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Does Medicaid Cover Behavioral Therapy?

insurance, Medicaid, health insurance

With nearly one in five Americans suffering from mental illness today, it is no longer unusual or taboo to consider seeking mental health treatment options. In 2020 alone, 2,540.4 per 100,000 visits to US hospital emergency departments involved individuals with a mental disorder, substance abuse problem, or both. It is a good thing, then, that Medicaid is available to cover behavioral therapies that address mental health needs for uninsured people or whose insurance has significant limitations in coverage.

What Is Medicaid?

Medicaid is a government-assistance program that provides free or low-cost health insurance to low-income individuals. It was first introduced in 1965 when President Lyndon B. Johnson signed it into law. At that time, it was designed to provide medical insurance to Americans who were also receiving cash assistance. Medicaid has significantly expanded since this first iteration. It now covers not just low-income individuals but also pregnant women, people with disabilities, and others who require long-term care.

While the federal government sets Medicaid guidelines, it is up to each state to run its own Medicaid program, drawing from funds pooled together by both the federal and state governments. Because of this joint responsibility, each state may have its own rules that differ from other states in the country. It also means that eligibility and services will vary from state to state.

With the emergence of the pandemic came a surge in Medicaid enrollments, welcoming 82.8 million Americans under its coverage, including those under the Children’s Health Insurance Program (CHIP). It has also become the single largest payer of mental health services in the country, assisting over 79.9 million Americans as of January 2022.

Does Medicaid Cover Mental Health Services?

While not all health insurance plans have coverage for mental health, the Affordable Care Act (ACA) requires all marketplace insurance plans to cover mental health services, including behavioral therapy. Medicaid does as well. 

As of now, all Medicaid programs cover some mental health and substance use disorder programs, with variations on covered services depending on your state of residence. Not only that, but the Mental Health Parity and Addiction Equity Act of 2008 requires healthcare insurance plans to provide equal coverage for mental and physical health. The copay or deductible for a mental health service cannot be higher than that of a physical service.

What Is Behavioral Therapy?

Behavioral therapy is the general term used to talk about all the different types of therapy meant to treat mental health disorders. With the underlying notion that all behaviors are learned and can be changed, this therapy will identify and subsequently modify what could be considered self-destructive or unhealthy behaviors.

People with the following conditions or disorders can benefit from behavioral therapy:

  • Depression
  • Anxiety
  • Panic disorders
  • Excessive anger
  • Eating disorders
  • Post-traumatic stress syndrome 
  • Bipolar disorder
  • Attention deficit hyperactivity disorder
  • Phobias
  • Obsessive-compulsive disorder
  • Self-harming behavior

While this is not a complete list of mental health issues that warrant treatment, they are some of the most common problems which people seek treatment for. Most behavioral therapies for these illnesses are in the form of counseling and psychotherapy. However, other evidence-based therapies are options for treatment. These include mindfulness-based cognitive therapy (MBCT), cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and acceptance and commitment therapy (ACT).

What Services Does Medicaid Cover?

The good news is that Medicaid covers all of these therapies, as well as some other services that may include the following:

  • Psychological testing and evaluation
  • Medication evaluation, prescription, and management
  • Mental health clinic services
  • Mental health rehabilitation
  • Tobacco use cessation
  • Crisis services
  • Inpatient psychiatric hospitalization
  • Social work services
  • Case management for chronic mental illness
  • Mental health skill-building
  • Peer support

Additionally, Medicaid considers substance use disorder as a mental health disorder and provides coverage for its treatment. Commonly known as drug rehabilitation, treatment for substance use disorder starts with detoxification, wherein the patient receives 24/7 supervision during withdrawal from substance use. Considered the first step to rehab, Medicaid covers detoxification to a certain extent. People can get this treatment through inpatient and residential care or an outpatient program. 

Medicaid also covers any medication-assisted treatment (MAT) needed for the subsequent recovery process. This involves using three FDA-approved drugs: methadone, buprenorphine, and naltrexone, taken together with counseling and behavioral therapies. 

Are There Mental Health Services that Medicaid Does Not Cover?

It depends on where you live. Different states will have various mental health benefits. For example, states like Maryland and Virginia do not have Medicaid coverage for family and marriage counseling, even though individual counseling services are covered.

Most states, though, typically will not cover couples therapy, career counseling, coaching, acupuncture, massage therapy, and other holistic treatments.

Who Qualifies for Medicaid?

Eligibility depends on your state of residence but is usually determined by the following factors:

  • Income – how much is your modified adjusted gross income?
  • Household size – how many people occupy the household?
  • Family size – how many people in the housing unit are related by birth, adoption, and marriage?
  • Disability – do you have a physical or mental condition that limits movements, senses, and activities?

Income is usually the most significant factor in determining eligibility, but there can be other barriers to receiving mental health care. Some mental health providers, for example, may not accept Medicaid. In these instances, it may be good to look for available community resources to help you get the treatment you need. Inquire about community health and mental health clinics or medical schools with programs for reduced-rate psychotherapy with doctors in training. 

The mental health support provided by Medicaid exists, but it is far from perfect. While there may be holes in the system that may take time to fix, we can still do many things to put ourselves in the best possible position to receive the treatment we need and deserve.

We Are Ready to Help 

Our experienced team is ready to listen to your needs, answer your questions, verify your insurance, and create an individualized treatment plan. Whether you are struggling with mental illness issues or substance use disorders, a trained medical staff is ready to help you live a happier and healthier life. Contact us today to learn more about our intensive therapy programs. 

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