Key Takeaways
- Medicaid covers both in-person and online individual and group therapy if you have a diagnosis and prescription.
- Medicaid is the largest payer for mental health services in the U.S., and therapy is now included as a benefit.
- Medicaid includes mental health support services like psychological testing, medication management, and crisis services.
Medicaid covers mental health, behavioral health, and substance use disorder services, including therapy, so if you’re a Medicaid beneficiary, take note of this benefit.
As of August 2024, 79.4 million Americans are enrolled in Medicaid or the Children’s Health Insurance Program (CHIP).
If you’re a new or returning Medicaid member, you’ll want to understand which mental health services are covered. We offer a breakdown below. Just know that health care coverage will vary state by state and plan by plan, so it’s important to check with your insurance provider before scheduling an appointment.
Therapy Is Covered By Medicaid
Over the years, the Affordable Care Act has adjusted the Medicaid requirements to ensure that Medicaid members have access to more comprehensive mental health care.
Thanks to these policy improvements and the enactment of the Mental Health Parity and Addiction Equity Act (MHPAEA)—which prevents limitations on mental health benefits for those enrolled in managed care organizations and state alternative benefit plans—Medicaid members now have access to a plethora of mental health services.
Medicaid also covers in-person and online individual and group therapy. Many providers offer family therapy, too. So long as you have a diagnosis and a medical prescription for a specific therapy, your health insurance provider should cover it. This means that health coverage also includes evidence-based therapies.
Some of these therapies include:
What’s not covered is couple’s therapy, career counseling or coaching, massage therapy, acupuncture, and other holistic treatments. Other types of therapy will depend on your plan. Transcranial magnetic stimulation (TMS), for instance, may or may not be covered. If you’re on Medicaid, you should ask to work with a care coordinator who can help you manage your care and treatment plans.
Verywell Mind’s Cost of Therapy Survey found that even with insurance, many Americans have struggled to find adequate care:
- 30% of Americans currently in therapy say they’ve encountered a lack of appointment availability or flexibility of the mental health professional
- 27% have had difficulty finding a mental health professional who is taking new patients
- 24% have had difficulty finding an in-network mental health professional
Medicaid Offers Additional Mental Health Support
Medicaid is the single largest payer for mental health services in the United States. While it didn’t always include therapy as a benefit and limitations do still exist, Medicaid now covers this and a myriad of other substance use, mental health, and behavioral health services.
If you’re enrolled in a Medicaid plan, some of your covered services may include:
- Psychological testing and evaluation
- Medication evaluation, prescription, and management
- Mental health clinic services
- Mental health rehabilitation
- Inpatient and outpatient treatment
- Residential rehabilitation
- Crisis services
- Inpatient psychiatric hospitalization
- Social work services
- Case management for chronic mental illness
Other services like tobacco use cessation, mental health skill-building, and peer support should also be covered. If you’re experiencing mental health concerns or battling a substance use disorder, it’s important to seek professional care and get the diagnosis and treatment you need.
Affording Out-of-Pocket Costs
Medicaid provides more mental and behavioral health coverage than Medicare. Both children and adults under Medicaid and CHIP have access to many different behavioral health services. But unfortunately, not every mental health service will be covered.
Here are some things to consider as you begin therapy or mental health treatment:
- Your plan may require a copay or coinsurance, which is the percentage or dollar amount you have to pay out of pocket.
- To get coverage, you need to choose a provider in your network.
- Your plan may set limits on the number of therapy sessions covered.
- You may need to get a referral from your primary care physician (PCP) before seeing a therapist.
- If the specific therapy isn’t covered, you will be expected to pay the full cost.
For patients with a severe mental health condition or illness, this can be problematic. Make sure you make the most of your plan before seeking alternative options. You may be surprised to find out just how much coverage you have.
If your therapy session, service, or treatment isn’t covered by Medicaid, for whatever reason, then you can make an appeal to your provider. If they are unwilling to pay for the service, then you’ll have to consider alternatives.
Here’s what you can do:
- Ask your provider about sliding-scale payment options which are based on income
- Consider community health centers or free clinics in your area
- Check available community mental health service programs in your state
- Call the NAMI HelpLine at 800-950-NAMI (6264) or text NAMI to 741-741 to talk with a crisis counselor
If you’re enrolled in Medicaid, you may be eligible for federal- or state-run programs, as well as free or low-cost services. Check with your state’s Medicaid program to see what’s available to you. There are many pathways to treatment, so don’t suffer in silence.
If you’re suffering from anxiety or depression, grieving a loss, battling a substance use disorder, or undergoing a major life change, look for a therapist in your area. There are many cost-considerate providers willing to offer low-cost services to those in need.
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