Is Therapy Covered by Illinois Medicaid?
Takeaway: Yes, therapy is covered by Medicaid in Illinois, but specific coverage details can depend on your plan, provider, and more. Here, we offer a comprehensive guide to understanding and getting the most out of your mental health benefits.
Navigating the maze of healthcare coverage can feel overwhelming, especially when seeking mental health support. If you're one of the millions of Illinois residents covered by Medicaid, you might be wondering whether therapy services are included in your benefits—and if so, how to actually access them.
As a licensed clinical professional counselor who accepts Medicaid (and other insurance plans), I recognize how important it is for people to understand their mental health coverage. Through my work with clients, I've gained extensive knowledge of the Illinois Medicaid system and its role in getting people the mental health services they need and deserve. The good news is that Illinois Medicaid does cover therapy services, though the specifics can sometimes be confusing.
This comprehensive guide will walk you through everything you need to know about accessing therapy through Illinois Medicaid: what services are covered, how to find a provider, and what steps to take to get the mental and behavioral health services you're looking for.
Whether you're seeking counseling for the first time or looking to better understand your existing coverage, my goal here is to provide clear, actionable information to help you make informed decisions about your mental health care.
Understanding Medicaid in Illinois
Let's start with the basics: what is Medicaid?
Medicaid is a partnership between federal and state governments designed to provide essential health coverage for those who need it most. Here, the Illinois Department of Healthcare and Family Services (HFS) manages the program and provides insurance to 3.3 million residents, which is 1 in 4 Illinoisans. There are different coverage groups for different populations, like moms and babies, people with disabilities, and more.
Eligibility for Illinois Medicaid is based on a few key factors, such as income, household size, and immigration status. Not sure whether you qualify? Check out this eligibility screening tool. Keep in mind that there's no penalty for applying, and even if you don't end up qualifying, you may still qualify for financial assistance to help you get coverage through the Health Insurance Marketplace.
For the most up-to-date and detailed information about eligibility requirements and how to apply, I encourage you to check out the Illinois Department of Healthcare and Family Services' Medicaid Guide.
Does Medicaid in Illinois cover therapy?
Yes, Illinois Medicaid covers therapy.
Some covered services that fall under this umbrella include:
Rehabilitation services at community mental health centers
Alcohol and substance abuse services
Detox services
Inpatient hospital services
Emergency transportation, such as in a mental health crisis
...and more.
For a full list of covered services, check out the "going the doctor" portion of HFS's Medicaid Guide.
Keep in mind that not all services may be covered in every situation. Sometimes, there are pre-approval requirements or limitations, such as a limit to how many providers of a certain type you can see in one day. It's best to contact your health plan directly if you have questions about your particular coverage.
How to find an Illinois therapist who takes Medicaid
Trying to find a therapist, especially one who takes your insurance, can feel overwhelming. Here are some starting points to help you take the next step toward getting the care you're looking for.
Use online directories
Online directories are valuable tools for locating therapists who accept Medicaid. Websites like Psychology Today allow you to filter therapists by location, specialties, and insurance accepted. These platforms often provide detailed profiles, including therapists' qualifications, areas of expertise, and contact information, so you can find the right fit for your situation.
Use the SPIDER database
HFS offers an online tool to help people who qualify for Medicaid find mental health and substance use recovery services. Access the SPIDER database here.
Consult your Medicaid Managed Care Plan
If you're enrolled in a Medicaid Managed Care Plan, your plan's member services can help you find an in-network therapist. Contact the customer service number on your insurance card to speak to a representative.
Get a referral from your PCP
Primary care physicians and other healthcare providers can be excellent resources for referrals. Even if you don't need a referral to start a particular service, consulting with your PCP can be a great place to start, and it can ensure that your entire health team is kept up-to-date about your care.
Consider our practice
At Feel Good Counseling Center, we firmly believe in making mental health services accessible. We are proud to accept every Managed Care Organization (MCO) under Illinois Medicaid, so if you ever need to switch MCOs, your therapy with us won’t be affected. Unlike many providers who only work with a select few MCOs, we’re set up to offer consistent care no matter which Medicaid plan you have. This way, you can focus on your mental health without worrying about your therapy services getting interrupted by insurance changes.
In addition to accepting your insurance, we also offer a wide range of services including individual therapy, couples and family therapy, child and teen therapy, and group therapy. Our therapists have diverse specialties and provide services in seven languages so you can find the right fit for you and your loved ones. Contact us here to request an appointment.
Common questions about therapy and Medicaid
Do I need a referral for therapy?
In some cases, you may need a referral to start services. Most Medicaid plans require you to choose a primary care provider (PCP). If you need to see a specialist, your PCP can refer you. However, not all services require a referral. For example, you can typically start outpatient mental health therapy without getting a referral from your PCP.
Are online therapy sessions covered?
Yes, telehealth services are typically covered under Illinois Medicaid. This can make it easier to get the care you need without having to coordinate transportation, find child care, or take more time than necessary out of your busy schedule.
Does Medicaid cover out-of-network providers?
Typically, Medicaid only covers services provided by in-network providers.
However, there are certain exceptions depending on which Medicaid plan you have. Plans will often cover out-of-network services if they're provided during an emergency or if there are no in-network providers who offer a medically necessary service.
Before scheduling an appointment, always verify whether a provider accepts Illinois Medicaid and is part of your plan’s network.
How do I verify my coverage?
You can verify your Medicaid coverage online (select "manage my case") or by calling 1-855-828-4995.
When calling, consider asking the following questions:
Does my plan cover therapy services?
Are there specific therapists or clinics in-network?
Does this therapist accept Medicaid, and are they in-network?
Are telehealth services covered under my plan?
Being proactive ensures that you can get the care you need without any surprises.
Additional resources for mental health support in Illinois
If you're interested in therapy but are concerned about the costs or simply aren't ready to take the next step yet, there are several free and low-cost resources available in Illinois.
National Suicide Prevention Lifeline: Call 1-800-273-TALK (1-800-273-8255) for immediate support.
Crisis Text Line: Text HOME to 741741 for free, confidential support via text messaging.
Illinois Warm Line: Call 1-866-359-7953 for peer support services.
The Trevor Project: Call 1-866-488-7386 or text START to 678678 for LGBTQ+ crisis support.
Illinois Domestic Violence Helpline: Call 1-877-863-6338 for support and resources related to domestic violence.
Illinois Department of Human Services: Visit their website to find a comprehensive list of mental health resources.
These services offer immediate support, and many can connect you with ongoing care when you're ready.
Final thoughts
If you're ready to start therapy, our team at Feel Good Counseling Center is here for you and your loved ones. We believe that everyone has the right to affordable mental health treatment, which is why we accept Illinois Medicaid plans. We understand that navigating insurance and starting therapy can feel overwhelming, but we're here to remind you that you're not alone in this process.
Whether you're interested in individual therapy, couples and family therapy, child and teen therapy, or group therapy, our trained clinicians are here to support you. We have experience helping people with a wide range of challenges, which you can learn more about on our specialties page.
Contact us today to request an appointment and take the next step toward creating a life you love.
