Does Medicaid Cover Therapy?
- Learn when Medicaid is likely to cover therapy. Get the facts about coverage for mental health services and addiction counseling under state Medicaid programs.
The Substance Abuse and Mental Health Service Administration estimates that 16.3 million people over the age of 50 suffer from some form of mental illness. In addition, 11 million adults over the age of 26 show symptoms of alcoholism, and 4.6 million have illicit drug use disorder. As mental health problems and addiction rates continue to rise, states are responding by making therapy and other services more readily available to Medicaid recipients. Find out if Medicaid is likely to cover therapy and what is and isn't included in coverage.
Does Medicaid Cover Therapy?
The federal government establishes overarching regulations for Medicaid but allows states to determine the details of their programs. As a result, whether Medicaid covers therapy varies throughout the country.
The Mental Health Parity and Addiction Equity Act (MHPAEA) requires that Medicaid recipients in Managed Care Organizations and state alternative benefit plans receive parity for mental health services. Parity means that Medicaid plans can't place stricter restrictions on mental health services than the ones used to determine medical and surgical benefits. Under the law, affected plans cannot:
- Charge higher copays or coinsurance for mental health
- Have different maximum out-of-pocket expense caps for mental health
- Use stricter standards to limit the number of inpatient hospitalization or outpatient visits for mental health services
- Impose narrower eligibility requirements to determine when mental health services are medically necessary
Simply put, parity means that certain Medicaid plans can't make it harder or more expensive for you to receive mental health services than a surgical procedure or treatment in a doctor's office. Still, some states have strict rules in place for non-mental health services. These same standards can then apply to mental health services.
Your state's Medicaid website should provide specific details about coverage for therapy and other mental health services.
How Does Therapy Work?
Psychotherapy helps people work through mental health concerns by talking to a highly-trained professional. People may seek therapy for help with:
- Grief following the death of a loved one
- Major life changes like a serious illness or loss of a job
- Relationship problems
- Substance abuse
- Traumatic events
- Other mental illnesses
Most people go to therapy sessions once per week, with sessions lasting for 30 to 50 minutes. Some people only require a few sessions while others remain in therapy for months or years. You can receive therapy from:
- Licensed marriage and family therapists
- Licensed professional counselors
- Licensed social workers
- Licensed substance abuse counselors
- Psychiatric nurses
No matter what type of professional you choose, your therapist must keep the personal details that you share with them confidential unless they believe you may harm yourself or someone else.
Do Therapists Accept Medicaid?
Therapists are free to determine whether to accept Medicaid as payment. Some choose to, and others don't. Your state's Medicaid website can help you find therapists in your area who provide services for Medicaid recipients.
How Much Is Therapy With Medicaid?
The amount that you'll pay for therapy for Medicaid depends on which state you live in, what type of professional you receive therapy from and the reason for therapy. For example, the Kaiser Family Foundation reports that more than half of all states covered visits with psychologists as of 2018. In the remaining states, therapy with a psychologist is not a covered service.
When therapy is covered by Medicaid, any of the following may be true:
- You may have to pay a copay or coinsurance. In some states, everyone on Medicaid pays the same amount for copays. Others base copay and coinsurance rates on the cost of services or income.
- Certain types of therapy may not be covered.
- There may be caps on the number of sessions you can have per month or year or limits on how long sessions can be.
- You may need to receive authorization from your Medicaid plan before you receive services or after a certain number of therapy sessions.