constant.
Who Qualifies for Medicaid in North Carolina?
Children’s eligibility for Medicaid/CHIP is based on household income and age. In North Carolina, NC Health Choice (the state’s former separate CHIP program) was combined with Medicaid on April 1, 2023, simplifying coverage for kids. (Income thresholds vary by age band.)
Separately, North Carolina expanded Medicaid on Dec. 1, 2023 for adults 19-64 (up to 138% FPL). That doesn’t change teen EPSDT benefits, but it can help parents/caregivers qualify, often easing family access to coordinated care.
How to Use Your Teen’s Medicaid Benefits
- Find your plan. Check your member card or call the NC Medicaid Help Center if you’re not sure whether you’re in a Standard Plan or a Tailored Plan.
- Confirm covered providers. Use the state’s provider lookup or your plan’s directory to locate in-network mental health providers. BlueRock can also help navigate this step.
- Get an assessment. An outpatient diagnostic assessment by a licensed clinician is the on-ramp to care and determines medical necessity. (No copay under age 21.)
- If needs are urgent, call crisis. Mobile Crisis Management provides rapid, in-community help and can coordinate next steps.
- If higher levels of care are recommended, EPSDT can help. Your plan will review medical necessity and, when criteria are met, authorize enhanced youth services or residential care.
What About Costs?
- Copays: $0 for members under 21, including behavioral health.
- Transportation: Many plans include non-emergency medical transportation to covered appointments. Ask your plan care manager. (See your plan handbook/benefits page.)
Why This Matters
Youth mental health needs remain high in North Carolina. State data show 18% of high school students seriously considered suicide in 2023, an improvement from 22% in 2021 but still urgent. In 2023 there were 12,500+ emergency-department visits and 3,000+ hospitalizations for self-inflicted injury statewide. Access to timely, evidence-based care through Medicaid can be life-changing.
How BlueRock Helps Families
BlueRock provides comprehensive, relationship-centered care for adolescents, including therapy, psychiatry within program, accredited academics, and structured residential programming when clinically appropriate. We coordinate closely with North Carolina Medicaid plans and care managers to verify benefits, obtain authorizations, and keep treatment moving without financial surprises.
What we do with you:
- Review your teen’s needs and your Medicaid plan information
- Help request/submit referrals and authorizations when a higher level of care is indicated
- Coordinate with your plan’s care manager so services continue seamlessly before, during, and after residential treatment
If you’re unsure which plan you have, or whether your teen’s care might qualify for enhanced or residential services under EPSDT, call us. Our admissions and care coordination teams help families navigate these steps every day.
Quick FAQ
Do I need a referral?
Often no for an initial behavioral health assessment; ongoing services follow your plan’s rules, but EPSDT can override many limits for medically necessary youth care.
What paperwork should I have ready?
Your teen’s Medicaid ID number, plan name, any previous assessments or discharge summaries, current medications, and school/IEP information if applicable. (We can still start without everything, provide what you can.)
What if services are denied?
You have appeal rights. EPSDT requires coverage of medically necessary services for members under 21; denials can be reconsidered with clinical documentation.
Don’t Wait to Get Help for Your Child
If your teen is struggling, don’t wait because of insurance worries. North Carolina Medicaid, backed by EPSDT, was built to cover the full range of medically necessary mental health services for youth. We’ll walk beside you to make the benefits work and to get your family the support you need.
