Accessing Services and Care
Eligibility, Referrals, and Payments
Individuals are encouraged to walk into HealthWest during business hours where a member of the Response and Stabilization team will meet with the individual, complete an assessment and make a referral for services. Those services could be within HealthWest or with one of the various providers with which we contract. To walk in, visit the HealthWest Main Campus: 376 E. Apple Ave., Muskegon, MI 49442 or call 231-720-3200.
The Assessment Process
Your conversations are private and confidential. Trained and licensed clinicians will talk with you to determine your needs and eligibility. If you do not qualify for services, our staff will assist you to find other agencies in the community who might be able to help.
The Michigan Department of Community Health (MDCH) sets eligibility criteria for HealthWest services. Services are available to those who:
- Live in Muskegon County.
- Have a serious mental illness, developmental disability, serious emotional disturbance, and/or co-occurring substance use disorder.
- Have Medicaid. If you do not have insurance, we can help you fill out a Medicaid application. If you do not have insurance and meet all other eligibility criteria, you may be placed on a waiting list.
- Demonstrate medical need for services.
Services authorized for treatment of a behavioral health and/or co-occurring substance use disorder concern must be medically necessary. You will participate in a screening of your needs to identify the type of services you might be eligible to receive. Medical necessity also means that the amount (how much of a service you get), scope (who provides the service and how), and duration (how long the service will last) of your services are enough to meet your needs. Medicaid recipients are guaranteed to receive services that are medically necessary. For people who have no insurance, there is no guarantee they will get services if there is not the money to provide those services, and they may be placed on a waiting list.
If you have Medicaid:
- You are eligible for a specific set of services based on medical necessity. Explore our Guide To Services to learn more.
- You cannot be put on a waiting list for a service considered “medically necessary” unless you are in agreement.
If you do not have Medicaid (General Fund):
- The list of services is not as large as it is for those who have Medicaid. Explore our Guide To Services to learn more.
- You can be put on a waiting list if there is not enough funding to provide the service and you do not qualify for Medicaid.
Setting up services through Self Determination allows an individual to have more control over their budget and those who provide their care. It gives individuals a choice of who provides the services and supports identified in their person-centered plan.
Partners Advancing Self-Determination is a collaborative effort that works to increase the availability and use of arrangements that support self-determination. You can find more information by visiting them on Facebook or at https://bit.ly/SelfDeterminationInfo
We accept referrals from a variety of resources including schools, doctor offices, and mental health professionals. Concerned family or friends may call to inquire about services, but anyone over the age of 18 who serves as their own guardian will have to call to make their own referral. Parents or legal guardians can make referrals for anyone under the age of 18.
Out of County Emergency Mental Health Care
If you have Medicaid, carry your card with you at all times. You are covered for emergency mental health services anywhere within the State of Michigan. If you have a mental health emergency while you are outside of the county where you receive services, you should contact the Community Mental Health (CMH) office where you are during the time of the emergency, or go the nearest hospital emergency room. The CMH office where you are during the emergency will contact HealthWest to arrange for your care.
Payment for Services
If you are enrolled in Medicaid and meet the criteria for the specialty behavioral health and/or co-occurring substance use disorder services, the total cost of your authorized mental health or substance abuse treatment will be covered (no fees will be charged to you.) If you are a Medicaid beneficiary with a deductible (“spend-down”), as determined by DHHS, you may be responsible for the cost of a portion of your services. In this case there is a sliding fee scale. You can find the costs on the Sliding Fee Scale provided here:
Make sure that you inform HealthWest of all the insurances that you are covered by, as well as any changes to your insurance. If you fail to provide insurance information you may be at risk of being charged for services.
HealthWest serves all patients regardless of their inability to pay. Discounts for essential services are offered based on family size and income. When you begin treatment, we will work with you to determine your costs. Please notify us of any changes in your status, income or insurance.