Insurance coverage
State Medicaid programs
Spravato coverage under Medicaid varies dramatically by state. Most state Medicaid programs now cover Spravato for treatment-resistant depression, but with strict step-therapy (usually requiring 2-4 prior antidepressant trials and often augmentation attempts). A growing number of states also reimburse for ketamine-assisted psychotherapy billed under psychiatric and nursing codes.
Coverage at a glance
| Modality | Status |
|---|---|
| Spravato (esketamine) | Sometimes covered |
| Ketamine IV infusion | Not covered |
| Ketamine IM injection | Not covered |
| Ketamine oral/lozenge | Not covered |
| Psilocybin (Oregon licensed) | Not covered |
| Psilocybin (Colorado licensed) | Not covered |
What the plan requires
- Must use a Medicaid-credentialed REMS site (smaller list than commercial).
- Prior authorization with documented TRD criteria.
- Some states require attempt at ECT or TMS first.
Practical tips
- Pennsylvania, New York, California and Oregon have the broadest Medicaid coverage for Spravato.
- Your clinic has to accept Medicaid - many REMS-certified sites do not. Ask before booking.
- Managed Medicaid plans (Molina, Centene, UPMC for You) follow different formularies than fee-for-service.
Providers accepting Medicaid
Always confirm in-network status with both the clinic and your plan before your first session.
No verified providers currently list Medicaid. This can mean the plan is typically self-pay, or that we have not yet surfaced plan acceptance - check back as we expand clinic onboarding.