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3350.00.00 BEHAVIORAL & PRIMARY HEALTHCARE COORDINATION (BPHC) Individuals who have severe psychiatric needs but can reside in the community rather than institutional setting can receive Medicaid services through an approved waiver under Section 1915(i) of the Social Security Act. Sections 3350.00 through 3350.25.00 explain the eligibility requirements that apply to individuals who have been approved for Behavioral & Primary Healthcare Coordination (BPHC). Certain provisions are special for BPHC and provide an additional eligibility methodology as an option to regular eligibility in the Aged, Blind, and Disabled categories. 3350.05.00 GENERAL INFORMATION ABOUT BPHC Behavioral and Primary Healthcare Coordination (BPHC) provides behavioral and primary healthcare coordination services to individuals with serious mental illness who demonstrate impairment in self-management of health services, which includes coordination of healthcare services to manage the healthcare needs of the recipient including direct assistance in gaining access to health services, coordination of care within and across systems, oversight of the entire case and linkage to appropriate services. Eligibility for the BPHC services is handled and determined by the Division of Mental Health and Addiction (DMHA) based upon the demonstrated needs of the applicant. Individuals wishing to apply for BPHC services should consult a Community Mental Health Center (CMHC) about submitting a BPHC application with DMHA. An application for BPHC services is not considered an application for Medicaid. There are not any specific number of slots that can be filled in each time period. BPHC services are provided to people who reside in the community, have a primary mental health diagnosis (including but not limited to schizophrenic disorder, major depressive disorder, bipolar disorder, delusional disorder, or psychotic disorder), and have specific needs requiring the service as determined by DMHA.8 To be approved, an individual must meet the “BPHC” criteria described above and must meet Medicaid eligibility requirements. If an applicant/recipient is eligible for both an HCBS waiver and BPHC, then the waiver budgeting would apply.9 If the member fails the waiver budgeting, but qualifies for BPHC, and the member wishes to voluntarily withdraw from the waiver while pursuing the BPHC, then it is best practice to get voluntary withdraw in writing. Until the waiver is ended, the waiver budget will form. The individual should work with the waiver care manager to withdraw from the waiver.