Virginia teen mental health resources.

Virginia is in the middle of building a modern behavioral health crisis system — the Marcus Alert system, named for Marcus-David Peters, which coordinates 988 and regional crisis call centers so that a mental health emergency gets a behavioral health response, not only a police one. For anything urgent, 988 works statewide. Virginia also runs an unusual funding mechanism, the Children's Services Act, that can pay for services for at-risk youth across agency lines. This guide explains how those pieces fit with Medicaid and private insurance.

The information here comes from Virginia state sources — the Department of Behavioral Health and Developmental Services (DBHDS), the Department of Medical Assistance Services (DMAS), the Office of Children's Services, and the State Corporation Commission's Bureau of Insurance — all linked at the bottom.

If you need help right now

Virginia's crisis system is being rolled out region by region, so exactly what's available can depend on where you live. Calling 988 is the reliable front door everywhere in the state, and the call center can tell you what mobile and community options exist locally.

How Virginia's children's system is organized

• DBHDS runs the public behavioral health and crisis system, including Marcus Alert.
• Community Services Boards (CSBs) — roughly 40 across the state — are the local public providers and operate regional crisis hubs.
• DMAS runs Medicaid (Cardinal Care), with Magellan of Virginia managing behavioral health services.
• The Office of Children's Services administers the Children's Services Act, Virginia's distinctive cross-agency funding system.
• The Bureau of Insurance (within the State Corporation Commission) regulates private health plans and runs external review.

The Children's Services Act and FAPT

Virginia does something most states don't. The Children's Services Act (CSA), enacted in 1993, pools state and local funds to purchase services for at-risk youth and their families across agency lines — child welfare, juvenile justice, education, and behavioral health. The aim is a child-centered, community-based plan that isn't limited by which agency a family happens to walk into first.

Access usually runs through a local Family Assessment and Planning Team (FAPT), which reviews a youth's strengths and needs — using the CANS (Child and Adolescent Needs and Strengths) assessment — and builds a service plan. If your teen has complex needs that cross systems, ask your locality's CSA office or FAPT how to be referred.

Cardinal Care and Medicaid

Virginia's Medicaid program is Cardinal Care, which in 2023 combined the state's earlier managed care programs into a single program to reduce gaps as a family's needs change. Behavioral health services are managed by Magellan of Virginia, which authorizes services using medical-necessity criteria.

Under the federal EPSDT benefit, children and adolescents under 21 on Medicaid are entitled to all medically necessary services to treat physical and mental health conditions; the standard is medical necessity, not a fixed cap. Higher levels of care, including PRTF-level residential treatment, are authorized through Magellan and, in many cases, coordinated with CSA funding. If a service is denied, you have the right to a plan appeal and a Medicaid state fair hearing.

Residential treatment and what to verify

For youth who need 24-hour care, Virginia uses Psychiatric Residential Treatment Facilities (PRTFs) and other residential programs, authorized through Magellan on medical-necessity grounds and often funded with CSA dollars. Before any placement:

• Confirm licensing and that the placement is being coordinated through the CSA/FAPT or Medicaid process, which is built to find the least restrictive appropriate option.
• Be cautious about out-of-state placements. Families are sometimes steered toward out-of-state residential or wilderness programs Virginia would not license. Hartley's investigative cluster explains why that pattern deserves skepticism.
• Ask about restraint and seclusion, staffing, and discharge planning — and get the answers in writing.

Insurance and parity

For privately insured families, mental health and substance use coverage is protected by the federal Mental Health Parity and Addiction Equity Act, which requires plans to apply no more restrictive rules to behavioral health care than to medical care. When a state-regulated plan denies care, Virginia's Bureau of Insurance offers a free external review — generally requested within 120 days of your final denial — in which an independent organization decides whether the denial was appropriate.

For self-funded ERISA (large-employer) plans, the federal external review process and complaints to the U.S. Department of Labor apply instead. In every case, get the denial in writing with the specific criteria used, and ask your teen's clinician to document medical necessity.

School-based mental health resources

School counselors and social workers are usually a family's fastest entry point for evaluations, 504 plans, and IEP processes when a teen's mental health is affecting school. Virginia's large divisions — Fairfax County, Prince William, Loudoun, Virginia Beach, and Chesterfield — have invested in school counseling and behavioral health, and the CSA can fund services written into a child's plan. If your teen is struggling academically because of anxiety, depression, or another condition, start with the school counselor and ask specifically about evaluation timelines.

Other Virginia-specific resources

What this guide doesn't cover (yet)

• Regional resource pages for Northern Virginia, Richmond, Hampton Roads, and Southwest Virginia
• A directory of Community Services Boards and regional crisis hubs
• A step-by-step walkthrough of the CSA/FAPT referral process
• How Virginia authorizes and oversees residential treatment
• Virginia's adolescent substance use treatment landscape

If something here is wrong or out of date, please tell us.

Sources

1. Virginia DBHDS, "The Marcus Alert System" and crisis services, dbhds.virginia.gov
2. Virginia Office of Children's Services, "A Guide to the Children's Services Act for Children and Families," csa.virginia.gov
3. Virginia DMAS, "Cardinal Care" and "EPSDT," dmas.virginia.gov
4. Virginia State Corporation Commission, Bureau of Insurance, "External Review," scc.virginia.gov
5. disAbility Law Center of Virginia, Virginia protection and advocacy agency, dlcv.org
6. Federal Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).