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.
Lucidity Health
Portland, OR
Portland interventional psychiatry clinic. Oregon Medicaid (OHP) accepted for Spravato when TRD criteria are met - one of few clinics in the Pacific Northwest doing Medicaid billing.
New Pathways Psychiatry
Philadelphia, PA
Philadelphia psychiatry group. Accepts PA Medicaid (Keystone First, AmeriHealth Caritas, UPMC For You) for Spravato - rare in the region.