Because taking Medicaid and being in network with your Medicaid plan are two different things. To see you through a Medicaid managed care plan, a therapist in New York needs a State Medicaid provider number and also needs to be in network with the insurance company named on the front of your card. A lot of therapists have the first and not the second, so they can take Medicaid and still not be able to accept your plan.
I handle the calls and emails from people looking for a therapist at Reframed Mental Health, and this is the Medicaid question I explain most, sometimes more than once on the same call. So here’s how it works, how to check before you reach out, and which Medicaid plans we can take.
What is a Medicaid managed care plan?
When you qualify for Medicaid in New York, most people choose a health plan run by an insurance company, through the NY State of Health marketplace. That’s Medicaid managed care. Your coverage is still Medicaid, but the insurance company runs the plan, and that includes deciding which providers are in its network. Most New York Medicaid members are in a managed care plan.
If your card just says New York State Medicaid, with no insurance company name on it, you have what’s called fee-for-service Medicaid (sometimes called straight Medicaid). Any therapist enrolled with New York State Medicaid who accepts fee-for-service can bill it directly, without a company network in the middle.
Why does the company on my card matter?
To see you through a Medicaid managed care plan, a therapist needs both of these:
- Enrollment with New York State Medicaid. Federal law requires every provider in a Medicaid plan’s network to be enrolled with the state. This is the Medicaid provider number.
- A contract with the insurance company that runs your plan. Each company decides who’s in its network, separately from the state. Joining a network isn’t up to the therapist alone. Insurance companies decide when to add providers, and some plans have had their networks closed to therapists in New York City for a long time. So a therapist you’d like to see may have applied more than once and still not be in network with your plan.
The first one doesn’t come with the second. That’s why a therapist can say they take Medicaid and still not be able to see you through your plan.
“But it’s Medicaid, not a commercial plan”
A typical call goes like this. Someone tells me they have Medicaid. I ask whether their card shows an insurance company’s name or just says New York State Medicaid. They tell me it’s Fidelis, and I explain that we aren’t in network with Fidelis. Then comes the pushback: “It’s not a commercial plan, it’s Medicaid, and you said you take Medicaid.”
They’re right that it’s Medicaid. What makes it confusing is that when Fidelis runs your Medicaid plan, Fidelis decides who’s in network, the same way it does for its other plans. The same goes for Anthem (Blue Cross Blue Shield) or any other company on your card. Being enrolled with New York State Medicaid doesn’t put us in any company’s network, so we can’t see you through that plan.
I know that’s frustrating to hear, especially when you’ve finally found a therapist you want to see. That’s why I’d rather explain it up front, so you can spend your time on therapists who can take your plan.
How do I find a therapist who takes my Medicaid plan?
- Start with the front of your card. The company name there is the network you need.
- Use the plan’s online provider directory and look for therapists or behavioral health, or call the member services number on the back of your card. Directories aren’t always up to date, so confirm with the therapist’s office too.
- Filter for both. On directories like Psychology Today, select Medicaid and the company name on your card. That gives you a much better list of therapists who are likely to accept your plan.
- Ask about the Medicaid plan specifically. Some therapists are in a company’s regular network but not its Medicaid network, so ask whether they’re in network with that company for Medicaid.
Which Medicaid plans does Reframed Mental Health take?
We’re enrolled as a New York State Medicaid provider, so we can see you if your card just says New York State Medicaid. We can also accept Medicaid managed care plans run by the companies we’re in network with, and you’ll find the full list on our insurance and fees page. Our intake team confirms your plan before your first session, so you’ll know before you get started.
We see clients in person at our Midtown Manhattan office and online anywhere in New York State. Keilyn also offers therapy in Spanish, and you can meet our therapists before you reach out.
The Bottom Line
A therapist who takes Medicaid can only see you through your Medicaid plan if they’re also in network with the company on the front of your card. Check your card, filter directories for both Medicaid and that company’s name, and ask about both when you reach out.