Medicaid for Mental Health Coverage

Medicaid is a federal health insurance program that provides coverage to lower-income families and individuals through the Affordable Care Act and is the single largest payer for client mental health services in the country. While it is a federal program, each state runs its own Medicaid health insurance plans through managed care organizations. All states offer behavioral health, mental illness and substance use disorder services, nursing facility services, and therapy coverage. Recent laws enacted to improve Medicaid expansion coverage across the nation include the Mental Health Parity and Addiction Equity Act (MHPAEA) to support substance use disorder services to people with Medicaid; as well as the Children’s Health Insurance Program (CHIP), which helps to increase behavioral health benefits for children and youths. Read on to learn more about how to use Medicaid to pay for therapy.

Does Medicaid cover therapy?

Yes, Medicaid health insurance plans cover behavioral health services and mental health treatment for therapy and other mental health services. However, how much Medicaid coverage offers its members depends on the exact plan, location, and behavioral health providers.

While Medicaid is available directly through the client’s state, many individuals sign up for their Medicaid coverage 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 plan covers behavioral health services and mental health, 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 figure out the scope of your health coverage plan — and how much you might have to pay out-of-pocket.

If you can’t find this information using your Summary and Benefits document, find 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 coverage plan and share information about your mental health benefits with you.

How much does therapy cost with the Medicaid plan?

With many health care 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 and serious mental illness, as well as substance use disorders. To reimburse therapists or clients, Medicaid requires that the client receive a diagnosis from their therapist. This diagnosis guides mental health treatment and insurance coverage.

Examples of eligible mental health conditions include:

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:

What types of therapy does Medicaid NOT cover?

Medicaid does not cover certain behavioral health services like 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 mental health care 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 through in-person clinic services — that is, the cost of behavioral health benefits stays the same despite location.

It is likely that Medicaid will revisit its online mental health and behavioral health care policies in the coming years, as they changed this policy due to the pandemic. If you’re considering online mental health care, 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 receive help 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 a 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. While your primary doctor or GP can diagnose mental illness, treatment with a licensed, clinical professional is key to improving your mental health and finding proper strategies to support positive behavioral health.