Therapy coverage with Medicaid
Dealing with mental health problems can be challenging enough on its own. Figuring out how to pay for treatment, and if you’re covered by health insurance, can add additional stress to the situation. For those covered by Medicaid, a joint federal and state program that provides health coverage for some citizens, mental health treatment can be accessible.
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 is 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 includes:
- 41% of all births
- Nearly half of children with special health care needs
- Five in eight nursing home residents
- 29% of non-elderly adults with any mental illness
- 40% of non-elderly adults with HIV
- Over 25% of adults with disabilities
Who is eligible for Medicaid?
Medicaid covers individuals and families with household incomes below a certain level, including children, parents, and pregnant people. Medicaid also covers elderly people with certain income levels, and people with disabilities.
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 services 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 138% of the federal poverty level (FPL), thanks to the Affordable Care Act (ACA). 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 payer of mental health services in the U.S. People on Medicaid can get many mental health and substance use disorder services, including inpatient and outpatient hospital support, rural health clinic services, and nursing facility services.
The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 has made it easier for millions of people on Medicaid to 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.
How much does therapy cost with Medicaid?
The cost of therapy with Medicaid depends on the state, the specific Medicaid plan, and the type of therapy needed. In most cases, Medicaid covers mental health, behavioral health, and substance use disorder services, including individual and group therapy. Many people receive these services at little to no cost. Some Medicaid plans may require a small copayment per session, usually ranging from $0 to $25, while others cover the full cost.
Certain services may require a diagnosis or a doctor’s referral to be covered. Medicaid reimbursement rates for therapy also vary by state and region. To find out exactly what therapy services Medicaid covers and any costs you may need to pay, check with your Medicaid plan provider or visit your state’s Medicaid website.
What types of therapy does Medicaid cover?
The types of psychotherapy and mental health services covered by Medicaid vary by state. Common types include:
- Cognitive behavioral therapy (CBT)
- Prescription drugs (all states offer this, but covered medicines may differ)
- Targeted case management
- Marriage and family therapy
- Rehabilitation services
- Occupational, physical, speech, or other therapies
- Medication management
- Clinic services
- Licensed clinical social work services
- Peer supports
- Short-term stays in inpatient psychiatric hospitals
- Long-term stays in mental health institutions for people 65 and over and children up to age 21
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. You may need a referral and prior approval for Medicaid to cover your therapy.
What does Medicaid not cover?
Holistic treatments and career counseling are two services that Medicaid might not cover. Visit Medicaid.gov to get the most up-to-date information. There, you can check services that are covered and learn about specific exclusions in your state.
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.
Does Medicaid cover group therapy?
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.
Does Medicaid cover couples therapy?
Couples therapy coverage under Medicaid varies by state. Some states may cover couples therapy if it is deemed medically necessary—such as when one partner has a diagnosed mental health condition and couples therapy is essential for treatment—or if 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 healthcare provider for a referral
- Check with local community health centers that accept Medicaid
Does Medicaid cover online therapy?
In addition to in-person therapy, 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, and reduced transportation barriers. To use online therapy services with Medicaid, check if your state Medicaid plan covers telehealth for mental health and find a Medicaid-approved online therapy provider.
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 Medicare and Medicaid benefits. This is called “dual eligibility.”
How do I find a therapist who accepts Medicaid?
Once you know your Medicaid coverage, finding a provider through Grow Therapy is easy. We have many qualified therapists who 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.
Whether you’re looking for individual therapy, couples counseling, or specialized mental health services, our platform simplifies the search process so you can focus on what truly matters—your well-being.