Does Medicaid Cover Counseling?

Does Medicaid Cover Counseling?

In the United States, approximately 16 million people over the age of 50 suffer from mental illness, and as this number continues to rise, states are working to make counseling and other services more readily available to Medicaid recipients.

Medicaid is a federal health insurance program that, through the Affordable Care Act, provides coverage to low-income families and individuals.

Medicaid is the country’s largest payer of client mental health services. Although Medicaid is a federal program, each state administers its own Medicaid health insurance plans, and all states provide therapy coverage.

Does Medicaid Cover Counseling?

What Mental Health Conditions Does Medicaid Cover?

Medicaid covers in-person and online individual and group therapy. Many providers also provide family therapy.

Your health insurance provider should cover it if you have a diagnosis and a medical prescription for specific therapy. This means that evidence-based therapies are also covered under health insurance.

Career counseling or coaching, couples therapy, acupuncture, massage therapy, and other holistic treatments are not covered. Other types of therapy will be determined by your treatment plan.

For example, transcranial magnetic stimulation (TMS) may or may not be covered. If you have Medicaid, you should request to work with a care coordinator who will assist you in managing your care and treatment plans.

Many mental health conditions are covered by Medicaid. Medicaid requires a diagnosis from a therapist in order to reimburse therapists or clients. This diagnosis directs treatment as well as insurance coverage.

Here is just a selection of mental health issues that are covered by Medicaid:

Anxiety

It is natural to feel anxious from time to time. People with anxiety disorders, on the other hand, frequently experience intense and persistent fear and worry about normal, everyday situations.

Anxiety disorders frequently involve repeated episodes of intense fear or terror that reach a peak within minutes and are recognized as panic attacks.

Anxiety can disrupt daily activities, is hard to control, is out of proportion to the perceived danger, and is likely to follow a person all throughout their life.

Depression

Depression is a serious medical illness that is sadly very common and has a negative impact on how you think, feel, and behave in day-to-day life.

It causes feelings of numbness, sadness, and apathy, making it difficult to enjoy the things you used to enjoy.

Plus, it can create a variety of emotional and physical problems, as well as a reduction in your ability to function at home as well as at work.

Alcoholism

Alcoholism is the most serious form of alcohol abuse; it is the term given to someone who cannot control their drinking and experiences addiction.

It is also known colloquially as alcohol use disorder. If alcoholism is left untreated, it can spiral out of control very quickly and can even prove fatal.

Grief

When someone or something you love very much is taken away either by death or otherwise, it is likely that you will experience intense feelings of grief.

It is not quite the same as depression as grief is a range of feelings such as anger, shock, disbelief, sadness, and guilt. 

Suffering from grief can ruin your home and work life as it makes it very difficult to focus and find motivation and joy in the things you once did.

You may also struggle with the feeling that you do not have any closure with the person or thing that was taken away from you. This is especially common if the loss was sudden.

Eating Disorders

Eating disorders are psychological conditions characterized by severe disruption in eating behaviors as well as distressing feelings and thoughts.

They can be severe conditions that negatively affect physical, social, and psychological function. Bulimia, anorexia, and binge eating disorder are examples of common eating disorders.

Does Medicaid Cover Counseling?

Learning Disabilities

Those with learning disabilities have a harder time learning certain life skills. The difficulties encountered vary from person to person but may include aspects such as communication, writing, reading, learning new things, or personal care.

There are many different types of learning disabilities. A person with mild disabilities might be able to live independently with little assistance, whereas someone with severe disabilities will likely require 24-hour care and assistance with most daily living skills.

Cost Of Counseling With Medicaid

You will have to pay a co-payment of $0-25 for every counseling session with an in-network therapist under a lot of Medicaid plans.

Thus, you are accountable for that cost each time you have a session with your mental health professional.

Due to each state having an individual Medicaid program, the cost of therapy covered by Medicaid plans can be different.

However, because they value behavioral and mental health access, a lot of Medicaid plans are able to make seeing a therapist much more affordable.

It is important to note that covered therapy visits may be limited by Medicaid in some states, often to 30 sessions per year.

When a client reaches this number of visits, they may be required to pay the session fee in full.

Cost Of Counseling Without Medicaid

On average, the cost of counseling in the U.S. ranges from $100 to $200 per session. When seeing a counselor in person, you will usually be charged per session. 

Sometimes you would be billed a monthly cost. Your monthly expense relies on your per-session rate and frequency.

If your counselor has what is called a sliding scale payment plan, they will typically determine the price of your sessions by looking at your income information.

Final Thoughts

It is not unreasonable to say that everyone could benefit from counseling, but for some, it could mean the difference between life and death so the fact that it can cost between $100 and $200 a session makes it very accessible to a lot of people. 

Luckily, Medicaid is able to cover these costs but make sure that you check the laws within your state as this will determine what your Medicaid plan will cover. 

Also, be aware that not all therapies are covered by Medicaid and if you require things such as couples counseling or career coaching then you will have to pay out of pocket. 

Frequently Asked Questions

How many sessions of therapy a week?

Going to therapy once a week allows you time to process your session. It also ensures too much time doesn’t pass between your appointments. This makes it easier to pick up where you left off after each session. As a result, you’ll see better progress.

How often should the average person go to therapy?

Generally, most patients will start with this frequency, then increase or decrease as needed. A weekly session is ideal for people who want to build skills related to things like mindfulness, coping, and communication. It’s also good for people working through a specific type of problem.

Is therapy 2 times a week too much?

Attending therapy more than just once a week can help you to achieve results faster. Keep in mind that attending therapy multiple times per week does not necessarily mean that you experience the same format each time.