Medicaid

We want to make sure you are informed about Medicaid insurance and understand it as best as possible so that you are aware of its benefits as well! We hope the below information will answer some of your questions

  • Yes! Medicaid supports therapy for individual, couples, families and group types of therapy. Medicaid requires that there be a “medical necessity,” for therapy. This would mean that a diagnosis form the DSM V-TR be given by the therapist. We, at Whole Connection, always make sure that if there is a diagnosis it is always discussed at length and worked collaboratively to be created.

  • As the state has explained this means

    The individual has a mental health/substance use condition/illness that ….

    •has produced a current problem in functional status

    •as shown by signs and symptoms that interfere with functionality

    •that can be helped by providing services

    •services named on the treatment plan

    Six Components of Medical Necessity

    1.The service must treat a behavioral health condition/illness or functional deficits that are the result of the illness.

    2.The service has been authorized or prescribed by a licensed practitioner of the healing arts.

    3.The service is accepted as effective for the disorder being treated.

    4.The individual must participate in treatment.

    5.The individual must be able to benefit from the service.

    6. It must be an active treatment focus

  • As long as we are working towards a goal and showing progress while meeting the standards needed by the state, therapy does not have a limited number of sessions.

  • $0, Medicaid makes sure that you do not have to cover your costs of therapy. To the point they request no provider charge a client with Medicaid for services that can be provided. You should never have to pay for services as long as Medicaid covers them.

  • We have therapists who speak English, Spanish , Mandarin, and Farsi


Regional Accountability Entity (RAE) Map

The below map gives you an idea of where the different RAEs are so you have a better idea what RAE is taking care of you! For more information the Colorado Health Institute has wonderful information here on what RAEs are.