Sharing the Cost of Services

Letter from the Director

Dear Consumers of Department Services:

Each year the Department of Mental Health provides services for more than 170,000 Missourians and their families. Through its state-operated facilities and contract programs, the department assists persons with mental illnesses, developmental disabilities, and alcohol or drug abuse problems. It also provides services to persons who are compulsive gamblers.

This information is intended to explain how the department charges its clients for services. Unanswered questions should be addressed to the reimbursement administrator in the department's Office of Administration. The telephone number is 573-751-3398.


Mark Stringer, Director

Service costs shared by many

Caring for and treating people with mental illnesses, developmental disabilities, and those with substance abuse problems is expensive. In Missouri, such care can cost hundreds of dollars per day. Many families cannot bear the cost for this care and treatment alone. The Missouri Department of Mental Health is there to help.

Through its many programs, the Missouri Department of Mental Health provides assistance to thousands of persons. Many resources must be tapped to help recover costs incurred. The department, however, makes every effort to provide quality services to its clients while keeping costs as low as possible.

For example, third-party benefits are applied to offset costs first. Those benefits can come from private or public health insurance policies, or from Medicare or Medicaid.

If those payments are insufficient, a client or his family is asked to contribute a portion of the costs based on the family's ability to pay for care given to a client. Those charges are determined using a table that considers family size and income.

The table is administered by each individual facility. It is applied uniformly throughout the state and is reviewed annually.

Other assets are collected when the client is without spouse or dependents and determined to need full-time, long-term (inpatient or placement) care. In such cases, a client's earned and unearned income can be applied to costs. Unearned income, including benefits from disability, survivor's retirement, or pension plans, is used first. Examples of unearned income include payments by the Social Security Administration, the Veterans Administration, the Railroad Retirement Board, the Civil Service Commission and the Division of Family Services. Earned income from wages and salaries is charged if unearned income fails to cover costs.

However, a client is permitted to keep some income for personal spending. The amount, $30 a month or more, is determined by the team of professionals planning for a client's care.

Missouri law requires the Department of Mental Health to charge for the services it provides and to take certain steps to recover its costs. The charges to a client or his family, however, are kept to a minimum so services are affordable to all. Missouri law also requires the state to recover costs from a deceased client's estate. By sharing the costs with a client or his family, the department is able to offer better care. And caring is what the Department of Mental Health is all about.

Questions and answers about service charges

Q. The costs for providing health care seem so expensive. What is included in the costs to the department?

A. The department provides a wide variety of services, which are indeed expensive. Major expenses include room and board, nursing care, medical expenses, day treatment, family support services, and case management.

Q. Can charges to me exceed costs of the services provided?

A. No. The Department of Mental Health is required by law to determine charges and redetermine them each year. When private sources are employed to provide services, costs are set through contracts. Your charges are never allowed to exceed costs of the services provided.

Q. My child is over age 18. Am I liable for charges of services to him/her?

A. No. Parents are not liable from their incomes for the charges for services to their children ages 18 or older. Monies received by parents for their children in a fiduciary capacity are, however, subject to charges.

Q. My school-age child needs special education. Can I be charged for it?

A. No. A parent of a recipient ages 3 through 18 is not liable for costs of education or special education. You may, however, be charged for certain medical expenses, including medical supplies, chiropody medication, anesthesiology, oxygen therapy, radiology, electrocardiology, and electroencephalography. In addition, operating room, laboratory, dental, and physician's expenses are also chargeable. Parents are also asked to provide personal spending money.

Q. What items are considered personal expenses?

A. Clients' personal spending needs vary widely. A family may be asked to provide money for candy or soft drinks. Other items, such as clothes, jewelry, games, and some toiletries are also the family's responsibility.

Q. If two members of my family received services in the same month, must I pay double?

A. No. Your monthly ability to pay is the same amount regardless of how many visits you receive in that month. It is the same for any number of family members being seen. It is the responsibility of the client or family to notify the provider if two or more members receive services in the same month.

Q. Am I required to provide documents to verify my income, assets, and dependents?

A. No. A client or his family should verbally divulge financial resources and dependents.

Q. My financial status changed and I make less money now. Must I continue to pay the same amount?

A. Not necessarily. If your financial situation changes, you should submit new information and request a review of your financial status. Charges to you would be adjusted, if appropriate.

Q. When are my bills due?

A. Bills for each month's services are mailed the following month. They are payable upon receipt.

Q. What can I do if I believe my charges are unfair?

A. You may appeal your charges only if you believe your assessment was inaccurately calculated. An appeal to the director cannot be made because you disagree with your share of the payment. It must be based on what you believe is an inaccurate calculation of allowable exemptions under Standard Means Test rules.

Q. What if I fail to pay the costs assigned to me through the Standard Means Test procedure?

A. The state will pursue other means to receive payment; for example, the Income Tax Intercept Program and any other means allowable under state and federal law.

Q. I can't afford to pay for the care my family member needs. Can we be turned away?

A. No. The department has never refused to provide services to someone unable to pay. However, if the department finds you can pay and won't, the department reserves the right to refrain from providing services.

Q. Where can I get further information?

A. Contact the administrator at your local facility.

Admission checklist

You should provide the following information when requesting services for individuals from a Department of Mental Health facility.

  • Insurance company name and address
  • Insurance policy or group number
  • Medicare number
  • Medicaid number
  • Proof of Income
  • Proof of Dependents
  • Social Security number of client, spouse, or parents of a minor child

Department Facilities

To receive information on the Standard Means Test, contact any of the following Office Locations