Does Medicaid cover PRP in Maryland?
Yes. Psychiatric Rehabilitation Program services are a covered Maryland Medicaid benefit for adults and children who meet medical necessity criteria, and for most participants there is no out-of-pocket cost.
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How Maryland Medicaid pays for PRP
Maryland carves specialty behavioral health out of the medical MCO networks and runs it through the public behavioral health system. In practice that means your PRP coverage does not hinge on which Medicaid MCO card you carry: it hinges on eligibility, a qualifying diagnosis, and an assessment showing PRP is medically necessary.
Open Arms PRP verifies coverage and handles authorization paperwork for you before services begin.
Maryland Medicaid MCOs we work with
Participants enrolled with any of these plans can be served:
- Aetna Better Health of Maryland
- CareFirst Community Health Plan Maryland
- Jai Medical Systems
- Kaiser Permanente of the Mid-Atlantic States
- Maryland Physicians Care
- MedStar Family Choice
- Priority Partners
- UnitedHealthcare Community Plan
- Wellpoint Maryland (formerly Amerigroup)
Do not see your plan? Call us. See the full accepted insurance list.
Who is eligible
- Maryland residency and active Medicaid or MCO enrollment
- A qualifying mental health diagnosis such as depression, anxiety, ADHD, bipolar disorder, PTSD, or schizophrenia
- A recent assessment from a licensed mental health provider recommending PRP
- For Child PRP, school-age children and adolescents with a qualifying diagnosis and caregiver participation
New to the term? Start with what a PRP is.
What it costs
For eligible Medicaid participants, PRP is covered with no copay in the vast majority of cases. If you are uninsured or between plans, ask us about a Good Faith Estimate and options for applying through Maryland Health Connection.
Common questions
Does Maryland Medicaid cover PRP?+
Yes. Psychiatric Rehabilitation Program services are a covered Maryland Medicaid behavioral health benefit for adults and children who meet medical necessity criteria. Behavioral health benefits are administered through the state's public behavioral health system rather than your MCO's medical network.
How much does PRP cost with Medicaid?+
For eligible Maryland Medicaid participants, PRP services are covered with no copay in the vast majority of cases. If anything would be owed, we tell you before services begin and provide a Good Faith Estimate on request.
Which Medicaid MCOs work for PRP at Open Arms?+
Because Maryland behavioral health is carved out to the public behavioral health system, we can serve participants across the Maryland Medicaid MCOs, including Priority Partners, Maryland Physicians Care, Aetna Better Health, Wellpoint, UnitedHealthcare Community Plan, MedStar Family Choice, CareFirst Community Health Plan, Jai Medical Systems, and Kaiser Permanente.
Do I need a referral for PRP?+
You do not need a physician referral to contact us. You do need a current assessment from a licensed mental health provider documenting a qualifying diagnosis and recommending PRP. If you do not have one, we help arrange it.
What if I do not have Medicaid yet?+
Call us. We can point you to Maryland Health Connection to apply and, in some cases, begin the assessment process while your application is pending.
What documents should I bring?+
Photo ID, your Medicaid or MCO card, and any recent psychiatric evaluation, treatment plan, or referral form. If you cannot find them, come anyway and we will work from what you have.
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Start your journey with Open Arms.
Same-week intake appointments. Confidential, judgment-free care. Medicaid and most Maryland and Virginia insurance accepted.