Does Medicaid cover EMDR therapy?

Medicaid EMDR coverage details

Medicaid is jointly funded by federal and state governments, with each state setting its own covered services within federal guidelines. Mental health services, including psychotherapy, are covered in all states. EMDR is recognized as an evidence-based psychotherapy and is covered when provided by Medicaid-enrolled providers. Some states use managed care organizations (MCOs) like Molina, Centene, or UnitedHealthcare Community Plan to administer Medicaid benefits.

How EMDR is billed with Medicaid

CPT codes

Standard psychotherapy codes apply: 90834 and 90837. Medicaid reimbursement rates are typically lower than commercial insurance, which is one reason many EMDR specialists don't accept Medicaid.

Typical copay

Medicaid copays are minimal or zero for mental health services in most states. Some states have small copays ($1-5) for adults, while children typically have no copays. Cost should not be a barrier to accessing EMDR with Medicaid.

Prior authorization

Prior authorization requirements vary by state. Some states require authorization for mental health services beyond a certain number of sessions. Your provider handles authorization requests.

Session limits

Session limits vary by state. Federal EPSDT (Early and Periodic Screening, Diagnostic and Treatment) requires comprehensive mental health coverage for children under 21. Adult benefits vary more by state.

Finding Medicaid-covered EMDR therapists

Many EMDR specialists don't accept Medicaid due to lower reimbursement rates. This creates access barriers for Medicaid members seeking EMDR. Loma does not currently accept Medicaid; your state's MCO directory lists enrolled providers.

Frequently asked questions

Why is it hard to find EMDR therapists who take Medicaid?

Medicaid reimbursement rates are significantly lower than commercial insurance. Many EMDR specialists prefer higher-paying patients, which makes Medicaid-enrolled EMDR providers scarce.

Does Texas Medicaid cover EMDR?

Yes. Texas Medicaid covers EMDR under behavioral health services. Texas uses MCOs like Superior, Molina, and UnitedHealthcare Community Plan. Loma does not currently accept Texas Medicaid — check your MCO's directory for enrolled EMDR providers.

Can I get EMDR through Medicaid managed care?

Yes. If your Medicaid is through an MCO (like Molina, Centene, Amerigroup), EMDR is covered under mental health benefits. You'll need a therapist credentialed with your specific MCO.

Is there a waitlist for Medicaid EMDR?

Unfortunately, yes. Limited provider supply means longer waits for Medicaid members.