Medicaid typically pays between $78 and $111 for a standard 45-minute individual counseling session, with 60-minute sessions averaging around $118. These are the amounts paid to providers, not what you owe out of pocket. Your cost as a Medicaid beneficiary is usually $0 to $3 per visit, depending on your state.
The exact payment varies significantly by state, provider type, and whether your coverage runs through a managed care plan or directly through the state. Here’s what those numbers look like in practice.
What Medicaid Pays Providers Per Session
A 2022 analysis of Medicaid fee schedules across all states, published in Health Affairs, found these average reimbursement rates for individual psychotherapy:
- 45-minute session: Median payment of $77.81, with most states falling between $67 and $90
- 60-minute session: Median payment of $110.86, with most states falling between $95 and $135
These figures represent what the state pays the therapist or counseling practice. The range is wide because each state sets its own fee schedule independently. A counselor in one state might receive $67 for the same 45-minute session that pays $90 in another. This matters to you as a patient because lower reimbursement rates in your state can make it harder to find therapists who accept Medicaid, since many providers feel the payment doesn’t cover their costs.
For context, Medicaid is the single largest payer for mental health services in the country. Yet its rates consistently run below what Medicare and private insurance pay for identical services, which is a major reason some counselors limit how many Medicaid patients they see.
What You Actually Pay Out of Pocket
Most Medicaid beneficiaries pay little to nothing for counseling visits. Federal rules cap cost-sharing at nominal amounts, and many states charge no copay at all for mental health services. Among states that do charge, the typical copay falls between $0.50 and $3 per session. Some states set it as a flat dollar amount, others calculate it as a small percentage of the reimbursement (around 5%).
A few states cap your total monthly cost-sharing. For example, some limit copays to $20 per month regardless of how many sessions you attend. Certain groups are exempt from copays entirely, including pregnant women, children, and people in institutional care. If you’re enrolled in a Medicaid managed care plan, your plan may waive copays for behavioral health services even if the state technically allows them.
Group Therapy and Substance Use Counseling
Group therapy sessions pay significantly less per person than individual sessions. Using Wisconsin’s fee schedule as a representative example, a 60-minute group psychotherapy session reimburses around $22 to $38 depending on the provider’s degree level. Group substance use counseling pays anywhere from $15 for a bachelor’s-level counselor to $90 for a master’s-level clinician, though these rates vary dramatically by state and provider credential.
Substance use disorder counseling is covered under Medicaid in every state, though the specific services available and how they’re structured differ. Some states cover intensive outpatient programs as a bundled service rather than paying per session. The Mental Health Parity and Addiction Equity Act requires that Medicaid managed care plans and alternative benefit plans cover substance use treatment on equal terms with medical care, meaning they can’t impose stricter limits on addiction counseling than they would on, say, physical therapy visits.
Fee-for-Service vs. Managed Care
How your Medicaid coverage is structured affects which providers you can see and sometimes what gets covered. In a fee-for-service arrangement, the state pays your counselor directly for each visit at the rate listed in the state’s fee schedule. These are the published rates you can look up on your state Medicaid website.
In managed care, which covers the majority of Medicaid enrollees nationwide, the state pays a private insurance company a monthly fee per member. That company then sets its own provider network and negotiates its own rates with counselors. Managed care plans may pay more or less than the state fee schedule, and their rates aren’t always publicly available. Some states carve behavioral health out of their managed care contracts entirely, running mental health services through a separate specialized plan or through fee-for-service even when everything else goes through managed care.
From your perspective as a patient, the main practical difference is that managed care plans require you to use in-network providers, while fee-for-service Medicaid lets you see any provider who accepts Medicaid in your state.
Telehealth Counseling Rates
Every state has the flexibility to cover counseling delivered by video, and most do. However, states individually decide whether telehealth visits pay at the same rate as in-person sessions or at a reduced rate. Some states mandate payment parity for telehealth, while others allow lower reimbursement. States also set their own rules about which types of providers can bill for telehealth counseling, whether audio-only phone sessions qualify, and whether you need to be at a specific location (like a clinic) or can connect from home.
If you’re considering telehealth counseling through Medicaid, check with your specific plan or state program. Coverage is nearly universal at this point, but the details around eligible providers and visit formats still vary.
Why Rates Vary So Much by State
Unlike Medicare, which uses a single national fee schedule, Medicaid gives each state broad authority to set its own reimbursement rates. The only federal requirement is that payments be high enough to ensure adequate access to care, a standard that’s loosely enforced. This creates the wide spread you see in the data: a 45-minute therapy session reimbursed at $67 in one state and $90 in another.
Your state’s rates are usually published in a fee schedule on the state Medicaid agency’s website. Search for your state’s name plus “Medicaid fee schedule behavioral health” to find the current numbers. If you’re in managed care, you may need to call your plan directly to learn what they pay, since managed care rates aren’t always posted publicly.
Recent Changes Expanding Coverage
Federal policy changes finalized for 2025 are expanding the types of behavioral health services eligible for reimbursement. New billing codes now cover safety planning for patients experiencing suicidal thoughts or overdose risk, paid in 20-minute increments. Monthly follow-up contact codes allow providers to bill for post-crisis check-in calls. Additional codes let clinical psychologists, social workers, marriage and family therapists, and mental health counselors bill for consultations with other providers on a patient’s care team.
These changes were made to the Medicare fee schedule, but they often influence Medicaid coverage over time as states adopt similar billing codes. Several telehealth services, including certain types of counseling, have also been permanently added to approved telehealth lists rather than remaining temporary pandemic-era allowances.