Depending on the state and the individual plan, Medicaid may cover physical therapy services for recipients. Physical therapy is considered an optional benefit for some plans. Some plans have a limit on the number of sessions per calendar year, or they may require a prior authorization before health services can begin. Other state Medicaid plans may have a deductible, or may require a co-payment. Some health insurance plans require a treatment plan and a re-evaluation after a certain number of sessions to determine whether rehabilitation services are still necessary. Home and Community Based Medicaid services may cover home health services, meaning that the physical therapist would visit the patient at home.
For those receiving long-term care Medicaid, Medicaid may cover physical therapy if it is determined to be of medical necessity by a physician or nurse practitioner. Enrollees can often receive services at their inpatient nursing facility, and do not have to go to an outpatient clinic for health care.
Other covered services and interventions may include occupational therapy, speech therapy, speech-language pathology, and mental health therapy, but coverage will vary by state and individual health plan.
Medicaid eligibility is determined by income and/or assets, and is generally available for low-income and low-asset people. To see if you may be eligible for Medicaid coverage, visit your state’s .gov website for Medicaid, where you will find more information on what Medicaid programs and Medicaid benefits your state offers.