Medicaid Coverage for Therapy Services

What is Medicaid?

Medicaid is a health insurance program that provides coverage to certain individuals with limited income and resources. Medicaid can also provide coverage for certain services that are not covered by Medicare. Although Medicaid is a program funded and managed by the federal government, each state runs its own Medicaid program, and applicants choose their plans through their state Medicaid agency.

Does Medicaid Cover Therapy?

Yes. All fifty states offer coverage for therapy and mental health services through their own Medicaid programs. In fact, Medicaid pays more for client mental health services than any other insurance provider in the country. However, the amount and type of coverage Medicaid provides to its members will depend upon the location, the service provider, and the specifics of the plan.

How do I Sign Up for Medicaid?

You can apply online for Medicaid by visiting your state’s online healthcare portal, or by visiting the Affordable Care Act’s website, www.healthcare.gov. You can also call the Health Insurance Marketplace at the following number:

1-800-318-2596

(TTY: 1-855-889-4325)

The Marketplace will be able to direct you to your state’s Medicaid agency. You can also find the number for your state’s Medicaid agency using this contact page. Finally, you can sign up for a Medicaid plan through a third-party health insurance company.

How can I find out if my Medicaid Plan covers Therapy?

When you first sign up for your Medicaid plan, your state agency will send you a welcome packet which includes a Summary and Benefits document, as well as your Medicaid card. The Summary and Benefits document will list your copayment and/or coinsurance rates per service type. On that list you should see “outpatient mental health services,” followed by the amount that your plan covers and how much you’ll have to pay out-of-pocket (if anything).

If you don’t see “outpatient mental health services” among your list of covered services, or can’t find your Summary and Benefits document, call the customer service phone number on the back of your Medicaid card. Once you reach a live representative, they will be able to pull up your plan using your biographical information and explain the details.

Finally, when you sign up for Medicaid benefits, you are given a username and password for accessing your Medicaid account online. When you log in, you should be able to locate your plan on your membership page. Once you find it, you can pull up your Summary of Benefits document, and look for outpatient mental health services.

How much will I pay Out of Pocket for Mental Health Services Covered by my Medicaid Plan?

When you have a Medicaid plan, Medicaid will pay the entire balance of your therapy session – except for your copay – as long as your therapist is in your plan’s provider network. Many Medicaid plans have a copayment of $0-25 per therapy session. If you opt to see a therapist that is outside of your provider network, you will be responsible for the full balance. If you want to know whether a specific provider is in your network, contact your state agency using the number on the back of your card, or look up the therapist’s name using the appropriate search tool on your state’s Medicaid website.

Many states limit the number of Medicaid-covered therapy sessions to a certain number of sessions per calendar year. Often the limit is 30 sessions, but each state sets its own limit. Once Medicaid has covered that number of therapy sessions, you will have to pay the full balance of each subsequent session until your next coverage year begins.

The amount of the copay and the number of covered sessions can vary from state to state and plan to plan. However, the purpose of Medicaid is to make services affordable for their residents. You can usually find a way to get quality mental health services if you need them.

What Mental Health Conditions will Medicaid cover?

In order to reimburse therapists or clients, Medicaid requires a diagnosis from the therapist. Based on the terms of the plan, that diagnosis will dictate how treatment will proceed, as well as which services will be covered.

Here are some of the mental health conditions covered by Medicaid:

Depression
Anxiety and stress
Alcohol abuse
Infertility concerns
Grief and loss
Eating disorders
Learning disabilities
Many more conditions

Although these conditions are fairly common, Medicaid covers many others. If you want to know whether the specific condition that you are suffering from is covered, contact your plan representative or consult your Summary and Benefits document.

What Types of Therapy will Medicaid Cover?

Medicaid covers many of the commonly accepted treatment modalities in modern psychotherapy, but not everything. Some questions the therapist should consider are: Is the therapy evidence-based? Is it clinically rigorous? Is the chosen therapy appropriate for the given diagnosis? If yes, Medicaid will provide coverage.

Some of the evidence-based therapies covered by Medicaid include:

Cognitive Behavioral Therapy (CBT)
Dialectical Behavioral Therapy (DBT)
Eye Movement Desensitization and Reprocessing (EMDR)
Mindfulness practices
Child-parent psychotherapy
Acceptance and Commitment Therapy (ACT)

What Types of Counseling Services is Medicaid Unable to Cover?

The following are services that are NOT covered by Medicaid:

Life coaching
Career counseling
Holistic medicine (e.g. aromatherapy, massage therapy, acupuncture)
Energy-based healing (e.g. Reiki healing, Qigong)

Medicaid will not cover sessions with providers who are not professionally credentialed. Providers must be able to provide proof of their credentials. You can also look up your provider’s name on the list of credentialed providers with your state.

Does Medicaid Coverage Include Online Therapy?

Yes. Because of COVID-19 and other logistical concerns, Medicaid covers online therapy the same as if you were to visit your therapist in-person. There are many advantages of this coverage; in addition to protecting the health of the patients and the therapist, online therapy reduces the time and monetary costs associated with travel. You can also schedule an appointment with a therapist that is far away, provided that they are within your plan’s provider network.

Given that the pandemic is a big reason why online therapy is covered, there is the possibility that this option may change in the future. If you rely on online sessions for treatment, we recommend revisiting your plan’s terms from time to time to ensure that they will continue to be covered. Your therapist should notify you of any upcoming changes. You also may receive regular bulletins from your plan that will notify you of any upcoming changes.

Does Medicaid Cover Couples Therapy?

Unfortunately, Medicaid does not offer coverage for couples therapy. If you are seeking this form of therapy, you and your partner may find other ways to reduce the cost. For example, many couples’ therapists offer a sliding scale.

Am I Required to Visit my Primary Care Provider before Obtaining Coverage for Mental Health Services?

Depending on your state and plan, you may be required to get a referral from your primary care provider before receiving coverage for mental health services. Review your Summary and Benefits document or contact your plan representative prior to scheduling your appointment in order to determine whether you need to do this.

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