Medical Necessity

The Medicaid program entitles Medicaid recipients to receive all mental health services which are "medically necessary." 


The legal definition of "medical necessity" is: A term for describing a requested service which is reasonably calculated to prevent, diagnose, correct, cure, alleviate, or prevent the worsening of conditions in the recipient that endanger life, or cause suffering or pain, or result in illness or infirmity, or threaten to cause or aggravate a handicap, or cause physical deformity or malfunction, and there is no other equally effective, more conservative, or substantially less costly course of treatment available or suitable for the person requesting service.

For the purpose of this section, "course of treatment" may include mere observations or, where appropriate, no treatment at all.