Dealing with mental health issues can be stressful enough on its own; but when the question of how to pay for this much-needed care comes in, the financial burden can often be too much to bear.
That’s where Medicaid comes in: a joint federal and state program that helps people on low incomes gain access to medical and mental health care.
Keep reading to find out what aspects of mental health treatment Medicaid covers, and how to find a therapist who accepts it.
Key takeaways:
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Medicaid covers mental health services for low-income people, making therapy easier to get.
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Medicaid is the biggest payor of mental health services in the US.
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Medicaid covers many mental health and substance use disorder services.
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Medicaid covers therapy types like psychotherapy, CBT, marriage and family therapy.
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Grow Therapy helps people find Medicaid-covered therapists quickly and easily.
What is Medicaid?
Medicaid is America’s public health insurance program for people with low incomes. It covers more than one in five Americans, including many who need complex and expensive care. Medicaid the main source of long-term care coverage in the United States.
Medicaid is what’s known as an “entitlement.” This means people need to meet certain rules to get coverage. Medicaid eligibility depends on each person’s situation and where they live.
According to the Kaiser Family Foundation, Medicaid coverage is vast in the US, and includes:
- 41% of all births
- Nearly half of children with special health care needs
- Five in eight nursing home residents
- 23% of non-elderly adults with any mental illness
- 40% of non-elderly adults with HIV
- Over 25% of adults with serious mental illness
A 2023 poll by the Kaiser Family Foundation found that 75% of Americans have a favorable view of Medicaid. More than two-thirds think it works well for people with low incomes.
Does everyone in the US get Medicaid?
Some states have expanded their Medicaid programs to cover all people with household incomes below a certain level. However, according to HealthCare.Gov, “In all states, you can qualify for Medicaid based on income, household size, disability, family status, and other factors. Eligibility rules differ between states.”
In states with expanded Medicaid coverage, you can qualify based on income alone. If your household income is below 133% of the federal poverty level (FPL), you qualify. Due to how this is calculated, it’s actually 138% of the FPL. Some states use a different income limit. This was part of the Affordable Care Act (ACA), a 2010 law that made healthcare available to more people.
To see if you’re eligible for Medicaid based on your income, check here. There are also a few non-financial related criteria that need to be met for you to be covered by Medicaid, such as being a resident of the state in which you’re receiving Medicaid and being a citizen of the United States or a lawful permanent resident.
Does Medicaid cover therapy?
Medicaid is the largest payor of mental health services in the US, and is gearing towards playing an even greater role in reimbursing services for substance use disorders.
People on Medicaid can get many mental health and substance use disorder services. These include:
- Inpatient hospital support when needed
- Outpatient hospital support
- Rural health clinic services
- Nursing facility services
- Home health services
- Doctor services
The Mental Health Parity and Addiction Equity Act (MHPAEA), a law passed in 2008, has made it easier for millions of people on Medicaid get care for mental health and substance use disorders. The law says that the coverage for these must be as good as that for medical services. This applies to copays, coinsurance, out-of-pocket limits, and other factors.
In 2019, children covered under the Children’s Health Insurance Program (CHIP) could get full coverage for therapy and other mental health services. There are plans to expand coverage for adult mental health and substance abuse therapy.
Types of therapy Medicaid covers
The types of therapy covered by Medicaid vary by state. Common types include psychotherapy and cognitive behavioral therapy (CBT). For example, New York’s Medicaid program covers behavioral health-related preventive services. These include alcohol misuse screening and counseling or depression screening.
Marriage and family therapy coverage also varies by state. Sometimes, it’s only covered if done in a clinic or other institutional setting. About 38 states now offer some payment or recognize licensed marriage and family therapists (LMFTs) in their Medicaid programs.
To see what kind of mental health services you’re eligible for, you’ll need to check your Medicaid managed care plan’s summary of benefits and coverage (SBC) or call your Medicaid program hotline. This will tell you what therapy you can get and how many sessions you need. You may need a referral and prior approval for Medicaid to cover your therapy.
You may need to pay a copay for each therapy session in some states. Check your Medicaid benefits for details on out-of-pocket costs.
Many other mental health and substance use disorder treatment services are optional in Medicaid. These may include:
- Prescription drugs (all states offer this, but covered medicines may differ)
- Targeted case management
- Rehabilitation services
- Occupational, physical, speech, or other therapies
- Medication management
- Clinic services
- Licensed clinical social work services
- Peer supports
- Stays in mental health institutions for people 65 and over and children up to age 21
The Medicaid and CHIP Payment and Access Commission (MACPAC) defines behavioral health disorders as those in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Examples include:
- ADHD
- autism spectrum disorder
- conduct disorder
- mood disorders
- personality disorders
- PTSD, schizophrenia
- social anxiety disorder
- substance use disorder
Types of therapy Medicaid doesn’t cover
Medicaid may not cover massage therapies. The government calls these Alternative and Complementary Medicine. The ACA doesn’t see them as essential benefits. So, it’s hard to claim massage therapy through Medicaid and insurance. You’ll likely need to pay the full cost.
Holistic treatments and career counseling are two other services that Medicaid might not cover. Check your covered services to be sure.
How many therapy sessions does Medicaid pay for?
The number of therapy sessions Medicaid covers varies by state and individual plan. Some states may offer unlimited sessions, while others may have limits. For example:
- Some states cover up to 30 sessions per year
- Others might cover 12-16 sessions before requiring a review
It’s important to check with your specific Medicaid plan or state Medicaid office for exact details. Your therapist can also help you understand your coverage and may be able to request additional sessions if medically necessary.
Group therapy and Medicaid
Medicaid often covers group therapy sessions. Group therapy can be an effective and cost-efficient treatment option for many mental health conditions. Benefits of group therapy include:
- Peer support and shared experiences
- Learning from others’ coping strategies
- More affordable than individual therapy
Check with your Medicaid plan to confirm coverage for group therapy sessions in your area.
Couples therapy and Medicaid coverage
Couples therapy coverage under Medicaid varies by state. Some states may cover couples therapy if:
- It’s deemed medically necessary
- One partner has a diagnosed mental health condition
- The therapy is part of a treatment plan for a covered condition
To find out if your Medicaid plan covers couples therapy:
- Contact your state Medicaid office
- Ask your primary care doctor for a referral
- Check with local community health centers that accept Medicaid
Online therapy services and Medicaid
Many Medicaid plans now cover online therapy, also known as telehealth or teletherapy. This trend increased during the COVID-19 pandemic and is a popular option.
Benefits of online therapy include:
- Increased accessibility, especially for rural areas
- Convenience and flexibility
- Reduced transportation barriers
To use online therapy services with Medicaid:
- Check if your state Medicaid plan covers telehealth for mental health
- Find a Medicaid-approved online therapy provider
- Ensure you have the necessary technology (smartphone, computer, internet connection)
How to find a therapist that accepts Medicaid
Each state’s Medicaid and CHIP programs have their own provider networks. Contact your state Medicaid agency for a list of providers and start your search for the right therapist.
You could also check your healthcare provider’s website or call local mental health centers to find providers who accept Medicaid.
Grow Therapy is a great way to find a qualified Medicaid-covered mental health provider near you. Use filters to browse providers who accept Medicaid and specialize in different types of therapy. You can also choose providers who offer in-person or online therapy sessions.
What’s the difference between Medicaid and Medicare?
Medicaid and Medicare are both government health insurance programs, but they serve different purposes:
What is Medicaid?
- Joint federal and state program
- Serves people with limited income and resources
- Eligibility based on income and other factors
- May cover a wider range of services, including long-term care
What is Medicare?
- Federal health insurance program
- Primarily for people 65 and older
- Also covers some younger people with specific disabilities
- Eligibility not based on income
- Focuses more on acute care and less on long-term care
Both programs can cover mental health services, including therapy. Some people may qualify for both Medicaid and Medicare. This is called “dual eligibility.”
The Medicaid application process
When applying for Medicaid, the process can take up to 45 days. The key is to submit all required documents on time. But, if your application requires a disability determination, it may take up to 90 days.
To apply, you’ll need to provide documentation that proves your eligibility. This includes both general information, such as proof of income, and financial documentation. If you own a home, you may be asked to submit documents like a current tax bill, a real estate appraisal, or copies of your mortgage.
If you’re already enrolled in Medicaid or CHIP, reporting any changes that could affect your eligibility is important. These include changes in income, address, living arrangements, family size, or disability status.
Finding a therapist through Grow Therapy
Once you know your Medicaid coverage, finding a provider through Grow Therapy is easy. We have many qualified therapists: They accept various insurances, including Medicaid. Simply use our provider directory and filter by your state. Then, select Medicaid or your insurance provider to see which therapists accept them.
We also accept several private health insurance plans from providers such as:
- Blue Cross Blue Shield
- Aetna, Cigna
- Kaiser,
- UnitedHealthcare
Grow Therapy can also help you find Medicaid-approved therapists who offer online sessions. This can make it easier to access care from anywhere.
