Medicaid 

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Overview

While the majority of health care is provided through the private market, and the largest programs are administered by the federal government, state governments also play a critical role in how healthcare is delivered. There are many health programs that are common across the states, and ensuring MFT recognition and participation by these programs is key to the success of the profession. AAMFT and our divisions have been advocating for MFT inclusion in these critical programs for many years and have made great progress, but there is much work to be done. 

Medicaid is the largest provider of mental health services in the United States.  Medicaid is the primary source of health care for low-income families with children, the low-income elderly, and people with disabilities. In 2012, 60 million people were enrolled in Medicaid. Excluding prescription drugs, behavioral healthcare costs amount to 10% of all Medicaid spending. 

Medicaid is a joint federal-state partnership in both funding and administration. The federal government funds a majority of all Medicaid spending in almost each state, with poorer states receiving a higher percentage of federal funding.  On average, state spending on Medicaid accounts in 2008 accounted for approximately 22% of total spending by the states. Medicaid provides coverage for more than 40% of non-elderly persons living in poverty and 25% of all children.

Medicaid is overseen by the Centers for Medicare and Medicaid Services (CMS), an agency within the United States Department of Health and Human Services. Although federal guidelines require all states to cover specific categories of people and types of benefits, each state administers its own Medicaid program.  In each state, the program is administered by an agency designated by the governor as the state Medicaid agency. Most states have a traditional Medicaid program, as well as managed care plans.

Some people confuse the Medicaid program with Medicare, because both were established by federal statute and because there is some overlap in their purpose and beneficiary populations. Both Medicaid and Medicare provide health insurance to the low-income elderly and people with disabilities. Approximately 1 in 6 Medicare beneficiaries are “dual eligibles” who are enrolled in both programs.  However, Medicare is purely a federal program, funded and administered at the federal level, in contrast to Medicaid's federal-state partnership. 

Medicaid covers a variety of services. State Medicaid programs are required to cover mandatory services, such as physician and hospital services. Additionally, states may cover certain optional services, such as family therapy.  Medicaid mental health benefits are covered through several mandatory and optional service categories, such as physician and psychologist services, outpatient services provided in hospitals and clinics, rehabilitation services, and personal care services.  Although the states are required to provide mandatory services, the states have discretion in determining the duration and scope of coverage for services. 

MFT Recognition in Medicaid 

Federal rules allow for the use of MFTs as providers, but do not mandate recognition of MFTs.  After many years of advocacy, approximately thirty-eight states now have at least some reimbursement or recognition of Family Therapists in their Medicaid programs. As the largest provider of mental health benefits in a state, comprehensive Medicaid recognition of MFTs is crucial to the success of the profession.  The level of recognition is currently varied as many states have multiple Medicaid products and MFTs are covered by some Medicaid products and not others. In some states, MFTs and other Master’s level providers can only receive Medicaid reimbursement if their services are performed in a clinic or other institutional setting. 

Most states describe the details of their Medicaid services and provider qualifications in a Medicaid provider manual.  An examination of this manual is usually the easiest way to determine which mental health benefits are offered and within which service category, and whether MFTs may provide these benefits. Most of these manuals are now available online.  Since mental health and substance abuse benefits are provided through several service categories and different provider settings, it is important to examine the entire manual to determine if MFTs are eligible providers in all of the relevant service categories. 

State Chart

MFT Recognition in State Medicaid Plans

State

MFTs included in Medicaid plans?

State

MFTs included in Medicaid plans?

Alaska

Partly

Montana

No

Alabama

Partly

North Carolina

Yes

Arkansas

Yes

North Dakota

No

Arizona

Partly

Nebraska

Yes

California

Yes

New Hampshire

Yes

Colorado

No

New Jersey

Yes

Connecticut

Yes

New Mexico

Yes

District of Columbia

No

Nevada

Yes

Delaware

Yes

New York

No

Florida

Yes

Ohio

Yes

Georgia

Yes

Oklahoma

Yes

Hawaii

Yes

Oregon

Yes

Iowa

Yes

Pennsylvania

No

Idaho

Yes

Rhode Island

Partly

Illinois

Yes

South Carolina

Yes

Indiana

Partly

South Dakota

No

Kansas

Yes

Tennessee

Yes

Kentucky

Partly

Texas

Partly

Louisiana

No

Utah

Yes

Massachusetts

Partly

Virginia

Yes

Maryland

Partly

Vermont

Yes

Maine

Yes

Washington

No

Michigan

No

Wisconsin

Yes

Minnesota

Yes

West Virginia

No

Missouri

No

Wyoming

Yes

Mississippi

No

 

 

Based on data collected by AAMFT staff and reports from AAMFT division leaders.  Data represents AAMFT’s best estimate of the status of MFT recognition in Medicaid plans for each state.  “Partly” means that some, but not all, Medicaid mental health programs, or Medicaid managed care plans recognize MFTs.  Even plans that appear to broadly recognize MFTs might not recognize MFTs as providers in each service category or health plan.  Since MFT status with these plans is subject to change, AAMFT does not guarantee that these plans will recognize MFTs.

SEHP Fact Sheet

All states offer some form of health benefits for eligible state employees and their dependents. Approximately 3.4 million state employees and retirees are covered by a state employee health plan. The AAMFT has developed the following fact sheet concerning these plans and the role of MFTs within these plans.       

Explore TherapistLocator.net, a public service of the AAMFT Research and Education Foundation, and find a marriage and family therapist in your area today. In this directory, you will find information about a range of problems facing today's families, and can search from over 15,000 AAMFT professionals, qualified to treat a variety of situations, from individuals, to couples, to entire families.

Vendorship Fact Sheet

In a majority of states, MFTs have achieved recognition under state Freedom of Choice (Vendorship) and Any Willing Provider laws. These laws require certain health plans to reimburse MFTs for providing mental health services covered by the plan. The following fact sheet developed by AAMFT provides an overview of MFT recognition under these laws in each state.

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