Does Florida Medicaid cover therapy and mental health?

Florida Medicaid is a government program that provides free or low-cost health insurance for individuals, couples, families, and children. Over five million Floridians are eligible for Medicaid, highlighting the critical need for not just the general health services it provides, but also therapy, mental health counseling, substance use treatment, psychiatric care, behavioral health services, and medication management.

Follow along as we uncover how to navigate Florida Medicaid with ease, ensuring you or your loved ones can receive the mental health support they deserve. From eligibility to finding a Medicaid-approved provider, we break down every step to help take the stress out of the process.

Overview of Florida Medicaid

Medicaid is a popular medical assistance program in the United States that provides low-income individuals and families with greater access to healthcare. Each state runs its own Medicaid program, and in Florida, Medicaid covers many services.

There is often confusion about the difference between Medicaid and Medicare. While both are government programs, Medicaid is designed to assist low-income individuals and families based on financial need. In contrast, Medicare primarily provides health services to individuals over 65 and to those with disabilities, making healthcare more accessible for these populations regardless of income. Medicaid is run by the states, meaning Mediciad plans can vary greatly in terms of eligibility and coverage. Medicare is federally run, so the requirements are the same regardless of which state you live in.

Eligibility for mental health services through Medicaid

Having financial support to cover mental health services can make a significant difference in not only accessing therapy, but also in receiving essential medications, attending support groups, and participating in community programs that foster healing, personal growth, and the development of coping skills for managing life’s challenges.

Qualifying for mental health services through Florida Medicaid involves several basic eligibility requirements:

1. You must be a resident of the state of Florida
2. You must be a U.S. citizen or qualified non-citizen (i.e. lawful permanent resident)
3. You must be qualified as “low income” based on your household size and Medicaid category

According to a 2023 coverage update, the annual income limits (before taxes) are as follows, based on the Federal Poverty Level (FPL):

Mental health services are considered essential benefits within Florida Medicaid and fall under the Behavioral Health Therapy Services Coverage. According to the guidelines, eligibility is extended to “Florida Medicaid recipients who require medically necessary community behavioral health services.”

This ensures that individuals who need mental health support can access the necessary care as part of their Medicaid benefits.

Eligibility for specific populations

Recognizing that every individual has unique needs and coverage requirements, Florida Medicaid provides tailored mental health services and support to various populations.

Based on the Medicaid category you fall under, there are additional eligibility requirements to qualify for Florida Medicaid.

Medicaid categories include:

• Children: Individuals under 21 are eligible for Medicaid if they meet the income requirements. They can receive a range of mental health services, including therapy and behavioral interventions
• Adults: Low-income individuals between the ages 19 and 64 can qualify for Florida Medicaid services that cover both physical and mental health needs
• Elderly and disabled: Individuals aged 65+ or those with disabilities have specific Medicaid categories including:
  • Supplemental Security Income (SSI): Available for those who qualify to receive access to mental health services as part of their overall Medicaid benefits
  • Institutional Care Program (ICP): For those requiring nursing facility care
  • Medicaid Waiver Programs: For home and community-based services, particularly beneficial for those with disabilities or immediate mental health needs
• Non-elderly and disabled: Individuals under the age of 65 with documentation of a qualifying disability (i.e. physical, mental, or developmental that impedes the ability to perform daily tasks) can qualify for Florida Medicaid
• Pregnant women: Expectant mothers have access to mental health services addressing both general mental health and prenatal care needs (for example, screenings, therapy, support groups, etc.)

Mental health services covered by Florida Medicaid

When it comes to accessing mental health, Florida Medicaid covers a wide range of services aimed to help individuals find the support they need for better emotional and psychological well-being.

Types of mental health care services provided under these benefits include: 

• Outpatient therapy: Individual, group, and family therapy sessions with providers such as licensed marriage and family therapists (LMFTs) and licensed clinical social workers (LCSWs)
• Inpatient mental health services: Hospital-based care for acute mental health crises
• Family therapy: Focusing on family dynamics to address mental health as an integral part of the treatment plan
• Group therapy: Providing education and guidance to assist specific mental health challenges
• Psychiatric evaluations and ongoing medication management
• Crisis interventions and mobile response services for immediate mental health support
• Behavioral health assessments (i.e. mental health screening tools, substance use assessments, etc.) to evaluate mental illness
• Substance use treatment services: Both inpatient and outpatient programs are available

Within Florida Medicaid benefits, there are also several therapeutic approaches available to address a number of mental health needs of individuals and families.

Common types of therapies under Medicaid include: 

• Cognitive behavioral therapy (CBT): Focusing on changing negative or unhealthy thought patterns
• Dialectical behavior therapy (DBT): Improving mood regulation and coping skills
• Trauma-informed therapy: Effective for addressing various forms of trauma, which can result in feeling on edge, easily startled, or having difficulty trusting others.
• Family and couples therapy: Support for relationship dynamics to improve emotional health
• Play therapy: Child-specific form of therapy to improve communication and promote healing
• Online therapy: Also referred to as teletherapy, telehealth, or online therapy, this is remote therapy meant to improve accessibility of mental health support

Many of these therapies are used to treat common mental health conditions, including depression, anxiety, attention deficit hyperactivity disorder (ADHD), low self-esteem, post-traumatic stress disorder (PTSD), substance abuse and addiction, personality disorders, and so many others.

Cost expectations

When using Florida Medicaid for mental health services, knowing what costs might look like is important.

Here is what to expect:

• Copayments: You may need to pay a small fee, or copayments, which range in value (i.e. copayment for outpatient therapy may be between $1-$3 while inpatient may not require a fee).
• Deductibles and Coinsurance: Most Medicaid recipients do not need to worry about this, however, consider your plan to know what you may owe for specific services.
• Sliding Scale Fees: Some mental health providers charge based on income – those who earn more might pay more, but those who have lower incomes might pay less.
• Additional Costs: While many services are covered within a plan, specific treatments or assessments may come with a fee.

For the most accurate information, always check with your Medicaid provider.

Accessing therapy and mental health care through Florida Medicaid: a step-by-step guide

Navigating Medicaid can feel daunting. We want to simplify the process of getting mental health support. Follow along as we provide five steps to accessing therapy and mental health care with Florida Medicaid.

Step 1: Determine your eligibility

First and foremost, access requires eligibility. An eligible recipient of mental health services must be enrolled in the Florida Medicaid program on the date of service and meet the criteria provided in this policy.

It’s important to note that mental health care providers must verify an individual’s eligibility each time a service is provided to ensure all eligible Florida Medicaid recipients receive the appropriate care without any issues or interruptions in treatment.

Step 2: Find a Medicaid-approved provider

Once your eligibility is confirmed, the next step is to find a Medicaid-approved provider. This is a mental health care professional who is in your area or offering telehealth services that accept Medicaid.

Here are some helpful strategies to locate a Medicaid-approved provider:

• Use Medicaid’s online provider search tool on the Florida Medicaid website, or call 877-711-3662.
• Consider platforms like Grow Therapy, where you can search for Florida therapists who accept certain Medicaid plans. At this time, Grow Therapy clinicians in Florida accept Humana Dual Medicaid and UnitedHealthcare/Optum Medicaid.
• Work with your primary care provider for recommendations or referrals to a professional

Taking time and performing an in-depth search for your provider can help ensure you receive the best care that meets your individual goals and mental health needs.

Step 3: Get a referral (if applicable)

If your Florida Medicaid plan requires a referral to visit a mental health specialist, having the following steps in order can help ease the process:

• Consult with your primary care physical or other healthcare provider
• Document your mental health concerns clearly to simplify the referral process
• Ask your provider about any forms or authorization required for referral (i.e. specific treatments like CBT or medication management)

From here, your provider will submit the referral and once approved, you can proceed with the final step to accessing mental health support.

Step 4: Schedule an appointment

Now that you’ve identified a Medicaid-approved provider that specializes in your mental health concerns, it is time to set up your appointment for an initial evaluation or consultation.

Some questions to consider asking your provider at this phase of the process include:

• What is your experience with treating my specific mental health concern?
• What is your therapeutic approach, and how might it help me?
• How do you measure progress in therapy?
• What are the fees associated with your services?
• What should I expect during the first appointment?
• How do you handle confidentiality and privacy in our sessions?
• What is your availability and how flexible are your scheduling options?
• Are telehealth services available?

As you prepare for therapy and begin your sessions, it’s essential to maintain open communication with your provider and advocate for the care and support you need throughout the process.

Mental health care for children through Florida Medicaid

Florida Medicaid provides behavioral health services for children through the Children’s Medical Services (CMS) Health Plan. This plan offers children with a range of conditions and needs, including autism spectrum disorders, family-centered support, therapy services, and community-based programs.

Children under the age of 21 are also able to receive school-based services, such as group services and individual services.

Early intervention and support for at-risk youth

Medicaid also offers early intervention for children under the age of three. This includes any child who may be experiencing delays in cognition, physical, motor and sensory, communication, social and emotional developmental skills, and more.

In addition, Medicaid provides support for youth who may be at risk. Special programs are designed to target youth with serious emotional disturbances, providing them with necessary resources and support. For minors needing more intensive care, Medicaid covers therapeutic group homes, psychiatric residential treatment facilities (PRTFs), and intensive outpatient programs (IOPs).

Taking care of your mental health with Florida Medicaid

Florida Medicaid provides essential health coverage for millions of residents each month, offering a range of services beyond general healthcare, including mental health counseling, substance use treatment, and psychiatric care.

A range of plans are available within Florida Medicaid to support low-income individuals, families, and children, and help more people access affordable mental health services.

To take the next step toward better mental health, reach out for support today. Find a Medicaid-approved therapist with Grow Therapy and start your journey to improved wellness and well-being.