Psychedelic-assisted therapy (PAT) is emerging as a potential treatment for select behavioral health conditions, such as treatment-resistant depression, post-traumatic stress disorder, and substance use disorders, particularly for people who have not responded to existing treatments. As research and policy activity around these therapies grow, Medicaid — the nation’s largest payer for behavioral health services — will play a key role in determining access to these treatments. Spravato (esketamine) is already approved by the U.S. Food and Drug Administration (FDA) for certain depressive disorders, and some states provide limited access to off-label intravenous ketamine. Availability of psychedelic drugs or drugs with psychedelic properties depends on future federal approval.

Yet, FDA approval and Medicaid coverage alone will not ensure meaningful access to PAT for people who may benefit from these treatments. States, health plans, and health care providers will need relevant evidence, clinical guidelines, practical care models, sustainable payment approaches, and a trained workforce to integrate these treatments into safety-net settings.

This report from the Center for Health Care Strategies highlights emerging evidence for PAT, current federal and state policy activity, and considerations for Medicaid coverage and care delivery. Drawing on interviews with state Medicaid and behavioral health officials, health care providers, and other subject matter experts, the report identifies opportunities to build the evidence base for Medicaid decision-making, develop care delivery approaches, learn from existing coverage models, and strengthen stakeholder and community readiness. The report was developed with support from the Psychedelic Mental Health Access Alliance.