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Ketamine and Medicaid by Jurisdiction

Updated: Nov 28, 2023

I am in the process of surveying all jurisdictional Medicaid Directors regarding racemic ketamine infusion coverage. I have asked three questions:


1) Does your Medicaid program currently cover racemic ketamine infusions for mental health?

2) If not, do you have plans to do so?

3) If #1 and #2 are no, have you definitively ruled out coverage?


Responses are trickling in, so this post will be updated from time-to-time.


As of this writing (or the latest update), the following Medicaid programs have responded (or I have found documentation myself) that they DO cover racemic ketamine infusions for mental health:


Arizona

Colorado

District of Columbia

New Hampshire

Pennsylvania

Utah

Wisconsin*


If you live in one of those states above and are a Medicaid beneficiary, you or your psychiatrist should inquire with Medicaid about how the coverage works. It will likely require a prior authorization showing unsuccessful attempts with pharmaceuticals and, perhaps, treatments such as TMS. We do not have the details for each jurisdiction.


The following states have responded that they DO NOT cover racemic ketamine infusions for mental health:


Idaho (added 11/28/2023)

South Dakota

Wyoming


If you live in one of the "DO NOT offer" states and wish to advocate with your Medicaid agency, feel free to reach out to us for documents that might be helpful in that pursuit.


Together, we CAN get this done!


*Note: Progress is being made with Wisconsin Medicaid! Be sure and watch our Blog page for coming updates!







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