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Medicaid Mental Health Benefits Explained

Medicaid Mental Health Benefits Explained

Medicaid is a public insurance plan that was established in 1965 along with Medicare. Its original purpose was to expand access to healthcare for people receiving public financial assistance. Before Medicaid, people who couldn't afford to go to the doctor could usually only receive medical and mental health care at charitable organizations or state facilities. Medicaid allowed many people living in poverty to choose their providers for the first time.

Medicaid has expanded and contracted in different ways since its inception but has ultimately grown. Medicaid now covers more people than ever before, including people with disabilities, pregnant women, and people who work low-income jobs but don't have access to insurance through their employers. Not only does Medicaid link millions of Americans with primary medical care, it has also become the single largest payer of mental health services in the United States.

Who Is Eligible for Medicaid?

Historically, Medicaid has had both financial and categorical eligibility requirements. In other words, until recently, people were only eligible for Medicaid when they 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 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 While the law originally made Medicaid expansion a requirement for all states, in 2012, the Supreme Court ruled that states could elect whether to expand Medicaid.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 that as of 2019, some states retain categorical eligibility requirements for Medicaid while others do not.

Does Medicaid Cover Mental Health?

Federal regulations require states that have Medicaid to cover certain services. Mandatory benefits under Medicaid include:

  • Physician services
  • Home health services
  • Rural health clinic services
  • Inpatient hospital services
  • Outpatient hospital services
  • Laboratory and x-ray services
  • Authorized nurse midwife services
  • Family planning services and supplies
  • Services at federally qualified health centers
  • Non-emergency transportation to medical care
  • Certified pediatric or family nurse practitioner services
  • Nursing facility services (for people aged 21 years and over)
  • Tobacco cessation counseling and pharmacotherapy for pregnant women
  • Early and periodic screening, diagnostic, and treatment services for individuals under 21

Optional benefits that states can elect to cover under Medicaid include the following:

  • Eyeglasses
  • Clinic services
  • Dental services
  • Hospice services
  • Prescribed drugs
  • Personal care services
  • Private duty nursing services
  • Targeted case management services
  • Other licensed practitioners' services
  • Home and community-based services
  • Community supported living arrangements
  • Inpatient psychiatric services for individuals under age 21
  • Other diagnostic, screening, preventive, and rehabilitative services
  • Inpatient hospital and nursing facility services for people 65 or older in institutions for mental diseases

These mandatory and optional benefits are outlined in federal policy. Only two of these benefits are specifically defined as mental health benefits. All other mental health services are covered under the most relevant general benefit category. For example, psychiatrists' services are covered under "physician services." Interventions from psychologists and clinical social workers may be covered under "other practitioners' services" or covered with other outpatient mental health services under "outpatient hospital services" and "clinic services."

Due to its historic role in supporting community mental health programs, Medicaid doesn't cover long-term care in psychiatric hospitals. Otherwise, it covers most basic mental health services, as well as many services private insurance often doesn't cover, including nursing home care, other long-term services, round-the-clock services, case management, psychosocial rehabilitation, supported employment, and in-home mental health care. Based on 2016 data provided by the Medicaid and CHIP Payment and Access Commission (MACPAC), every state's Medicaid plan currently covers individual and group counseling. Many states' plans also cover family counseling.

Medicaid Mental Health Providers

Because Medicaid typically pays lower rates than private insurance and Medicare, many mental health practitioners elect not to accept Medicaid. Some states administer Medicaid through a managed care system and have a list of in-network Medicaid managed care providers. You can contact a provider directly to determine whether they accept Medicaid or inquire at a local Social Services office about covered providers.

Another way to use your Medicaid coverage to get therapy or other mental health services is to go to a provider specifically set up to accept Medicaid. Any outpatient clinic that qualifies as a Federally Qualified Health Center (FQHC) accepts Medicaid, as well as sliding scale fees. You can search for FQHCs using the U.S. Department of Health and Human Services' online search tool.

Every state has public mental health providers, typically called community mental health centers, that accept Medicaid. Whether a community mental health center has an outpatient clinic where therapy is available varies not only from state to state, but from county to county within each state. OpenCounseling is currently compiling lists of public mental health providers in every state to make it easier to find and contact local providers for information about local services.

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 ask—Medicaid will link you with an impressive range of medical and mental health services. If you find out you're not eligible, consider signing up for affordable online counseling with BetterHelp (a sponsor) or using OpenCounseling's search tools to find free or low-cost counseling at a local provider. Getting the care you need may only be a click away.

How Does Medicaid Vary from State to State?

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. This means that whether a person is eligible for Medicaid varies from state to state. Covered services also vary between states. Some states have higher income requirements than others, while others cover special programs that are relevant to their  population. Some states use waiver programs to cover additional groups or services, while others use waivers to restrict services.

One of the most significant ways Medicaid varies between states is whether a given state has accepted Medicaid expansion and extended eligibility to people based on income level alone.  As of April 2019, the following states have not accepted Medicaid expansion:

  • Alabama
  • Florida
  • Georgia
  • Kansas
  • Mississippi
  • Missouri
  • North Carolina
  • Oklahoma
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Wisconsin
  • Wyoming

Several states have accepted limited Medicaid expansion but have sought to impose additional restrictions on Medicaid eligibility beyond those established by the Affordable Care Act, including work requirements that are being challenged in the Supreme Court. These states include:

  • Arizona
  • Arkansas
  • Idaho
  • Indiana
  • Iowa
  • Kentucky
  • Maine
  • Michigan
  • Montana
  • Nebraska
  • New Hampshire
  • Ohio
  • Utah
  • Virginia

This means that as of 2019, only 36 states have expanded Medicaid and only 22 states have implemented full Medicaid expansion without imposing or seeking to impose any additional eligibility requirements. This means that 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.

If you think you might be eligible for Medicaid, you can apply for coverage at your local Social Services office. Another way to learn whether you are eligible is to apply for an individual insurance plan through the federal Health Insurance Marketplace on HealthCare.Gov. As part of the application process, you will be evaluated for Medicaid eligibility and allowed to apply online if you are eligible.

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Stephanie Hairston, MSW
Posted on 05/14/2019 by Stephanie Hairston, MSW

Stephanie Hairston is a freelance mental health writer who spent several years in the field of adult mental health before transitioning to professional writing and editing. As a masters-level clinical social worker, she provided group and individual therapy, crisis intervention services, and psychological assessments. She has also worked as a technical writer for a medical software company and as an editor for a company that appeals denials of insurance coverage for behavioral health treatment. As a writer, she is motivated by the same desire to help others that brought her into the field of social work and believes that knowledge is one of the most essential recovery tools. She strongly believes in the mission of OpenCounseling and in making therapy accessible for everyone.