Does Medicaid Cover Therapy? Tips to Find a Covered Provider

Medicaid is a public insurance plan that was created in 1965. Its original purpose was to expand access to healthcare for people who were receiving public financial assistance.

Before Medicaid, if you couldn’t otherwise afford to go to the doctor, you could usually only receive medical and mental health care at charitable organizations or state facilities.

Medicaid has expanded and contracted in different ways over time, but it has ultimately grown. It now covers more people than ever before, including people with disabilities, pregnant women, and people who qualify based on their income level. This includes people who have low-wage jobs but who don’t have access to healthcare through their employers.

Medicaid offers great benefits, but it can be hard to orient yourself to what they are and how to use them when you first qualify for it. If you have Medicaid, but you’re not sure what it covers or where to find therapists and other providers who accept it, read on to learn how to get the most out of your plan.

Yes, Medicaid covers therapy. What kind, how much, and where you can get it depends on where you live.

The way Medicaid law is written means there’s a lot of variation from state to state in which mental health services it covers.

According to the Medicaid and CHIP Payment and Access Commission (MACPAC), every state’s Medicaid plan covers “some form of outpatient mental health services.” This usually includes group and individual counseling. Many states’ plans also cover family counseling.

In every state, the public mental health system, which usually—but not always—provides therapy and other outpatient mental health services, accepts Medicaid. In fact, if you have Medicaid and are looking for therapy, it’s probably one of the first places you should look. Read the tips box below to learn more.

Another place to look for outpatient mental health care if you have Medicaid is a Federally Qualified Health Center (FQHC). Any outpatient clinic that qualifies as an FQHC accepts Medicaid (and also offers sliding-scale fees to people without insurance).

Many FQHCs offer both outpatient medical and mental health services, and many offer cutting-edge integrated care. You can search for FQHCs using the U.S. Department of Health and Human Services’ online search tool.

Medicaid covers online therapy, but what kind of online therapy you can get with Medicaid, and whether you can get it in your home, will depend on which state you live in.

According to the Kaiser Family Foundation (KFF) and the Center for Connected Health Policy (CCHP), all 50 states and the District of Columbia cover online mental health services including therapy.

Specifically, all state Medicaid programs cover online mental health services provided by live video, and 44 states and the District of Columbia cover audio-only mental telehealth services as well.

The tricky part is that not all states’ Medicaid plans cover in-home telehealth services. According to CCHP, 37 states’ Medicaid programs currently cover telehealth services delivered in a person’s home.

You can explore your state’s policies on CCHP’s live video telehealth policy page. You can also contact your state’s Medicaid program to ask if you can get online therapy at home using Medicaid.

You can find information for how to contact your state’s Medicaid program and how to search for providers who accept Medicaid in the next section of this article.

There are a few different ways to find mental health providers who accept Medicaid.

You can contact a provider directly to ask if they accept Medicaid or you can ask a representative at your local Medicaid office for a list of covered providers.

You can also search online. You can look for a therapist who accepts Medicaid on Psychology Today, but the best way to do it is probably to use your state’s Medicaid page.

Many states now administer Medicaid through a managed care system. This means there may be different Medicaid plans in your state, so not all providers who say they accept Medicaid may actually accept your specific Medicaid plan.

The best way to avoid confusion is to go to your plan’s page and use their provider search to look for providers who accept your plan. If you’re not sure how to find it, we’re here to help. The tips box below lists Medicaid provider search pages for every state.

Another way to use your Medicaid coverage to get therapy or other mental health services is to go to a provider that’s specifically set up to accept Medicaid.

Each state has publicly-funded outpatient mental health providers, typically called community mental health centers, that accept Medicaid. Which specific mental health services they provide depends not only on which state you live in, but also on which city or county. You can learn more about your local options for state-sponsored care by going to this page and clicking on your state.

Another great place to go if you have Medicaid is a Federally Qualified Health Center (FQHC). All FQHCs are required to accept Medicaid, and many offer outpatient mental health as well as outpatient medical services. You can find your nearest FQHC by using this online search tool.

Medicaid covers inpatient mental health care, but there are limits to the types of inpatient care it covers.

In general, Medicaid covers inpatient mental health treatment in the psychiatric unit of a general hospital. It does not cover long-term inpatient care in psychiatric hospitals.

In other words, you’re typically covered if you get the mental health care you need at a local general hospital, but not if you get it in a specialty psychiatric facility.

This policy comes from Medicaid’s historic role in supporting community mental health by giving more money to states that offer accessible community mental health care outside of psychiatric institutions.

However, while the original policy was well-meaning, it’s created many problems for people trying to get the right level of mental health care in their community using Medicaid.

Advocacy groups like the National Alliance on Mental Illness (NAMI) are advocating to change this outdated policy. Many states have already changed their policies so that Medicaid covers short-term inpatient stays in psychiatric facilities.

However, while there may be tricky restrictions on where you can get inpatient mental health care with Medicaid, it makes it easier to get other kinds of intermediate, long-term, residential, and specialty care than it would be with without it.

In addition to most basic mental health services, Medicaid covers many services private insurance often doesn’t, including nursing home care, other long-term services, round-the-clock services, case management, psychosocial rehabilitation, supported employment, and in-home mental health care.

In fact, many people “spend down” their income and assets to qualify for Medicaid so they can access care they couldn’t get without it.

One of the biggest differences between Medicare and Medicaid is that Medicare is a purely federal program, while Medicaid is a joint state and federal program.

While federal policy requires Medicaid programs to cover certain types of care, each state interprets and applies these requirements differently.

What this means for you is that whether you qualify for Medicaid and what your Medicaid plan covers depends on the state you live in.

Some states have higher income requirements than others. Some cover special programs that are relevant to their population that aren’t covered in other states. Some states use waiver programs to cover additional groups or services, while others use waivers to restrict services.

Another key difference is that some states have expanded Medicaid while others have not. Medicaid expansion extends Medicaid coverage to more people by allowing people to qualify based on income alone. Traditionally, you could only qualify for Medicaid by belonging to one of the categories of people that Medicaid covers.

As a result of many states choosing not to expand Medicaid, many Americans who are younger than 65, who do not have children, and who are not legally disabled continue to be ineligible for Medicaid even when their income is 138% of the Federal Poverty Level or less.

Until recently, you were only eligible for Medicaid when you had income below a certain level and were also a member of one or more of the following vulnerable groups:

• Pregnant women
• Low-income children
• Low-income adults aged 65 or older
• Low-income parents of Medicaid-eligible children
• Disabled adults receiving SSI or Social Security Disability

The 2010 Patient Protection and Affordable Care Act expanded Medicaid to anyone whose income was at or below 138% of the Federal Poverty Level regardless of their membership in any of these groups.

While the law originally made Medicaid expansion a requirement for all states, in 2012, the Supreme Court ruled that states could elect whether to expand Medicaid. This means some states retain categorical eligibility requirements for Medicaid while others do not.

Many people who are eligible for Medicaid don’t realize they are eligible, especially since expanded Medicaid became available under the Affordable Care Act. If you’re on a limited income, you should look into it—Medicaid will link you with an impressive range of medical and mental health services.