Yes, Virginia Medicaid does cover therapy, including mental health counseling, substance use disorder treatment, and physical, occupational, and speech therapy. Coverage depends on your age, diagnosis, and whether a provider determines the service is medically necessary. Most therapy carries only a small copay, and some visits go through without any prior approval at all.
Who Can Get Covered
The Virginia Department of Medical Assistance Services (DMAS) runs the program. Since Virginia expanded Medicaid under the Affordable Care Act, most adults ages 19 through 64 with household incomes up to 138% of the federal poverty level qualify. For a single adult in 2026, that works out to $22,025 per year, which includes a standard 5% income disregard.1U.S. Department of Health and Human Services. 2026 Poverty Guidelines – 48 Contiguous States Children, pregnant individuals, older adults, and people with disabilities fall under separate eligibility categories, some with higher income limits.2Department of Medical Assistance Services. Commonly Asked Questions
Mental Health Therapy
Behavioral health is a core benefit. Virginia Medicaid pays for individual psychotherapy, family and couples counseling, group therapy, crisis therapy, and diagnostic psychiatric evaluations.3Department of Medical Assistance Services. Benefits and Services Psychological testing and psychiatric medication management are covered when a provider determines they are medically necessary.
More specialized services are also available through the Project BRAVO program, including Assertive Community Treatment, Multisystemic Therapy, Functional Family Therapy, and Applied Behavior Analysis (ABA) for autism spectrum disorder. These services are delivered through Managed Care Organizations or the Behavioral Health Services Administrator contracted by DMAS.4Department of Medical Assistance Services. Behavioral Health
Substance Use Disorder Treatment
Virginia Medicaid has one of the more comprehensive addiction benefits in the country through its Addiction and Recovery Treatment Services (ARTS) program, launched in 2017. ARTS covers all Medicaid-enrolled members, including those in FAMIS.5Department of Medical Assistance Services. Addiction and Recovery Treatment Services
Covered services include:
- Outpatient counseling
- Medication-assisted treatment with buprenorphine and other medications
- Medically managed detoxification
- Intensive outpatient programs
- Partial hospitalization programs
- Residential treatment for adults6Virginia Department of Medical Assistance Services. Addiction and Recovery Treatment Services One-Pager
Physical, Occupational, and Speech Therapy
Virginia Medicaid covers outpatient physical therapy, occupational therapy, and speech-language pathology when a physician prescribes them and the services are medically necessary. Each of these three services comes with an initial allowance of five visits per year that do not require prior authorization.7Virginia Code Commission. Virginia Administrative Code 12VAC30-50-200 – Physical Therapy, Occupational Therapy, and Speech-Language Pathology
Beyond that, your provider must submit a service authorization request showing continued medical necessity. Without approval, additional visits won’t be paid. Let your therapist know early if you expect to need more than a few sessions.
Coverage can be ended when you’ve reached maximum improvement, when more therapy won’t produce meaningful functional gains, or when a home program can maintain your progress. The program pays for rehabilitation toward a functional goal, not indefinite maintenance therapy that no longer requires a licensed therapist’s skill.
Broader Coverage for Children Under 21
Children get more than the standard adult benefit through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) rule. If a screening identifies a health condition, Medicaid must provide whatever treatment is needed to correct or improve it, even services not routinely covered for adults.8Department of Medical Assistance Services. Early and Periodic Screening, Diagnostic and Treatment (EPSDT)
For therapy, that means a child can access behavioral health counseling, ABA for autism, private duty nursing, assistive technology, and residential treatment when medically necessary. Services that help a child maintain functioning or prevent a condition from worsening also qualify. So while an adult might lose continued therapy once progress plateaus, a child can keep receiving services to prevent regression.
Telehealth Therapy
Many therapy services are covered by video, and most of those same services also qualify for audio-only delivery when video isn’t feasible. Psychotherapy, diagnostic evaluations, crisis therapy, family counseling, and group therapy are all approved for telehealth.9Virginia Department of Medical Assistance Services. Telehealth Services Supplement
Telehealth has to meet the same standard of care as an in-person visit. Some services carry limits — initial ABA assessments, for example, generally can’t be done remotely, though reassessments may be. If your provider decides in-person care is clinically necessary, telehealth won’t substitute.
Copays
Virginia Medicaid charges a $3 copay per visit for physical, occupational, and speech-language therapy.10Virginia Code Commission. Virginia Administrative Code 12VAC30-20-150 – Copayments and Deductibles for Categorically Needy Behavioral health copays vary by coverage category and MCO, and many mental health visits carry none. Children, pregnant individuals, and certain other groups are exempt under federal law. If you’re not sure whether a copay applies, ask your provider or MCO before the appointment.
Finding a Therapist
Most members are enrolled in one of the state’s five managed care health plans.11CoverVA. Health Plans Your MCO coordinates all your care, including behavioral health, and maintains its own provider directory. The fastest starting point is the number on your membership card or your plan’s online directory.
If you’re in the fee-for-service program instead of managed care, use the DMAS provider portal to search for participating therapists.12Department of Medical Assistance Services. Find a Provider A referral from your primary care doctor also works well. When you call to schedule, confirm the provider currently accepts Virginia Medicaid, and bring your Medicaid card and photo ID to your first visit.
Prior Authorization
Some services need approval before Medicaid will pay. For PT, OT, and speech therapy, the first five visits per service each year go through automatically; anything beyond that needs authorization.7Virginia Code Commission. Virginia Administrative Code 12VAC30-50-200 – Physical Therapy, Occupational Therapy, and Speech-Language Pathology
For behavioral health and ARTS, higher levels of care such as residential treatment, partial hospitalization, and intensive outpatient programs require service authorization through Acentra Health, the DMAS contractor.13Department of Medical Assistance Services. ARTS – Service Authorization and Registration Routine outpatient therapy usually doesn’t. Your provider handles the paperwork, but ask upfront so a delay doesn’t surprise you.
If Your Therapy Is Denied
You have the right to appeal a denial, a reduction in benefits, or a cut to an already-authorized treatment. The DMAS Appeals Division handles these cases.14Department of Medical Assistance Services. Virginia Medicaid Client Appeal Process Step By Step To file, contact DMAS with your name, contact information, the date of the denial notice, and your reason for disagreeing. Hearings are conducted by phone, and you can submit supporting documents from your therapist or doctor ahead of time.
Timing matters. If you want your existing therapy to continue while the appeal is pending, you generally need to file within 10 days of getting the denial notice. Don’t let the paperwork sit.
If You Don’t Qualify
If your income is above Medicaid limits, or you’re still waiting on a determination, Virginia has other affordable options. Community Services Boards operate throughout the state and provide mental health, substance use, and developmental disability services on a sliding-scale fee tied to income.15Virginia Department of Behavioral Health and Developmental Services. Community Services Boards Federally Qualified Health Centers offer integrated primary care and behavioral health to anyone, with sliding fees for the uninsured.
Marketplace plans through the ACA are another route. Every Marketplace plan must cover mental health and substance use disorder services as essential health benefits, and premium subsidies can cut costs sharply for households earning just above the Medicaid line.16HealthCare.gov. Mental Health and Substance Abuse Coverage