Medicaid for Therapy

Medicaid is a federal health insurance program that provides coverage to lower income families and individuals through the Affordable Care Act. Medicaid is the biggest payer for client mental health services in the country. While Medicaid is a federal program, each state runs its own Medicaid health insurance plans, and all states offer therapy coverage. Read on to learn more about how to use Medicaid to pay for therapy.

Does Medicaid cover therapy?

Yes, Medicaid health insurance plans provide coverage for therapy and mental health services. However, how much coverage Medicaid offers its members depends on the exact plan, location, and service provider.

While Medicaid is available directly through the client’s state, many individuals sign up for their Medicaid benefits through a third-party health insurance company. Either way, Medicaid provides coverage to help offset the cost of therapy for its members.

How do I check if my Medicaid plan covers therapy?

To check if your Medicaid plan covers therapy, find your Summary and Benefits document, which is usually mailed to you with your Medicaid card or is posted online. On this document, you’ll find your copayment or coinsurance rates per service type. Look for “outpatient mental health services” in the list to determine how much your plan covers — and how much you’ll have to pay out-of-pocket, if anything.

If you can’t find this information using your Summary and Benefits document, locate the customer service phone number on the back of your Medicaid card. The representatives on the hotline will be able to look up your health insurance plan and share with you information about your mental health benefits.

How much does therapy cost with the Medicaid plan?

With many Medicaid plans, expect to pay a copayment of $0-25 per therapy session with an in-network therapist. This means that every time you see your therapist, you are responsible for that amount.

Because each state offers their own version of Medicaid, the cost for therapy under Medicaid plans can vary. However, many Medicaid plans make seeing a therapist affordable because they value mental and behavioral health access.

It is important to note that in some states, Medicaid limits the number of covered therapy visits, often to 30 sessions per year. After a client has reached this number of visits, they may need to start paying the session fee in its entirety.

What types of mental health conditions does Medicaid cover?

Medicaid covers many mental health conditions. To reimburse therapists or clients, Medicaid requires that the client receive a diagnosis from their therapist. This diagnosis guides treatment and insurance coverage.

Examples of eligible mental health conditions include:

• Depression
• Anxiety and stress
• Alcohol abuse
• Infertility concerns
• Grief and loss
• Eating disorders
• Learning disabilities

There are many more diagnosable — and reimbursable — mental health conditions, all of which Medicaid covers.

What types of therapy does Medicaid cover?

Medicaid covers many different types of therapy. As long as the therapist provides an evidence-based, clinically rigorous therapy modality that is appropriate for the given diagnosis, Medicaid will provide coverage.

These evidence-based therapy modalities include:

• Cognitive Behavioral Therapy (CBT)
• Dialectical Behavioral Therapy (DBT)
• Eye Movement Desensitization and Reprocessing (EMDR)
• Mindfulness practices
• Child-parent psychotherapy
• Acceptance and Commitment Therapy (ACT)

What types of therapy does Medicaid NOT cover?

Medicaid does not cover life coaching, career counseling, or holistic treatment modalities like aromatherapy, massage therapy, or acupuncture. It also does not cover energy work such as reiki healing, or sessions with providers who are not professionally credentialed

Does Medicaid cover online therapy?

Yes, Medicaid covers online therapy. If you see your therapist online, you’ll still receive the same coverage as if you saw your therapist in-person — that is, the cost of therapy remains the same despite location.

It is likely that Medicaid will revisit their online therapy policy in the upcoming years, as they changed this policy due to the pandemic. If you’re considering online therapy, be sure to check with your Medicaid plan prior to your session to ensure that online therapy is still a covered option.

Does Medicaid cover couples therapy?

Medicaid does not cover couples therapy. However, many couples still benefit from seeing a therapist together. If you’re still interested in working with a couples therapist, there may be ways to decrease the cost, such as sliding scale.

Do I need to see my primary doctor before starting therapy?

Depending on your state’s Medicaid health insurance plan, you may need to see your primary care physician to get a referral for therapy services. However, this isn’t the case for all states, so determining the requirements for coverage for your plan specifically will potentially save you time — and you can begin your search for the right therapist as soon as you’re ready.