Dealing with mental health issues can be stressful enough on it’s 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.
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 require complex and expensive care needs, and is the main source of long-term care coverage for people in the United States.
Because Medicaid is an entitlement, individuals need to meet eligibility requirements to secure guaranteed coverage. Medicaid eligibility is determined on a case-by-case basis depending on individual circumstances and geographical state.
Here are some interesting statistics about the vastness of what Medicaid covers in the United States, courtesy of the Kaiser Family Foundation.
- 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 human immunodeficiency virus (HIV)
- Over 25% of adults with serious mental illness
Interestingly, in a 2023 tracking poll also held by the Kaiser Family Foundation, it was found that 75% of the American public possess favorable views of Medicaid, and more than two-thirds think it works well for people on low incomes.
Does Medicaid Cover Therapy?
Medicaid is the largest payer of mental health services in the United States and is gearing towards playing an even greater role in reimbursing services for substance use disorders.
People who receive Medicaid can access a range of mental health and substance use disorder services, including inpatient hospital support when medically necessary, outpatient hospital support, rural health clinic services, nursing facility services, home health services, and physician services.
In line with Medicaid making it easier for Americans to access behavioral health services, the Mental Health Parity and Addiction Equity Act (MHPAEA) is the most recent law (passed in 2008) that has a significant impact on millions of Medicaid beneficiaries.
The MHPAEA makes it easier for Americans with mental health and substance use disorders to get the care they need. The coverage for mental health and substance use disorders must be no less restrictive than that for medical services. This requirement applies to copays, coinsurance, out-of-pocket maximums, and other factors.
As reported in 2019, children covered under the Children’s Health Insurance Program (CHIP) were eligible to receive therapy and other mental health services at full coverage, and plans are in motion to expand coverage for adult mental health and substance abuse therapy.
Therapists who accept Medicaid
Types of Therapy Medicaid Covers
You’ll need to check the Summary of Benefits and Coverage (SBC) on your Medicaid managed care plan or contact your Medicaid program hotline to check what kinds of therapy you’re eligible for and how many sessions. You may need a referral and get prior authorization for your therapy to be covered by Medicaid.
Whether it’s psychotherapy, cognitive behavioral therapy (CBT), or another kind of therapeutic approach, the types of therapy covered by Medicaid vary by state. For example, New York’s Medicaid program covers behavioral health-related preventive services, such as alcohol misuse screening and counseling or depression screening, to help support health and wellbeing.
Marriage and family therapy is another example of Medicaid services that vary by state. It’s sometimes only covered if the services are performed in a clinic or other institutional setting.
However, after many years of pushing for change, around thirty-eight states now offer at least some reimbursement or recognize Licensed Marriage and Family Therapists in their Medicaid programs.
In some states, you may need to pay a copay for each therapy session. When you access the details of your Medicaid benefits, you can find out about your out-of-pocket costs as well.
Many other services used for the treatment of mental health and substance use disorders are optional services in the Medicaid program, such as:
- Prescription drugs (which all states currently offer, but specific medicines covered may differ)
- Targeted case management
- Rehabilitation services
- Rehabilitative therapies, such as occupational, physical, speech, or other therapies
- Medication management
- Clinic services
- Licensed clinical social work services
- Peer supports
- Stays in institutions for mental health conditions for individuals aged 65 and over and children up to age 21
According to the Medicaid and CHIP Payment and Access Commission (MACPAC), “Behavioral health disorders are defined as those that can be found in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Examples of behavioral health disorders include attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, conduct disorder, disruptive mood dysregulation disorder, intellectual disability, personality disorders, post-traumatic stress disorder, schizophrenia, social anxiety disorder, and substance use disorder.”
Types of Therapy Medicaid Doesn’t Cover
Massage therapies may not be covered by Medicaid because they’re categorized as Alternative and Complementary Medicine by the government, and not considered an essential benefit by the ACA. Therefore, it’s hard to claim massage therapy through Medicaid and insurance, so you’ll need to cover the entire cost.
Holistic treatments and career counseling are two other examples of services that might not be covered by Medicaid, but it’s best to find out for sure by checking your covered services.
Does Everyone in the U.S. Get Medicaid?
Some states have increased what their Medicaid programs offer to cover all people with household incomes below a certain threshold. Yet, 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 that have expanded Medicaid coverage: You can qualify based on your income alone. If your household income is below 133% of the federal poverty level (FPL), you qualify. Because of the way this is calculated, it turns out to be 138% of the federal poverty level. A few states use a different income limit. This was done as part of the Affordable Care Act (ACA), a law that was passed in 2010 to make 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.
What States Have Medicaid?
As of April 2023, 87,062,629 individuals were enrolled in Medicaid in 50 states and the District of Columbia, while 7,089,139 individuals were enrolled in Children’s Health Insurance Program, a program which provides health coverage to eligible children through both Medicaid and separate CHIP programs.
Since March 2023, 41 states, as well as Washington DC, have expanded their Medicaid offering to include coverage for adults without children.
To discover the key characteristics of Medicaid and CHIP in various states, you can use this state overview search function.
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 begin your search for the right therapist.
You could also try looking at your healthcare provider’s website or calling local mental health centers to find providers who accept Medicaid.
Grow Therapy is an excellent way of finding a qualified Medicaid-covered mental health provider near you. Use our filters to browse providers who accept Medicaid and specialize in different types of therapy. You can also choose providers who offer in-person or virtual sessions.
An Alternative to Medicaid
Should you not be eligible for Medicaid but still require low-cost therapy, there’s the option of looking for a sliding-scale provider. This is the term used to describe a discounted payment schedule agreed upon between a patient and therapist if the patient has a low income and can’t afford the costs of therapy sessions without insurance.
To find a therapist who accepts sliding-scale fees, use Grow Therapy. Providers often list on their profiles if they accept sliding-scale payments.
Finding a Therapist through Grow Therapy
If you’re seeing or experiencing signs that you might need to see a therapist, it’s understandable that money might be a barrier to entry. However, it’s important not to let the financial stress surrounding therapy costs and insurance worsen your mental health.
With a little research, you should be able to find out what mental health benefits you’re eligible for. If that sounds daunting, ask for the help of a family member.
Once you have an understanding of your Medicaid coverage, you can find a provider through Grow Therapy. We have many qualified therapists who accept various insurances — including Medicaid — who can get your mental health on track.
