Yes, Virginia Medicaid does cover therapy. The program pays for mental health counseling, substance use disorder treatment, and physical, occupational, and speech therapy, as long as a provider documents that the service is medically necessary. What’s covered, how many visits you get, and whether you’ll owe a copay depends on your age, your diagnosis, and the type of therapy.
Mental Health Therapy
Behavioral health is a core Virginia Medicaid benefit. Covered services include individual psychotherapy, family and couples counseling, group therapy, crisis therapy, and diagnostic psychiatric evaluations.1Department of Medical Assistance Services. Benefits and Services Psychological testing and psychiatric medication management are covered when a provider determines they’re medically necessary.
Virginia also covers more intensive behavioral health services through Project BRAVO, including Assertive Community Treatment, Multisystemic Therapy, Functional Family Therapy, and Applied Behavior Analysis for autism.2Department of Medical Assistance Services. Behavioral Health These services are delivered either through your Managed Care Organization or through the Behavioral Health Services Administrator contracted by the Department of Medical Assistance Services (DMAS).
Substance Use Disorder Treatment
Addiction care runs through Virginia’s Addiction and Recovery Treatment Services (ARTS) program, launched in 2017 and available to every Medicaid-enrolled member, including those in FAMIS.3Department of Medical Assistance Services. Addiction and Recovery Treatment Services ARTS covers the full continuum of care: outpatient counseling, medication-assisted treatment with buprenorphine and other medications, medically managed detox, intensive outpatient programs, partial hospitalization, and residential treatment for adults.4Virginia 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 they’re medically necessary. Each of the three disciplines carries an initial allowance of five visits per year with no prior authorization needed.5Virginia Code Commission. Virginia Administrative Code 12VAC30-50-200 – Physical Therapy, Occupational Therapy, and Speech-Language Pathology
If you need more than five visits in a service, your provider has to submit a service authorization request to DMAS or its contractor showing continued medical necessity. Visits beyond the initial five won’t be paid without that approval, so flag ongoing needs with your provider early.
Coverage can end when you’ve reached maximum improvement, when continued therapy won’t produce meaningful functional gains, or when a home maintenance program can sustain the progress you’ve already made. Virginia Medicaid pays for rehabilitation toward a functional goal, not indefinite maintenance therapy that doesn’t require a licensed therapist’s skills.
Expanded Therapy Coverage for Children Under 21
Children get broader therapy coverage than adults through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. If a screening identifies a health condition, Medicaid has to provide whatever treatment is needed to correct or improve it, even services not routinely covered for adults.6Department of Medical Assistance Services. Early and Periodic Screening, Diagnostic and Treatment (EPSDT)
For therapy, that means a child can access behavioral health therapy (including ABA for autism), private duty nursing, assistive technology, and residential treatment when medically necessary. It also includes services that help a child maintain functioning or prevent a condition from worsening. An adult might see continued therapy denied once improvement plateaus; under EPSDT, a child can keep receiving services to prevent regression.
Telehealth Therapy
Many therapy services are covered when delivered by telehealth. Psychotherapy, diagnostic evaluations, crisis therapy, family counseling, and group therapy are all approved by video, and most of those services also qualify for audio-only delivery when video isn’t feasible.7Virginia Department of Medical Assistance Services. Telehealth Services Supplement Telehealth has to meet the same standard of care as an in-person visit. If your provider decides in-person care is clinically necessary, telehealth isn’t an option for that service. Initial ABA assessments carry telehealth limits, though reassessments can be done remotely.
What You’ll Pay
Virginia Medicaid charges a $3 copay per visit for physical therapy, occupational therapy, and speech-language pathology.8Virginia Code Commission. Virginia Administrative Code 12VAC30-20-150 – Copayments and Deductibles for Categorically Needy Behavioral health copays depend on your coverage category and MCO, and many mental health visits have no copay at all. Children, pregnant members, and certain other groups are exempt from copays under federal law. If you aren’t sure, ask your provider or MCO before the appointment.
Who Qualifies
Virginia expanded Medicaid under the Affordable Care Act, so most adults ages 19 through 64 with household incomes up to 138% of the federal poverty level can qualify. For 2026, a single adult can earn up to $22,025 per year and still be eligible (the figure includes a standard 5% income disregard).9U.S. Department of Health and Human Services. 2026 Poverty Guidelines – 48 Contiguous States Children, pregnant members, elderly adults, and people with disabilities fall into their own eligibility categories, some with higher income limits. DMAS reviews your full circumstances and enrolls you in whichever category gives you the strongest coverage you qualify for.10Department of Medical Assistance Services. Commonly Asked Questions
Finding a Therapist and Getting Approval
Most Virginia Medicaid members are enrolled in managed care through one of five health plans.11CoverVA. Health Plans Your MCO coordinates all your care and keeps its own in-network provider directory. Call the number on your membership card or search the directory online. If you’re in fee-for-service rather than managed care, use the DMAS provider portal.12Department of Medical Assistance Services. Find a Provider A referral from your primary care doctor also works. When you book your first visit, confirm the provider accepts Virginia Medicaid, and bring your Medicaid card and a photo ID.
Routine outpatient therapy visits generally don’t need prior authorization. Higher levels of behavioral health and ARTS care, including residential treatment, partial hospitalization, and intensive outpatient programs, require authorization submitted through Acentra Health, the DMAS service authorization contractor.13Department of Medical Assistance Services. ARTS – Service Authorization and Registration Your provider handles the paperwork, but ask upfront whether a service needs approval so a delay doesn’t surprise you.
If Therapy Is Denied
If Virginia Medicaid or your MCO denies a therapy service, reduces benefits, or cuts off an authorized treatment, you can appeal through the DMAS Appeals Division.14Department of Medical Assistance Services. Virginia Medicaid Client Appeal Process Step By Step File by contacting DMAS with your name, contact information, the date of the denial notice, and why you disagree. A hearing officer will later call you and the agency by phone, hear both sides, and issue a written decision. You can submit supporting documents from your therapist or doctor beforehand.
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 notice sit.
If You Don’t Qualify for Medicaid
Virginia has backup options if your income is above Medicaid limits or you’re still waiting on a decision. Community Services Boards operate statewide and provide mental health, substance use disorder, and developmental disability services on a sliding fee scale.15Virginia Department of Behavioral Health and Developmental Services. Community Services Boards Federally Qualified Health Centers across Virginia provide primary care and behavioral health to anyone regardless of insurance, with sliding fees for uninsured patients. Plans sold on the ACA Health Insurance Marketplace must cover mental health and substance use disorder services as essential health benefits, and subsidies can bring premiums down for households that earn too much for Medicaid.16HealthCare.gov. Mental Health and Substance Abuse Coverage