QUICK ANSWER: MassHealth covers behavioral health services, including outpatient therapy, when they are determined medically necessary, and since April 1, 2024 there are no copays for MassHealth-covered services. Northeast Family Services accepts MassHealth at all five of its Massachusetts offices along with Blue Cross Blue Shield, Tufts Health Plan, Harvard Pilgrim, Fallon Health, United Healthcare, and Anthem. You do not need a referral, and our team can verify your benefits before the first appointment.
If you are searching this question, you are probably choosing a provider this week and want to know the number before you call. Below is what the state actually says, what happens with a managed care plan, and what to have in front of you when you reach out.
Does MassHealth cover therapy?
Yes. MassHealth is the Massachusetts Medicaid program, and its covered services guidance lists behavioral health and substance use disorder services among the care it pays for, both inpatient and outpatient, when the service is medically necessary. Its chart of covered services shows behavioral health as covered under MassHealth Standard, CommonHealth, CarePlus, and Family Assistance.
Medically necessary is not a hurdle most people trip over. It means a clinician documents why the care is needed. That documentation happens during your first appointments, not before you call.
One detail worth knowing: the visit limits people sometimes hear about apply to physical, occupational, and speech therapy, where prior authorization kicks in after a set number of visits in a 12-month period. Mental health counseling is handled separately through MassHealth’s behavioral health system.
Will I have a copay for therapy?
No, not for MassHealth-covered services. The state’s own covered services list for Primary Care ACO and PCC Plan members states that as of April 1, 2024 there are no copays for any MassHealth-covered service, and that applies to members in managed care plans as well.
Commercial insurance is a different story. If you have Blue Cross Blue Shield, Harvard Pilgrim, Tufts Health Plan, Fallon Health, United Healthcare, or Anthem, your cost per session depends on your plan’s copay and whether you have met your deductible. Northeast Family Services can check that for you and give you a number before you commit to an appointment.
Which insurance plans does Northeast Family Services accept in Massachusetts?
In Massachusetts we currently accept:
- MassHealth (Medicaid)
- Tufts Public Health (Medicaid)
- Mass General Brigham Public Health (Medicaid)
- Blue Cross Blue Shield
- Tufts Health Plan
- Harvard Pilgrim
- Fallon Health
- United Healthcare
- Anthem
The current list, including our Rhode Island, New Hampshire, and New York plans, is on our accepted insurance page. Plans change, so if yours is not listed, contact us rather than assuming the answer is no.
Do I need a referral to use MassHealth for therapy?
No. You can contact Northeast Family Services directly for therapy in our office and book without a referral from a primary care doctor.
Some MassHealth members are enrolled in a private health plan through MassHealth, and in that case the plan’s rules apply to which providers are in network. If you are not enrolled in a health plan, MassHealth’s guidance says you can go to any therapist who takes MassHealth.
If you are enrolled in a managed care plan and want to confirm coverage yourself first, the MassHealth Customer Service Center is 800-841-2900, and behavioral health questions for members served by the Massachusetts Behavioral Health Partnership go to 800-495-0086.
What do I need before my first session?
Bring or have handy:
- Your MassHealth or insurance card, including the member ID
- A photo ID for the adult attending
- A list of current medications, if any
- The name of your primary care doctor, which helps if we need to coordinate care
- For a child, the school name and any recent evaluations or letters from the school
You do not need a diagnosis, a doctor’s note, or a treatment plan. Your therapist builds that with you.
What if my plan is not on the list, or I do not have insurance?
Reach out anyway. Our team can verify your benefits directly and lay out your options before your first appointment, including whether another Northeast Family Services program covers what you need.
Massachusetts also has two free front doors that are worth knowing about regardless of coverage. The Behavioral Health Help Line is available 24 hours a day, 7 days a week at 833-773-2445 by call or text, and its Treatment Connection directory at masshelpline.com lets you search services near you. No insurance is required to use it, and interpretation is available in more than 200 languages.
For an immediate crisis, call or text 988 to reach the 988 Suicide and Crisis Lifeline, or go to the nearest emergency room.
Does MassHealth cover therapy for children?
Yes, and it covers more than office visits. Through the Children’s Behavioral Health Initiative, MassHealth pays for a set of home and community based behavioral health services for young people age 20 and younger, including In-Home Therapy, In-Home Behavioral Services, and Therapeutic Mentoring, with eligibility tied to coverage type and a CANS-based assessment of need.
Outpatient Therapy is one of the three hub services in that system, which means an office-based therapist can be your child’s primary behavioral health provider and coordinate anything else that gets added. Northeast Family Services provides in-home therapy, in-home behavioral therapy, therapeutic mentoring, and office-based family therapy across Massachusetts, so one conversation can sort out which of those your child qualifies for.
How do I book an appointment with MassHealth coverage?
Fill out the form on our Get Started page or call 774-206-1125 between 8:30 AM and 8 PM Monday through Friday. Tell us your plan name and which office is closest, whether that is Worcester, West Springfield, North Andover, Dorchester, or Fall River. Most clients are seen within the same week.
Frequently asked questions
Does MassHealth cover outpatient therapy?
Yes. MassHealth covers medically necessary behavioral health services, including outpatient therapy, across its Standard, CommonHealth, CarePlus, and Family Assistance coverage types.
Is there a copay for therapy with MassHealth?
No. As of April 1, 2024 there are no copays for MassHealth-covered services, including for members enrolled in managed care plans.
How many therapy sessions does MassHealth pay for?
There is no fixed session cap for mental health counseling. Coverage continues while the care is medically necessary, which your therapist documents as treatment progresses.
Do I need a referral to see a therapist with MassHealth?
No referral is needed to start therapy at a Northeast Family Services office. If you are enrolled in a private health plan through MassHealth, follow that plan’s network rules, and our team can check them with you.
Does MassHealth cover online therapy?
Massachusetts law requires coverage of clinically appropriate telehealth, and behavioral health delivered by telehealth is reimbursed at the same rate as in-person care under Chapter 260 of the Acts of 2020. Northeast Family Services offers telehealth therapy alongside office visits.
What if I cannot afford therapy and have no insurance?
Contact us and we will tell you your options. The Massachusetts Behavioral Health Help Line at 833-773-2445 is also free and does not require insurance.
Ready to check your coverage? Get started with Northeast Family Services or call 774-206-1125 and we will verify your benefits before your first appointment.
