Medicaid Frequently Asked Questions

How do I enroll in Medicaid in the State of Colorado?

If you are currently looking to enroll in Medicaid for medical and/or mental health services in Colorado, please visit: https://www.healthfirstcolorado.com/apply-now/

Are there any out-of-pocket costs when I use Medicaid?

No. We accept full payment from Medicaid for your services and currently have two therapists who are available to provide individual therapy. Read our description of what we provide for Medicaid HERE.

I live outside of Colorado, can you all see me using my Medicaid benefits?

We currently are only able to see clients in the state of Colorado. For information about finding Medicaid benefits in your area, please go to: https://www.medicaid.gov/medicaid/index.html

How many sessions are covered if I am using Medicaid?

Medicaid will continue to cover sessions as long as we have very clear goals and continue to show progression in our therapeutic work. In our experience, mental health therapy does not have a limit on how many sessions are covered. We recommend reaching out to your Regional Accountability Entity (RAE) to learn more about your specific plan.

Do you all accept other coverage from other health insurance or mental health programs along with Medicaid?

We do not accept any insurance outside of Medicaid. We believe that our clinicians should be equitably compensated with a living wage that allows them to not only serve clients well but be able to live well outside of their work so we can give fully to our work. However, we work with nonprofit organizations and community partners to provide mental health services. Please reach out to us to learn more via our CONTACT US PAGE.

You do not serve my county/my RAE using Medicaid. How do I find a therapist who does?

We are serving Adams, Arapahoe, Denver, Douglas, and Elbert Counties currently and will begin seeing clients in Boulder, Broomfield, Clear Creek, El Paso, Gilpin, Jefferson, Park, and Teller Counties starting March 1. If you live outside of these counties, you can search for a provider based on your RAE using the Health First Colorado website at: https://www.healthfirstcolorado.com/health-first-colorado-regional-organizations/

What does Medicaid require for me to use my benefits for mental health therapy?

Medicaid will cover the cost of therapy as long as there is a “medical necessity” with a diagnosis given by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM V-TR). In our practice, we believe that deciding a diagnosis should be a collaborative process that affirms your experience rather than dehumanizing the individual. Because of this, all diagnoses listed for Medicaid purposes will be discussed at length with your provider.

What does “medical necessity” mean?

The Colorado Revised Statutes (CRS) define medical necessity as:

“Medical necessity means that a Medical Assistance program good or service:

a. Will, or is reasonably expected to prevent, diagnose, cure, correct, reduce, or ameliorate the pain and suffering, or the physical, mental, cognitive, or developmental effects of an illness, condition, injury, or disability. This may include a course of treatment that includes mere observation or no treatment at all.

b. Is provided in accordance with generally accepted professional standards for health care in the United States;

c. Is clinically appropriate in terms of type, frequency, extent, site, and duration;

d. Is not primarily for the economic benefit of the provider or primarily for the convenience of the client, caretaker, or provider;

e. Is delivered in the most appropriate setting(s) required by the client's condition;

f. Is not experimental or investigational;

g. Is not more costly than other equally effective treatment options.”
To read its definition at length, click this link and go to page 55 to read more.

In other words: It means that:

  1. The service should help with a mental health issue or difficulties in daily activities caused by the condition

  2. A licensed health professional needs to approve or recommend the services.

  3. The service should be recognized as helpful for the specific problem.

  4. The person has to take part in the treatment and It not be any sort of medical trial.

  5. The person should be able to get better from using the service.

  6. The treatment needs to actively target the issue.

Note: This explanation was modified from the definition provided by Whole Connection.

Can I see a therapist in your practice remotely using Medicaid?

Yes! Our team members who are currently accepting clients can see clients both in person and remotely.