Psychology and psychiatry have come a long way in recent decades to tackle the challenges posed by mental health concerns, and it’s been shown that therapy provides a number of benefits to those facing mental health problems. Unfortunately, many people are concerned about the stigma of mental health care and worry about the costs associated with receiving therapy. Some people with lower incomes do not feel they have access to mental health therapy services. The good news, however, is that individuals who qualify for Medicaid services may be able to receive therapy and other mental health care under the program’s benefits.
Does Medicaid Cover Therapy?
Because Medicaid is administered on a state-by-state basis, the amount of coverage for therapy may differ depending on where an individual lives. While there are federal guidelines that govern Medicaid, states do not have to include optional benefits. Additionally, defining what constitutes therapy and the need for therapy can also have an impact on whether a service is covered. Most Medicaid programs offer some form of mental and behavioral health services, but therapy for conditions like substance abuse disorder may be limited. It should be noted that children who are covered under the Children’s Health Insurance Program are eligible to receive therapy and other mental health services at full coverage. This information is current as of 2019, but initiatives are underway to expand coverage for adult mental health and substance abuse therapy.
The Expanding Landscape of Psychology and Therapy Services
Psychology as a scientific discipline has really only been a recognized field of study since the 1940s, but the roots of therapy are intertwined with growth and changes in civilization throughout history. Things like cognitive-behavioral therapy may seem like they are new inventions, but the mechanisms behind these types of therapy are founded in traditional attempts to become a more self-aware, contributing member of society. It may seem difficult to pin down exactly what Medicaid covers in terms of therapy because therapy can be recognized in many different forms. The program offers mental health support services for some individuals, but a medical necessity needs to exist. Virtually everyone can benefit from some type of therapy, but only those with a verified medical need, such as a psychological condition like post-traumatic stress disorder, will be considered for coverage. Eligibility is determined on a case-by-case and state-by-state basis.
Look for Sliding-Scale Providers
As an alternative to Medicaid coverage for therapy, people who are facing limited income challenges may still be able to find affordable psychological care through sliding-scale providers. These providers have a fee schedule that changes with the income level of each patient. People who earn less will pay less under such a schedule. You may also be able to find providers who can offer services via virtual visits completed online or over the phone. These services may be less expensive because they do not require the time and overhead costs of a traditional office visit. Finally, you may also discuss your specific needs with your therapist to create a therapy session schedule that meets your individual needs while keeping your budget in mind.
Some individuals may also be considered dual-eligibles. These are people who qualify for both Medicare and Medicaid services, allowing them to potentially split the costs associated with therapy between the two programs. There are a number of income limitations required for dual-eligibles, so speak with your Medicare and Medicaid representatives for more information.
If you have any questions, it would be best to direct them toward your physician and you Medicare and Medicaid office. Your physician can help determine whether the therapy services you seek are covered, and may be able to refer you to local professionals in your area who will provide services in conjunction with Medicaid services. Keep in mind that not all therapy providers will be covered or accept Medicaid or Medicare, so do your research prior to making your first appointment to avoid surprise charges later.
Medicare.org Frequently Asked Questions (FAQ)