Medicaid is required to offer mental health coverage to its members. Individuals with Medicaid can see any in-network behavioral health providers at any time if you think you need help with your mental health or substance use. This includes clinic and detox services, and a referral from your primary care doctor is not required.
Yes, all members have access to behavioral health services, including substance use disorder treatment and rehabilitation services. Other covered services include psychiatric services, psychological services, inpatient and outpatient mental health treatment, injections for behavioral health-related conditions and individual and group counseling through the Office Of Mental Health clinics. For adults over the age of 21, Medicaid also covers substance use disorder services such as crisis services and detoxification, inpatient rehabilitation services, residential addiction treatment services, outpatient addiction treatment services and rehabilitation services, opioid treatment programs and gambling disorder treatment programs.
Yes, Medicaid covers inpatient psychiatric hospitalization as part of the Comprehensive Psychiatric Emergency Program (CPEP), as well as outpatient psychiatric services. Children under age 21 also receive mental health coverage for both inpatient and outpatient psychiatric support and services.
In New York, there is no general limit on the number covered, as coverage is determined by medical necessity.
Typically, Medicaid does not offer out-of-network coverage or reimbursements. However, you can ask for approval for an out-of-network provider if there is no provider in-network who can offer the required care. Your plan provider or primary care doctor must seek approval from MetroPlusHealth before they give you an out-of-network referral.
Psychologists, therapists and counselors typically cannot prescribe medication. If you or your therapist believes you need mental health medication, you’ll have to arrange an appointment with your primary care provider or a psychiatrist. Primary care providers often handle medications for diagnoses like anxiety and depression If you have more complicated or severe conditions, they may refer you to a psychiatric office. There, psychiatrists, psychiatric nurse practitioners, and psychiatric physician assistants can all diagnose, treat and prescribe medications for mental health conditions.
First, check your insurance plan to determine if a referral is required. If you do need one, you’ll have to meet with your primary care doctor. You’ll discuss your symptoms and concerns with them and ask them to provide you with a referral for a specialist.