Aethera

OHP Coverage & Psychedelic Care

Navigating Medicaid and the Oregon Health Plan (OHP) for alternative and integrative mental health services.

The Current Landscape of OHP Coverage

A common question among Oregonians exploring alternative mental health modalities is whether the Oregon Health Plan (OHP/Medicaid) or commercial insurance covers treatments like Ketamine-Assisted Psychotherapy (KAP) or Psilocybin Services.

The short answer is nuanced: The medicine itself is rarely covered, but the accompanying psychiatric evaluation and psychotherapy often are.

What OHP Generally Covers:

  • Psychiatric intake arrays and diagnostic evaluations.
  • The "Preparation" psychotherapy sessions prior to medicine administration.
  • The "Integration" psychotherapy sessions following the medicine experience.
  • Traditional psychiatric medication management (Spravato/Esketamine is FDA approved and sometimes covered for treatment-resistant depression under specific conditions).

What OHP Generally Does NOT Cover (Out-of-Pocket):

  • The cost of compounded racemic ketamine lozenges, IM injections, or IV infusions.
  • The extended 2-3 hour clinical observation time required during the medicine session itself.
  • Services provided at licensed Oregon Psilocybin Service Centers (currently strictly out-of-pocket under Measure 109).

Finding "Superbill" Friendly Providers

Many specialized providers in the Aethera directory operate out-of-network but can provide you with a "Superbill." A Superbill is an itemized receipt containing diagnostic (ICD-10) and treatment (CPT) codes. If you have a commercial PPO plan with out-of-network benefits, you can submit this Superbill to your insurance company for partial reimbursement of the therapy portion of your care.

Note: OHP does not process Superbills for out-of-network care. If you are exclusively using OHP, you must find a provider deeply credentialed with your specific Coordinated Care Organization (CCO), such as Trillium or PacificSource.

Filter by Providers Accepting OHP

Our directory explicitly highlights practitioners capable of serving Medicaid and OHP-enrolled patients.

View OHP Providers