In this guide, we answer the question, Does Medicaid cover therapy for depression?
Some people ask whether Medicaid provides depression therapy and wonder if mental health treatment services from Medicaid are just part of the provision of Medicare counseling services. For families and people, we know this is a significant concern.
Medicaid, while Medicaid is separate insurance from Medicare, is a public insurance scheme developed in 1965, at the same time as Medicare. Medicaid is funded by both the state and federal governments, which means Medicaid eligibility varies from state to state. For Medicare, a state provision would not exist since it is just a federal service.
What is Medicaid?
Medicaid is the United States’ single largest payer for mental health care and is gradually playing a greater part in the reimbursement of services for opioid use disorder. Significant health services are also used for persons with a behavioral health condition. In 2007, almost 12 million visits to U.S. hospital emergency departments included patients with a psychiatric disorder, drug addiction problem, or both. Congress passed numerous regulations to offer medical/surgical coverage to expand access to mental health and drug use dependency treatment under health insurance or benefit plans.
Does Medicaid cover therapy for depression?
Mental health services covered by Medicaid often include counseling, therapy, medication control, social work services, peer support, and drug use disorder treatment, according to MentalHealth.gov. Since depression is a problem with mental health, if you qualify, therapy will be covered.
Some mental health services are offered by all state Medicaid plans, while the Children’s Health Insurance Program (CHIP) mandates that Medicaid-enrolled children receive a wide variety of medically required services, including mental health services.
In addition, Medicaid has updated coverage to include short-term hospital stays and has recently begun to encourage states to qualify for exceptions to cover up to 30 days of hospital stays for the treatment of mental health and drug use disorders.
Coverage for the proposed extension of Medicaid for adults is expected to provide critical health benefits such as mental health services that meet parity criteria for mental health and opioid abuse under the Mental Health Parity and Addiction Equity Act (MHPAEA). Magellan, Optima Wellness, Medicaid, Anthem BC/BS, Wellpoint & its subsidiaries are credentialed to accept easy intervention insurance. Please visit Medicaid.gov if you need more explanation.
One of Medicaid’s surprising things is that it provides mental health benefits that are not provided by other private insurance plans, such as long-term care, round-the-clock services, subsidized employment, case management, and mental health care at home. Because most Medicaid benefits often provide basic mental health services such as counseling, visits to therapists, and comprehensive clinic treatment, many older adults who require these services prefer to liquidate their assets so that they can qualify for coverage from Medicaid.
How Medicaid helps individuals with depression?
Behavioral health disorders impact a large number of individuals in the U.S. and are particularly prevalent among low-income individuals. Mental ailments, such as anxiety disorders, severe depression, bipolar disorder, schizophrenia, and post-traumatic stress disorder, as well as drug use disorders (SUD), such as opioid addiction, are behavioral health conditions. Such situations vary in magnitude, with some being more debilitating than others. A variety of services, from outpatient therapy or prescription medications to inpatient care, can be needed by people with mental health needs.
Medicaid plays a vital role in covering and financing mental health care, as a significant source of insurance coverage for low-income Americans, and as the sole source of funding for certain advanced behavioral health services.
Eligibility criteria for Medicaid
Until recently, if their income was below a certain threshold, individuals were only eligible for Medicaid and were also members of one or more of the following disadvantaged groups:
- Women pregnant
- Children on low incomes
- Adults with low incomes aged 65 or older
- Low-income parents of qualifying children for Medicaid
- Adults with disabilities who have Social Security Impairment (SSI)
Medicaid was extended by the 2010 Patient Safety and Affordable Care Act (ACA) as the single largest payer for mental health services in the United States to allow individuals to benefit based on income alone.
As of Jan. 1, 2019, however, Medicaid is available in Virginia for qualifying individuals between 19 and 64 years of age who live in households earning $29,346 for a family of three or $17,237 for a person. Almost 400,000 Virginians are now eligible for income because they are making less than or equal to 138 percent of the level of federal poverty.
How to be eligible for Medicaid?
Based on having a disability, people with behavioral health needs, especially those with severe mental illness, can also qualify for Medicaid. People who have a mental condition that makes them eligible for Supplemental Security Income (SSI), the federal cash assistance program for people with low incomes that are elderly, blind, or disabled, are automatically eligible for Medicaid in most states. To be eligible for SSI, as a result of old age or significant impairment, people must have low wages, minimal assets, and an impaired capacity to function at a significant profit level. However, for the purposes of applying for SSI, SUD is not considered an impairment.
As of 2011, 50 percent of adults and 47 percent of kids qualifying for Medicaid have a mental health condition based on having a disability. Additionally, over four in 10 adults (41 percent) and one in six children (17 percent) are eligible for Medicaid based on disability among Medicaid recipients with mental health conditions.
States may opt to provide other Medicaid eligibility pathways related to disabilities to persons whose incomes surpass the SSI limit. For instance, as of 2015, people with disabilities could be eligible for Medicaid in 21 states, up to 100 percent FPL. Working people with disabilities whose incomes and/or assets surpass the limits for other routes can ‘buy-in’ to Medicaid coverage in 44 states. As of 2015, over 400,000 individuals have been able to purchase coverage via the buy-in option.
In addition, there could be mental health needs for children who are eligible for Medicaid due to their participation in the foster care system. Among Medicaid/CHIP children who had mental health problems in 2011, almost one in ten (8 percent) joined the program via the pathway of child welfare assistance.
What does Medicaid cover?
For these covered outpatient mental health programs, Medicare Part B (Medical Insurance) helps pay for:
One screening each year for depression. In a primary care doctor’s office or primary care facility that can offer follow-up services and referrals, the screening must be performed.
Person and community psychotherapy with physicians or other approved practitioners are authorized by the state where the services are given.
- Family therapy, if your primary objective is to assist with your recovery.
- Checking to find out if you’re receiving the services you need and if you’ve helped with your current treatment.
- Psychiatric testing.
- Control of drugs.
- Like some injections, some prescription medications are not typically “self-administered” (drugs you can generally take on your own).
- Tests for diagnosis.
- Partial inpatient admission.
- A one-time preventive visit to “Welcome to Medicare.” An analysis of your potential risk factors for depression is included in this visit.
- “A “Wellness” annual visit. Speak about improvements in your mental health with your psychiatrist or another health care professional. Year by year, they will assess the changes.
The outpatient mental health programs for the treatment of excessive alcohol and substance use are also covered in Section B.
In Initial Medicare, your expenses:
- When the doctor or health care provider accepts the assignment, you pay nothing for your annual depression test.
- For visits to your doctor or other health care provider to diagnose or treat your illness, you pay 20 percent of the Medicare-approved amount. The deduction from Part B applies.
- If you have your care in an outpatient clinic or outpatient department of a hospital, you will have to pay the hospital an extra copayment or coinsurance amount.
Mental health care and visits to these types of health providers are provided by Section B:
- A psychiatrist or other medical professional
- Psychologist in the clinic
- Social Clinical Worker
- Specialist nursing nurse
- Practitioner Nurse
- Assistant physician physician
Medicare only covers visits when they are made by an assigned health care provider.
Section B includes mental health care for outpatients, including services normally offered outside a hospital, such as in these settings:
- The office of a physician or other health care provider
- An outpatient department of a hospital
- A mental health hub for neighborhoods
If you need further clarification, please visit Medicaid.gov.
In this guide, we answered the question, Does Medicaid cover therapy for depression?
FAQs: Does Medicaid cover therapy for depression
Does Medicare cover therapy for depression?
Medicare Part B (Medical Insurance) mental health treatment (outpatient) helps pay for these insured outpatient mental health services: One depression assessment per year. In a primary care doctor’s office or primary care facility that can offer follow-up services and referrals, the screening must be performed.
How many mental health therapy sessions does Medicare cover?
Part A would help cover inpatient mental health care, no matter the type of hospital you select. Part A only accounts for up to 190 days of inpatient psychiatric medical care over your lifetime if you are in a psychiatric hospital (instead of a general hospital).
Is mental health therapy covered by insurance?
In certain cases, before your services are paid, you’ll have a deductible to pay. Coinsurance and copays may also be available. Health insurance policies usually cover services including therapist appointments, group therapy, and emergency mental healthcare. Also included are rehabilitative programs for addiction.
How do I pay for mental health treatment?
How can you get counseling if you can’t afford it? Find first in-network, switch to Federally Qualified Health Centers if you don’t have healthcare.
Private practitioners, as little as $10/hour, can also operate on a sliding scale.
See if you’re eligible for free therapy under Medicaid. Free sessions of up to two years can be offered by your local training institutes.
How much is the average therapy session?
For a one-hour session, the price for private counseling or therapy will vary from $50 to $240. In various provinces, the recommended rate is different. Community counseling can be less costly than individual therapy.
How many therapy sessions Does Medicare pay for?
In one calendar year, Medicare legislation no longer restricts how much it costs for your medically required outpatient rehabilitation services. What would I pay for counseling services that are medically necessary? You can pay 20 percent of the cost for therapy services after paying the Medicare Part B (Medical Insurance) premium.
What we recommend for depression
If you are suffering from depression then ongoing professional counselling may be your ideal first point of call. Counselling will utilize theories such as Cognitive behavioural therapy which will help you live a more fulfilling life.