Important: This page provides general information, not medical or legal advice, a diagnosis, or a guarantee of services, coverage, cost, availability, or a particular privacy outcome. Policies and benefits can change. Consult a qualified professional for personal guidance and verify coverage and costs with the provider and health plan. Do not delay emergency help to check coverage.
Insurance
Does Medicaid Cover Therapy in West Virginia?
West Virginia Medicaid covers many behavioral health services. Learn how to verify benefits, authorization requirements, providers, and possible costs.
The short answer: West Virginia Medicaid covers many medically necessary mental health services, but coverage depends on the member, service, provider, plan rules, and any required authorization.
But there’s more to know about what’s covered, how to access services, and what the first appointment involves. This guide breaks it down.
This page is about coverage and access. It is not medical advice, and nothing here should be used to decide what kind of care you need. That is a conversation for you and a clinician.
Services Medicaid may cover in West Virginia
The West Virginia Medicaid benefit includes a range of mental health and substance use service categories. Coverage for a particular person and visit still depends on eligibility, provider participation, medical necessity, service rules, and any required authorization.
Outpatient therapy:
- Individual counseling
- Group therapy
- Family therapy
Psychiatric services:
- Psychiatric evaluation
- Medication management
- Follow-up appointments
Crisis services:
- Crisis stabilization
- Mobile crisis teams
- 24-hour crisis lines
Substance use treatment:
- Medication-assisted treatment (MAT) for opioid use disorder
- Counseling
- Residential treatment
Children’s services:
- Individual therapy
- Family therapy
- School-based services
- Psychiatric evaluation
Other services:
- Case management
- Peer support
- Day programs
Coverage rules and authorization requirements vary by plan and by service. If you want to confirm something specific before you start, the clinic’s front desk can check it with your plan, or you can call the member services number on the back of your card.
Do you need a referral?
For Southern Highlands: You can call the clinic directly to request services without first obtaining a physician referral. A plan may still apply eligibility, network, medical-necessity, or authorization rules to a particular service.
For private therapists: It depends. Some require a referral from your primary care doctor. Some don’t. Call and ask.
How to find a provider that takes Medicaid
Community mental health centers can be a useful starting point. Many participate in Medicaid and serve people in their communities, but you should still verify the exact plan, provider, and service.
Southern Highlands is the community mental health center serving Mercer, McDowell, and Wyoming counties, with clinics in Princeton, Welch, Mullens, and Rockview. Southern Highlands participates in West Virginia Medicaid; call (304) 425-9541 and give staff the name on your Medicaid card so they can verify network status and coverage for the service you need.
Private therapists are hit or miss. Many don’t take Medicaid because reimbursement rates are low. Some do. You’ll need to call and ask.
To find providers:
- Call the mental health center directly
- Use the West Virginia Medicaid provider directory
- Call Mountain Health Trust member services at 1-866-642-8589 and ask for behavioral health providers in your county who are accepting new patients
- Search SAMHSA’s treatment locator at https://findtreatment.samhsa.gov/ and filter by payment accepted
- Ask your primary care doctor for recommendations
What if you don’t have Medicaid but think you might qualify?
West Virginia expanded Medicaid under the Affordable Care Act. More people qualify than you might think.
You might qualify if:
- Your household income is under the state’s limit for your household size
- You’re pregnant
- You have a disability
- You’re a parent or caretaker
Income limits are set by the state and change from year to year, so it’s worth applying even if you were turned down before.
How to apply:
- Online at wvinroads.org
- By phone: 1-877-716-1212
- In person at your local DHHR office
Application time varies. If you need help while an application is pending, call a community mental health center and explain your status. Ask whether services can begin, what financial-assistance options apply, and who is responsible for charges if Medicaid does not cover the earlier date of service. Do not assume approval will be retroactive or that an unpaid balance will be waived.
What if you have Medicaid but it’s not WV Medicaid?
If you have Medicaid from another state and have moved to West Virginia, contact your current plan and West Virginia Medicaid before scheduling nonemergency care. Out-of-state coverage is often limited, but emergency, transition, and other circumstances can be handled differently. The clinic can help you identify which program to call, but only the plan or Medicaid agency can confirm coverage.
Tell the clinic when you call. They deal with this regularly and can tell you what to do in the meantime.
Are there any costs with Medicaid?
Copays, deductibles, and other member responsibility depend on the service, eligibility category, and current plan rules. Do not assume that a visit or prescription has no cost. Ask the clinic to verify benefits and call the member-services number on your card if you need confirmation from the plan.
If you’re unsure, ask before your first appointment. Front desk staff answer this question all day and won’t be put off by it.
What if you don’t have insurance at all?
No insurance doesn’t mean no options.
Community mental health centers may offer a sliding fee scale based on household income and household size. Ask what proof of income is accepted, whether a payment arrangement is available, and what charge would apply. CCBHCs serve people regardless of ability to pay, but that does not make every service free.
Free resources:
- Crisis lines
- Support groups
- Some community programs
What if you have private insurance instead of Medicaid?
Participation in Medicare and commercial insurance varies by center, clinician, location, and service.
If you have private insurance, call and verify they take your plan. Bring your insurance card to your first appointment.
How many therapy sessions does Medicaid cover?
Session limits and authorization rules can vary by service and plan. Continued coverage commonly depends on eligibility, medical necessity, provider participation, required documentation, and any applicable service limit or authorization.
How often you’re seen, and for how long, is something you and your provider decide together and revisit over time. If you want to know where you stand on coverage at any point, ask your provider or your plan directly.
What if you need medication?
West Virginia Medicaid includes a pharmacy benefit, but coverage depends on the medication, prescriber, pharmacy, formulary, and any utilization-management requirements. Prescriptions come from an appropriately licensed prescriber.
Member cost-sharing varies. Check the plan’s current formulary and pharmacy benefit or ask the pharmacy what you would owe.
If a medication isn’t on your plan’s covered list, the prescriber’s office can request a prior authorization. Clinic staff handle that paperwork routinely, so if you hit a coverage problem at the pharmacy, call the clinic rather than going without and waiting for the next appointment.
Anything about which medication is appropriate, how it’s taken, or whether it should change is a question for your prescriber. Nothing on this page is a substitute for that conversation.
What about substance use treatment?
Medicaid may cover medically necessary substance use treatment, including these service categories when current requirements are met:
- Medication-assisted treatment (MAT) for opioid use disorder
- Outpatient counseling
- Intensive outpatient programs
- Residential treatment, which may require authorization through your plan
Southern Highlands provides substance use services, including MAT, and can tell you what your coverage looks like when you call.
What if you’re on a waiting list?
In rural West Virginia, waits happen. If you call and they can’t get you in right away:
- Ask to be put on a cancellation list
- Ask whether telehealth appointments are available sooner
- Ask whether another location in the service area has openings
- If you’re in crisis, ask about walk-in crisis services
The Southern Highlands crisis line is available 24/7. Call for current instructions about assessment, location, and availability. If there is immediate physical danger, an overdose, or a severe medical emergency, call 911.
Getting to appointments
Coverage doesn’t help much if you can’t get there.
Medicaid transportation (NEMT): If you have WV Medicaid, non-emergency medical transportation may cover rides to appointments. Call 1-844-549-8353 and schedule several business days in advance.
Telehealth: West Virginia Medicaid may cover eligible behavioral health services delivered through an approved telehealth method. Coverage depends on the service, provider, setting, and current Medicaid rules. Ask whether a specific appointment can be completed by video or phone.
Location: Southern Highlands has clinics in Princeton, Welch, Mullens, and Rockview. Ask which one is closest to you and what is offered there before you build a schedule around a longer drive.
What to bring to your first appointment
- Medicaid card
- Photo ID
- A list of medications you currently take
- Contact information for other providers, if you want your care coordinated
- Proof of income, if you’re asking about the sliding fee scale instead of using insurance
The first appointment is an intake and evaluation rather than a treatment session. It takes longer than a routine follow-up, so plan for that.
Crisis information
If you’re in crisis, you don’t need to sort out coverage first.
- Southern Highlands 24/7 crisis line: 1-800-615-0122
- 988 Suicide & Crisis Lifeline: call or text 988, or visit https://988lifeline.org/
- Walk into the Crisis Stabilization Unit
- Call 911 if someone is in immediate physical danger
Do not delay emergency help while trying to determine coverage. Medicaid coverage and authorization rules depend on the crisis service and current policy; clinic staff can address those questions after immediate safety needs are handled.
Frequently Asked Questions
Does Medicaid cover telehealth therapy?
Medicaid may cover eligible behavioral health telehealth services. Ask the provider and plan to verify the service and whether video, audio-only, or an in-person visit is required.
Can a teenager get services without a parent involved?
Rules about consent for minors are set by state law and depend on the service and the situation. Ask the clinic directly when you call. They can tell you exactly how it works before anyone schedules anything.
What if I lose my Medicaid coverage?
Tell the clinic. Community mental health centers use a sliding fee scale based on income, and staff can also help you reapply for Medicaid.
Does Medicaid cover therapy for children?
West Virginia Medicaid covers many medically necessary children’s behavioral health services. The child’s eligibility, provider, service, school arrangement, and any authorization requirements determine whether a particular service is covered.
Can I choose my own therapist?
You can seek care from a therapist who is appropriately enrolled, in network when required, accepting new patients, and able to provide the covered service. At a community mental health center, ask how clinicians are assigned and how to request a change.
Where can I read general information about mental health conditions?
The National Institute of Mental Health at https://www.nimh.nih.gov/ and SAMHSA at https://www.samhsa.gov/ publish plain-language, non-commercial information. For anything about your own situation, talk to a clinician.
If you have Medicaid and need mental health services in southern West Virginia, call Southern Highlands at (304) 425-9541. The center serves Mercer, McDowell, and Wyoming counties and participates in West Virginia Medicaid. Give staff the exact plan shown on your card so they can verify network status, coverage, authorization requirements, and possible costs. Medicare and commercial-plan participation also varies, and uninsured patients can ask about the sliding fee scale.