Does Medicaid Cover Behavioral Health Therapy?

Medicaid plays a crucial role in providing mental health services to millions of low-income people and families across the U.S. As a joint federal and state program, it offers essential healthcare services, including access to therapy, for those who may not be able to afford it otherwise. Medicaid is particularly important because therapy and other mental health treatments are often cost-prohibitive in private healthcare systems. 

However, Medicaid’s structure allows each state to set its own guidelines, leading to differences in coverage from one state to another. Also, not all therapy providers or programs accept Medicaid, in part because Medicaid’s reimbursement rates are often lower than private health insurance. This means that while Medicaid may cover mental health services in theory, finding a therapist or program that accepts the health plan can sometimes be challenging, depending on location and provider availability. Below, we delve into common Medicaid benefits for mental health services and explain how to find accessible treatment options.

What therapy services are covered by Medicaid?

Medicaid covers a range of therapy services to address mental health and behavioral health needs. The specific services covered can vary by state, but generally, the following therapy services are included in Medicaid benefits:

• Outpatient mental health services like individual and group therapy sessions for mental health conditions like anxiety, depression, PTSD, and more
• Intensive services like partial hospitalization programs and inpatient treatment 
• Evaluations and assessments by psychiatrists, medication management (including prescription drugs), and ongoing psychiatric care 
• Counseling and therapy for substance use disorder
• Family therapy sessions
• Behavioral health services that focus on improving behavior and coping skills
• Immediate support and intervention services for people experiencing a mental health crisis

Types of treatments not covered by Medicaid

The therapy options covered by Medicaid differ from state to state due to variations in state budgets and program guidelines. Some states may offer more extensive Medicaid services, such as teletherapy, while others may have more limited options. Additionally, alternative or specialized therapies, such as hypnotherapy or certain experimental treatments, are often excluded from Medicaid coverage. 

There are also some restrictions to keep in mind. Session limits may be imposed, meaning a cap on the number of therapy sessions you can attend within a specific period. Provider restrictions may also apply, as Medicaid typically covers licensed or in-network therapists. It’s important to review your state’s Medicaid guidelines or consult with a provider to understand what a covered service is and any limitations you may face. 

Does Medicaid therapy coverage include telehealth?

If you live in a rural area or have limited transportation options, teletherapy (virtual therapy via phone or video) is an increasingly available option. Many Medicaid programs have expanded their coverage of telehealth services, particularly during the COVID-19 pandemic, making it easier to access therapy remotely. This coverage typically includes virtual sessions with licensed therapists for individual therapy, group therapy, family therapy, and substance abuse treatment. 

However, because Medicaid is administered at the state level, coverage for online therapy services can vary depending on where a person lives. Some states offer full teletherapy benefits, while others may have more limited options or restrictions on the types of services that can be delivered remotely. Check with your state’s Medicaid program to confirm that teletherapy is a covered service and to find therapists who offer virtual sessions.

How to find therapy services that accept Medicaid

As mentioned, Medicaid coverage for therapy is comprehensive, but navigating the system can sometimes feel overwhelming. To make the process smoother, here are some steps you can take to find and access therapy services covered by Medicaid:

1. Check provider lists

The first step is to find a provider who accepts Medicaid. Each state’s Medicaid program offers a provider directory that lists licensed therapists, counselors, and mental health clinics enrolled in Medicaid. These directories can be accessed through the state’s Medicaid website, where users can search by location, provider type, or specialty. Additionally, Medicaid customer service representatives can assist patients in identifying nearby therapy providers who accept Medicaid. It’s important to ensure the provider is still accepting Medicaid at the time of scheduling, as participation can change. 

However, if a Medicaid customer service representative is hard to get in touch with, there are also online resources. For example, Psychology Today has a feature where you can filter providers in your area by insurance type (including Medicaid) and reach out to all of them directly through the website. 

2. See if you need a referral or prior authorization 

In some states, patients may need a referral from a primary care provider (PCP) to see a therapist. This requirement is especially common if the therapy is part of a larger treatment plan involving multiple healthcare providers. You may need to schedule an initial consultation with your PCP, who can then provide a referral to a Medicaid-approved therapist. 

Also, some states may require prior authorization before therapy services are covered. Prior authorization involves the therapist submitting a request to Medicaid to confirm that the services are medically necessary. This process can take a few days or weeks, so patients should plan ahead and be proactive in understanding the requirements of their state. You can ask your provider about the prior authorization process and any paperwork needed during your first appointment. This helps avoid delays in starting treatment.

3. Look into state-specific programs and resources

Each state runs its own Medicaid program, so coverage and access to therapy services can vary significantly. In some states, there are special programs for populations with specific mental health needs, such as youth, veterans, or people with a substance use disorder. These programs may offer enhanced therapy services, specialized treatment centers, or additional mental health support for ongoing care.

You can also speak with a caseworker at a local Medicaid office to learn about additional mental health resources that may be available through Medicaid-funded programs. Caseworkers can help explain coverage, connect individuals with mental health providers, and assist with any necessary paperwork, including referrals or prior authorizations. This personal assistance can be valuable for those new to Medicaid or unfamiliar with navigating the healthcare system.

4. Find a Federally Qualified Health Center (FQHC)

Federally Qualified Health Centers (FQHCs) are community-based health care providers that receive federal funding to provide comprehensive healthcare services, including mental health services, to underserved populations, many of whom rely on Medicaid for coverage. FQHCs offer services on a sliding fee scale based on income, making them an accessible option for low-income individuals and families, including those enrolled in Medicaid. You can find FQHCs using the Health Resources and Services Administration (HRSA) locator, and contact them directly to inquire about their mental health offerings and appointment scheduling.

How Charlie Health can help 

If you or a loved one is struggling with a mental health condition but can’t find accessible mental health treatment, Charlie Health is here to help. Our virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for people dealing with serious mental health conditions. And, as an online therapy provider, our mental health treatment is accessible — you can take a therapy session wherever and whenever is best for you. Charlie Health is also in-network with
most major health insurance providers, including commercial plans and Medicaid. With this kind of mental health support, healing is possible. Fill out the form below or give us a call to start healing today.